Claw toes are a type of foot deformity that is so named because the toes resemble the claws of an animal. The characteristic shape of claw toes is a curve, with the toes curving sharply upwards then downwards in a C-shape. Claw toe deformities are caused by an imbalance in the way the tendons of the toes contract. The underlying cause of this imbalance is often flat feet.
The movement of each toe on the foot is controlled by six different muscle sets, as well as several tendons. The muscles serve to stabilize the toes, and combine with the tendons to regulate movement. When the foot is imbalanced in some way, such as that which occurs in flat feet, this can cause the larger muscles of the toes to overpower the ability of the smaller muscles to perform correctly.
A number of structural foot deformities can result from this type of muscular imbalance. In the case of claw toes, the deformity develops when a muscle called the flexor digitorum brevis over-contracts and overpowers smaller toe muscles. The strong contraction causes the middle bone of the toe to pull downwards. This action causes another joint in the toe to buckle upwards, producing the characteristic C-shaped curve of the claw toe deformity. The most common symptom of the deformity is pain, which may be accompanied by complications such as calluses or abscesses.
One of the most common causes of claw toes is flat feet, which causes the foot to become slightly longer, and imbalances the muscles of the toes. Several neuromuscular diseases, including cerebral palsy and multiple sclerosis, also cause the development of this deformity. In addition, inflammatory diseases such as diabetes, psoriasis, and rheumatoid arthritis may cause the claw toe deformity. Claw toes are more common in older people, and are around five times more common in women than in men. The reason for this gender imbalance is unknown.
Claw toe treatment initially involves medication or therapy to treat the underlying cause of the problems. Anti-inflammatory medication, antibiotics, or other medications may be indicated depending on the cause of the claw toe deformity. Wearing wide or open-toed shoes can help prevent further problems, and shoe pads can be fitted to avoid putting pressure on the toes that may cause complications. These treatments can prove effective if the claw toe deformity is new, but if the toes have been clawed for some time, surgery may be necessary.
Claw toe surgery is the only treatment which can correct the structural defect if the soft tissues of the toes tighten and become rigid. The surgery involves trimming the joints which are causing the toes to buckle, so that the toes are able to straighten out. This surgery is called arthroplasty. If this surgery is not successful, a further procedure called arthrodesis may be performed. In this operation, bones in the deformed toes are fused together to restore the normal structure and mobility of the foot.