True to their name, claw toe is a deformity in which the toes take on a claw-like appearance. It can involve one or more toes and the second toe is most commonly affected. Whilst the claw toes can be a minor cosmetic issue for some people, for others this deformity can be a painful affliction and a source of much concern.
Clawing of the toes comes about due to an imbalance of muscle action on the toes. This can be present from birth or develop slowly over the years. Sometimes there is a deficit in which the nerve supply operating the toe muscles are impaired. This can be seen in diabetics and neurological conditions such as cerebral palsy. Other times the reason for the imbalance can be due to abnormal muscle function caused by another foot ailment such as the presence of bunions or excessively high arches. Beyond muscle imbalances, the emergence of claw toes may be the result of damage to toe joints secondary to rheumatoid arthritis and alike.
In claw toe, the tip of the toe becomes weightbearing instead of the pad on the underside of the toe. This puts force through a smaller area, causing the formation of painful corns on the end of the toe and damage to the toenail. As the toe becomes retracted, the top of the toe is pushed upward into the shoe. This too becomes a site of pain and corn formation. Simultaneously, the knuckle of the toe is pushed downward causing pressure under the ball of the foot. The skin under the ball is also subject to corn formation, whilst deeper tissues such as the knuckle joint itself can be traumatised by weightbearing.
A podiatrist is a health professional trained in treating the problems associated with claw toe. This includes painless removal of secondary lesions like corns, management of damaged nails and provision of devices to offload painful areas like those found on the tips of toes and under the ball of the feet. A podiatrist will also recommend the best footwear to accommodate the deformity, and provide advice regarding surgical management as required.