claw toe is a form of hammer toe. A claw toe can affect any
one of the toes or all of the toes simultaneously. Claw toes are a deformity
where the entire toe grabs and involves the MPJ (metatarsal phalangeal joint)
PIPJ and DIPJ.
How do we develop claw toes? Claw toes aren't due to ill
fitting shoes or high heels. Claw toes develop due to an imbalance in the tendons
that move the toe. The two primary causes of claw toes are called
extensor substitution and flexor substitution. These two conditions are
explained in the biomechanics tab below.
Treatment Of Claw Toes
Treatment of hammer toes (including claw toes) ranges from simple shoe modifications to
sophisticated surgical repair. Logic dictates that our initial attempts at
treating hammer toes would include softer and wider shoes. Shoes such as
clogs or Birkenstocks offer a wide toe box that in many instances may be enough
of a change to allow pain free walking.
Hammer toe pads are often used to control the
motion of the toe to hold it or bind it in place so that it doesn't rub on the
shoe. Many variations of pads are available for use. The right pad
really depends upon the individual toe location and problem.
Surgical treatment of hammer toes varies from simple releases of the extensor
tendon (top of the toe) to complex tendon transfers and bone fusions. The
most commonly used hammer toe procedure is that which was described by Post in
1895 and is referred to today as the Post Arthroplasty or Post Procedure.
The Post Procedure involves resecting (removing) the knuckle of the toe at the
level of the proximal interphalangeal joint (PIPJ) This joint is the joint
closest to the point where the toe attaches to the foot. Typically the
Post Procedure will be performed in conjunction with a tendon release on the top
(extensor surface) of the foot. The combination of these two procedures
results in a toe that will lay flatter avoiding direct pressure from the
shoe. The Post Procedure may be performed under local or general
The following pictures show the surgical steps of a claw toe
procedure called a Post arthroplasty. Modifications of this procedure may
include a fusion of the joint, pinning of the toe or digital implant. These photos show
dissection at the level of the proximal interphalangeal joint (PIPJ) for
correction of a hammer toe. Image 1 shows the pre-operative position of the hammer toe.
Image 2 shows a release of the dorsal capsule and extensors tendons with a #15
blade at the level of the metatarsal phalangeal joint. Image 3 shows the
long extensor tendon at the level of the PIPJ. In Image 4, the extensor
tendon is reflected and the PIPJ ligaments released from the medial and lateral
sides of the PIPJ. Image 5 show resection of the proximal phalangeal head
with a pair of bone nippers. In Image 6 we see final closure of the wound.
No information is available for this topic.
No information is available for this topic.
What causes claw toes? Claw toes are caused by two basic biomechanical problems called extensor substitution
and flexor stabilization.
Extensor substitution -
The extensor tendons are found on the top of the foot and lift the
foot, raising the foot toward the shin. There are two types of extensor
tendons; long and short. The long extensor tendon, called the extensor
digitorum longus (EDL), originates in the anterior leg. The EDL descends
the leg crossing the ankle and continuing on to the tips of the toes. The
EDL extends or lift the toes.
In cases of muscular imbalance, the EDL will change its' primary
function to aid other muscles maintain balance. When the calf is
particularly tight (see
equinus) the EDL will change its' primary function to assist the tibialis
anterior muscle to dorsiflex the ankle. As a result of the tight EDL, the
toes will form a hammer toe. One of the cardinal signs of extensor
substitution is pronounced hammer toes when the heel strikes the floor during
Flexor substitution -
The flexor tendons are found on the bottom of the foot.
There are two types of flexor tendons; long and short. The long
flexor tendons originate in the leg while the short flexor tendons originate in
the foot. The long flexor tendon to the toes is called the flexor digitorum
longus (FDL). The FDL traverses the bottom of the foot to insert into the
bottom tips of the toes.
When there is imbalance in the normal function of the foot, the
flexor tendons are often asked to stabilize the foot. Flexor substitution
is particularly common in cases of
Flexor substitution is used by the foot to help stabilize the foot. The
increased pull of the FDL to stabilize the foot will cause the toes to 'hammer'.
The symptoms of claw toes can be mild to severe and includes pain
that is described as a 'hot poker' to the toes. Symptoms vary with the location of the claw toe and the types of shoes worn.
Corns are the most common problem seen as a result of a
toe. A corn is a condition that can vary
in both location and appearance. The differential diagnosis for this
condition should include;
Products Recommended for Claw Toe:
This article was written by Jeffrey A. Oster, DPM and last updated 2/5/13.
No additional information is available for this topic.
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