Claw Toes
Definition
claw toe a toe deformity seen in many patients with rheumatoid arthritis, consisting of dorsal subluxation of toes 2 through 5; the metatarsal heads bear weight and become painful during walking so that the patient has a shuffling gait.
Causes
Tight shoes are the most common cause of these toe problems. Wearing tight shoes can cause the toe muscles to get out of balance. Two muscles work together to straighten and bend the toes. If a shoe forces a toe to stay in a bent position for too long, the muscles tighten and the tendons shorten (contract). This makes it harder to straighten the toe. Over time, the toe muscles cannot straighten the toe, even if you are not wearing shoes.
Less common causes include:
- Problems in foot structure at birth. This may run in families.
- Joint diseases, such as rheumatoid arthritis.
- Brain, spinal cord, or nerve injury (especially in the case of claw toe). Examples include stroke, cerebral palsy, and degenerative disc disease.
- Not using your toe. Having to stay in bed for a long period of time may cause muscles to shorten (contractures). This may lead to toe problems.
- Poor blood flow to your feet (peripheral arterial disease).
- Having little or no “feeling” in your feet (peripheral neuropathy). This is common in people with diabetes.
- Injury, such as breaking a toe.
Treatments and Preventions
Properly fitting footwear which doesn’t rub the affected toes. Forefoot products which straighten and or pad the toes are very helpful. Rigid claw toes may require custom orthotics as well to relieve pain at the ball of the foot, which is common as well.
A claw toe is a toe that is constricted at the DIP and PIP joints. These are joints at the middle and end of the toe. The tightening of the ligaments and tendons cause the toe to curl in and down. All toes may get this condition except the big toe. Discomfort will occur from the top of the toe pressing up against the roof of the shoe and the bottom pushing against the sole.
There are two classifications of claw toe – flexible and rigid. The toes of the foot with flexible claw toe can still move. The toes of the foot with rigid claw toe need to be manually straightened.
Movement of the toes in rigid claw tow is very restricted, and walking can result in great pain. This pain can cause people to walk differently to take some of the pressure off the toes, causing secondary pain from calluses and corns.
Muscle imbalances around the foot can cause the tendons and ligaments to tighten, causing the toes to curl downward. Wear and tear from arthritis can also cause degeneration of the joints and claw toes.
The first step towards treatment is changing the shoes you wear. When picking out footwear, be certain that the toe box is high and wide, and that the claw toes are not pressing up against the top and bottom.
Other conservative therapies include toe crests and hammer toe splints, which are designed to hold down the claw toe and take pressure off the balls of the feet. Gel shields and cups can also be inserted to reduce friction between the toes and the shoe.
If conservative therapies do not help, please consult your physician.
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