What are the causes and treatments of claw toes (hammer toes)?

From the Guidelines

Claw toes, also known as hammer toes, are a foot deformity that can be treated with conservative measures, but may require surgical intervention in severe cases, as recommended by the most recent guidelines 1.

Causes of Claw Toes

The causes of claw toes include muscle imbalances, tight tendons, and underlying conditions such as diabetes or rheumatoid arthritis. In people with diabetes, claw toes can increase the risk of foot ulcers, making early intervention crucial to prevent progression and maintain foot function 1.

Treatment of Claw Toes

Treatment of claw toes depends on the severity of the condition. For mild cases, conservative measures such as:

• Wearing shoes with roomy toe boxes
• Using cushioned pads to relieve pressure
• Performing toe stretching exercises daily
• Using custom orthotic inserts to redistribute pressure and provide support can be effective in managing the condition.

For severe or rigid claw toes, surgical intervention may be necessary. Digital flexor tendon tenotomy is a recommended procedure for treating non-rigid hammertoes with nail changes, excess callus, or pre-ulcerative lesions, as it can help prevent foot ulcers 1.

Management of Associated Conditions

In people with diabetes, it is essential to manage associated conditions such as foot ulcers, pre-ulcerative lesions, and excess callus. Providing therapeutic footwear, orthotic interventions, and educating patients on proper foot care can help prevent foot ulcers and manage claw toes 1.

Key Recommendations

• Consult a podiatrist for severe or rigid claw toes
• Perform toe stretching exercises daily
• Use custom orthotic inserts to redistribute pressure and provide support
• Consider digital flexor tendon tenotomy for non-rigid hammertoes with nail changes, excess callus, or pre-ulcerative lesions
• Provide therapeutic footwear and orthotic interventions to manage associated conditions

By following these recommendations, patients with claw toes can effectively manage their condition, prevent progression, and maintain foot function.

From the Research

Causes of Claw Toes

• Alterations in normal anatomy that create an imbalance between the intrinsic and extrinsic muscles 2
• Improper shoe wear, trauma, genetics, inflammatory arthritis, and neuromuscular and metabolic diseases 2
• Acute compartment syndrome 3
• Neurological disorders, such as sequelae of an ischemic contracture of the muscle belly after a compartment syndrome 4

Symptoms of Claw Toes

• Pain and pressure on the tips of the toes 3
• Metatarsalgia 5, 6
• Deformity in the forefoot 6

Treatments of Claw Toes

• Nonsurgical management:
  • Shoe modifications, such as rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel 5
  • Foot orthoses, such as custom-made silicone orthosis or metatarsal pad 5
  • Patient education 5
• Surgical management:
  • Lengthening of the flexor tendons, such as flexor hallucis longus and flexor digitorum longus 3, 4
  • Tenodesis and lengthening of the flexor hallucis longus and flexor digitorum longus tendons at Henry's knot 4
  • Stainsby procedure, which involves correction of rigid claw toe deformity 6
  • Soft-tissue correction, such as tendon transfer, and bony procedures, such as joint resection, fusion, or metatarsal shortening 2