Claw Toe

Claw Toe

A sagittal plane deformity of the toe(s) where the PIPJ and the DIPJ are in a flexed position and the MTPJ is neutral or dorsiflexed. MPJ’s are considered to be very unstable.

Aetiology:
Inappropriate footwear – narrow toe box, inadequate dept of toe box, too short, too small; ‘Flexor substitution’ – the long flexors compensate for a weak gastroc-soleus muscle ‘Flexor stabilisation’ – weakness of intrinsic muscles  flexor digitorum longus has mechanical advantage  clawing of toes; Familial predisposition/inherited factors; Neuromuscular disorders; Forefoot adductus (this causes a digital abductus  lumbricals shift laterally and loose some of its plantarflexory and adductory force.); Rigid cavus foot type; Plantarflexed forefoot (toes forced into dorsiflexion); Spasm of the toe flexors (eg in cerebral palsy and CVA – the spasm during the swing phase will cause the toes to claw)

Stainsby (1997) believes that the windlass mechanism to the lessor toes is defective in those with claw toes. (see reverse windlass)

Clinical Features:
Classify as flexible or rigid.
Many are asymptomatic
Pressure from footwear may cause bursal development over the PIPJ. Associated with the bursa may be a fistula and sinus.
May be hyperkeratotic lesions and/or bursa associated with the pressure on PIPJ and apex of joint.
May get plantar digital lesions
May be pain secondary to arthritic changes

Management:
Treat inflammatory states and reduce hyperatotic lesions.
Protective padding if fixed.
Corrective padding or splints if flexible
Footwear advice.

Surgery:
• Flexor digitorum tenotomy
• Fusion of IPJ’s
• Metatarsal head removal.

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