Fundamentals of Clawtoes/Hammertoes

Clawtoes are bent at the middle and end joints, and a dorsiflexion (a muscle that causes upward flexion) deformity at the metatarsal phalangeal joint. Hammertoes are bent at the middle joint only, with a dorsiflexion deformity at the metatarsal phelanged joint. The condition can cause pressure and pain and usually occurs in the four smaller toes. The joints of the toes buckle abnormally, and have a curved, claw-like, or hammer-like, appearance. Additionally, clawtoes are often associated with a high arched (cavus) foot type, or occasionally some other neurological condition.

Corns or calluses may result from the pressure and rubbing on the bottom of the shoe or on the top of the toes. Rarely, infections may occur. Ulcers may develop in diabetic patients because of decreased foot sensitivity.

Toe deformities can be congenital. Additionally, those with high arches, or those who tend to rotate their feet inward while walking, are susceptible to toe deformities.

What causes the pain?

An imbalance of foot muscles typically causes clawtoes and hammertoes. Foot muscles become imbalanced due to the following factors:

  • Ill-fitting shoes (by far #1)
  • Diabetes
  • Rheumatoid or osteoarthritis
  • Alcoholism
  • Charcot-Marie-Tooth Disease
  • Spinal cord tumors
  • Polio
  • Stroke

How is it treated?

Non-surgical treatment for clawtoes and hammertoes includes:

  • Wearing shoes that have roomy toe boxes, low heels, and good arch supports.
  • Wearing shoes that offer increased width and depth, with soft soles and minimal seams in the toebox.
  • Wearing pads, arch supports, or other shoe inserts to cushion the toe.
  • Strengthening and stretching toe muscles through exercises.

Surgical treatment of clawtoes and hammertoes includes:

  • Tendon lengthening and rerouting.
  • Shortening the bones of the phalanx.
  • Temporarily inserting a steel pin to hold the correct position of the toe until healing occurs.

What are the risks of treatment?

Risks include nerve injury, infection, and stiffness. Recurrence of the toe deformity can occur, especially if you return to wearing ill-fitting shoes.