Claw Toes

Claw toes happen when some of your toes curl into a claw-like shape, like you’re gripping into your shoe or the floor under your feet. Your toes may feel extra stiff and hard to move. They might also be stuck squeezing into that grip.

It can happen in any of your toes, but it’s most common in the middle three — the ones between your big toe and pinkie toe.

Your affected toes might hurt. You might develop corns, blisters or calluses on the tips of your toes from pushing down or rubbing against your shoes. The tops of your toes might rub against your shoes, too.

Claw toes can happen for lots of reasons. Some are serious. Visit a healthcare provider if you notice any pain or changes in your feet. Especially if you can’t move or control your toes.

Claw toe stages

There are two stages to claw toes:

• Flexible stage: Your affected toes feel stiff, but you can still move them. They might curl into a claw shape without you thinking about it.
• Rigid stage: You won’t be able to move or uncurl your toes. They’ll be stuck in the claw grip all the time.

Symptoms of claw toe deformity

You can usually see claw toes. Your affected toes will be noticeably curled.

Other symptoms can include:

• Pain or cramping in your toes and feet
• Trouble moving or straightening your affected toes
• Corns, calluses or blisters on those toes

Claw toe causes

All of your toes except your big one have three joints. Claw toe deformity happens when something makes joints in the middle and end of your toes bend too often and too much.

The joint in the middle of your toe is the proximal interphalangeal (PIP) joint. The one nearest the tip of your toe is the distal interphalangeal (DIP) joint. Claw toes form when these two joints spend so long bent and curled that they start to stick in that position.

This usually happens when something affects the natural balance of muscles and tendons in your feet. If your toe muscles squeeze (contract) too often, the tendons connected to them can stiffen. This leads to the stiff or stuck bend in your toe joints.

This can happen for lots of reasons, including:

• Nerve damage from a condition like diabetes-related neuropathy, an injury, Charcot-Marie-Tooth disease or conditions that affect your spine
• Inflammation from osteoarthritis or rheumatoid arthritis
• Stroke
• Naturally tight muscles or stiff tissue
• Wearing shoes that are too small or too tight, especially ones that pinch your toes

Risk factors

Conditions that affect your feet, nerves or muscles can increase your risk of claw toes. The natural shape of your feet can make them more likely to happen, too. You might have a higher risk if you have:

• High arch feet
• Diabetes
• Alcohol use disorder
• Foot injuries or surgery
• Spinal cord tumors
• Cerebral palsy or other neurological disorders
• A biological family history of claw toes

Claw toes are different from other toe issues, like hammertoes and mallet toes. They’re similar, but happen for different reasons. Hammertoes are bends in only the middle joint of your affected toes. Mallet toes bend in only the last joint. Claw toes are uncontrollable bends in both the middle and last joints.

Complications of this condition

Untreated claw toes can become permanent. This can affect your balance and your ability to use your foot normally. It can also lead to pain and damage in muscles and tendons in your foot.

How doctors diagnose claw toes

A healthcare provider will diagnose a claw toe deformity with a physical exam. They’ll examine your toes and joints. They’ll touch and move your toes to see if they move naturally.

Tell your provider which types of shoes you wear most often, and if you notice that some kinds of footwear make symptoms like pain better or worse.

You may need a foot X-ray to take pictures of your foot and toe bones. Your provider might also test you for neurological disorders that can affect the nerves and muscles in your feet.

How is it treated?

Your healthcare provider will recommend treatments based on the stage of claw toes you have and their cause.

Some treatments include:

• Making footwear changes: Wearing supportive shoes with plenty of room in the toe and lots of arch support can help. Make sure your shoes fit well but aren’t too tight. Wear shoes with a closed back or a strap around your heel so you don’t grip with your toes.
• Wearing a splint, pads or tape: Your provider may suggest ways to hold your toes in the correct alignment. This can take extra pressure off them and help them relax from the curled claw shape.
• Strengthening and stretching your foot muscles: You can exercise muscles in your feet just like any other kind of workout. Picking up marbles with your toes or using your foot to grab a towel that’s flat on the floor are common exercises for a claw toe deformity.
• Having surgery: You may need surgery if other treatments don’t help correct claw toes. A surgeon can release overly tight tendons or change the size and shape of the bones and tendons. They might also insert a steel pin into your toe that holds it in the right shape while it heals. This will prevent it from re-curling.

When should I see my healthcare provider?

Visit a healthcare provider if you notice your toes changing shape, especially if you can’t move or use them well. Talk to a provider if you have pain or other symptoms that make it hard to use your feet normally. See a provider right away if you lose feeling in your toes or develop sores or wounds on the tips or tops of your toes.

Tell your provider if it feels like treatments aren’t helping, or if the claw toes seem to be getting worse over time.

What can I expect if I have this condition?

Claw toes usually get better with treatment. If you need surgery, those toes may be a different length after they heal. It depends on which type of surgery you need.

You should be able to resume all of your usual activities once your healthcare provider or surgeon says it’s safe. You might have to avoid certain types of shoes in the future, but that might be the only long-term effect.

Your outlook might be different if a serious issue like a stroke causes claw toes. Your care team will tell you what to expect and will help you set realistic recovery goals.