Claw toe is characterised by deformity of a toe joint, causing the toe to lift above ground and adopt a curled up position, resembling a claw. It is frequently associated with a bunion deformity of the big toe. Commonly affected are the second and third toes but the fourth and fifth toes can be affected too. There can be many causes leading to the condition but the most common and important causes is mechanical stress. Since the feet are the only points of contact between our body and the ground when we are standing upright, our feet constantly absorb pressure from our body weight when we are standing and walking. When there is excessive pressure on the ball of the foot over time, the joint connecting the toe to the foot can become damaged. This damage causes the toe to dislocate upwards and subsequently adopt a claw-like posture. Although mechanical stress is the main cause of claw toe, there are other less common causes too, like arthritis or an untreated injury.
In the modern context, high pressure exerted on the forefoot is commonly attributed to excessive wearing of high-heeled shoes or tight calf muscle which pushes the front of the foot with excessive force against the ground. When a claw toe is formed, pain is often felt in the ball of the foot. The pain is a manifestation of the damage in the dislocated joint also the abnormal high pressures pain can also arise when it rubs against the footwear when walking.
Claw toe do not arise in a matter of days. The formation of a claw toe is usually a long process. In the early stages, the build up of excessive pressure on the forefoot leads to the formation of callosities. These are areas of thickened skin on the ball of the foot which are considered as precursos to claw toes. As the damaged progresses, the foot becomes painful and when the joint gets damaged to the extent where the toe dislocates upwards, a claw is formed. Areas of callosities tend to be painful but can also be painless if the toes have not developed clawing or the joint has not been significantly damaged. Therefore, relying solely on pain as a warning sign to claw toe may be inadequate. One should seek treatment when callosities are noted to have formed, especially for those who often wear high-heeled shoes, since callosities and claw toe are just manifestations of the same disease at different stages.
When callosities are noticed, it is advisable to give the calf muscles regular stretching to reduce the damaging forces under the front of the foot. This is known as “overloading”. Time spent in highly heeled shoes should be rationed. Since it may not be realistic to completely amount of “rest time” for the feet out of the high-heeled shoes may be the returning should be shaved regularly and analgesics can be taken for pain control. Once clawing has occurred, surgery is the only way to correct the deformity. Modern surgery can be performed endoscopically (Key Hole surgery) or through only very small incisions and with low recurrence risk of less than 5%. Despite the availability of very good surgical techniques for the treatment of claw toes, the best advise should be aimed at prevention. As prevention and delaying of disease progression can be achieved by simple lifestlye modifications, it is important for those at risk of developing claw toes to identify the problem early and take preventive measure against clawing.