What is claw / hammer toe?
Claw toe or hammer toe is a condition where you have an abnormal bend in one of the joints of a toe. With claw toe the bend is in the middle and ends of the toes making the curl appear curled down. Claw toes tends to affect the four smaller toes at the same time. Hammer toe refers to a bend in at the middle toe joint and it’s usually the second toe that’s affected.
Wearing tight shoes is the most common cause of claw/hammer toe. If the toes are forced to remain bent inside a shoe for a long time, the muscles tighten and the tendons contract. Over time, it becomes harder and harder to straighten the toes, even when barefoot.
Other causes include trauma (eg toe fracture, ankle injury), unbalanced and unstable toes muscles. Hammer toes often occur together with bunions. Very occasionally, these toe problems are related to conditions such diabetes, stroke and rheumatoid arthritis.
More women than men are affected by claw and hammer toes. It’s also more common in people whose second toe is longer than their big toe.
What are the symptoms of claw/hammer?
Apart from looking odd, your toes may be painful and difficult to move. You may also have corns or calluses where the raised bent toes rub on your shoes.
You might find it difficult to find shoes that fit comfortably. If your toes are severely affected, you could find your balance becomes a problem.
What does your doctor look for?
Your doctor will examine your feet and see if your toes straighten. Your doctor will ask you about symptoms such as pain and immobility. You will probably be asked about what sort of shoes you usually wear and if you’ve had any other foot problems or other conditions (eg arthritis, diabetes, poor circulation).
What investigations are needed?
Claw toe and hammer toe can be diagnosed on physical examination. Your doctor may order an X-ray to assess bone changes and help determine if surgery is indicated.
The blood flow in your feet may be assessed with a Doppler ultrasound if you have symptoms of poor circulation. Nerve testing may be needed if you have signs of a nerve problem.
How is claw/hammer toe treated?
Treatments for claw/hammer toe include:
- therapy (eg change of shoes; shoe inserts;corn/callus care; exercises to stretch and strengthen the muscles; taping you toes; toe caps, slings or splints)
- medications (eg anti-inflammatories)
Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.
Claw/hammer toe surgery
Surgery is generally reserved for severe claw/hammer toe and where other therapies don’t control your pain.
The type of surgery needed depends on whether your toes are fixed (they don’t straighten) or flexible (they do straighten). Surgery may involve:
- removing part of the toe bone (arthroplasty)
- removing part of the joint and joining the bones together (arthrodesis)
- releasing or moving contracted tendons
- placing an implant to straighten the toe
- removing the toe (amputation)
Surgery may relieve pain, but it may not improve how your toes look. Complications from surgery include infection and failure to relieve all pain. Your toe problems may also recur, especially if you continue to wear shoes that cause the problem.