How can claw toes be treated surgically?

Patients who come to me with painful and deformed little toes often have hammer or claw toes. This blog is about responding to the question of how claw toes can be treated surgically. There are conservative and surgical options. My focus in this post is: How can claw toes be treated surgically? First, I will briefly explain what claw toes actually are, how they develop and how they are diagnosed.

Claw toes are a malformation of the foot characterised by a deformation of the toes. In principle, ALL small toes can be affected. In claw toe, the phalanges are shaped like a claw. The tip of the toe is bent towards the ground (the distal toe joint is also permanently bent) and can therefore lead to additional pain at the tip of the toe.

The causes of claw toes are often problems with the statics of the foot, which can lead to overloading in certain parts of the foot. These overloads can in turn lead to misalignments of the pivot points of the toe muscles. This results in an imbalance between the flexor and extensor muscles of the toes. Since the toe muscles span several joints, this imbalance usually affects all toe joints.

Shoes that are too tight can also put the toes in such an imbalanced position.

Claw toes are diagnosed by a physical examination, even if a claw toe deformity is already visually apparent. Your foot surgeon will examine how advanced the deformity of the small toes is and will ask you questions, e.g. to find out whether the small toe deformity is a congenital problem or developed from a certain point. In some cases, an X-ray will be taken to determine the severity of the claw toe deformity.

Dr Gottlieb, MD informs:

"During the examination, I look at the whole foot to find out if there are other, possibly related diseases or deformities. In parallel, it is important to focus on the statics of the feet and the body. This is important to find out a possible cause. It serves as a prerequisite for sustainable treatment and possible surgical correction." 

Checking and, if necessary, rehabilitation of the statics of the foot

In order to basically have a chance of a sustainable correction of claw toes, any static causes of the deformity must be recognised and corrected.

Adjustment of the metatarsal bone parabola through osteotomies (realignments)

The toes are anchored to the metatarsus by metatarsophalangeal joints. The muscles that act on the toes largely originate from the lower leg. Their action depends on the course of the tendons and their relationship to the fulcrum of these tendons. This is located in the centres of the metatarsal heads. Consequently, the position of these heads is essential. Claw toes can be sustainably corrected by repositioning these heads (repositioning osteotomy).

Balancing the muscle strength

The position of the small toe joints is determined by the counterplay between flexors and extensors. If these are in a state of imbalance, the joint is either flexed or extended, depending on the excess weight. By shifting, lengthening or severing tendons, one can balance this equilibrium and correct deformed claw toes.

Stiffening of small toe joints

Corrective stiffening of small toe joints can have an additional favourable effect on the leverage of the muscles.

The healing process is as different as every person is different. And of course, the claw toe surgery also depends on how many toes are affected, how severe the deformity is and whether there may be other deformities on the toes or foot that are corrected along with the claw toe surgery. It usually takes about four to six weeks for the toe to heal. During this time it is important to follow the instructions of the foot surgeon and wear shoes with a wide toe box, for example, so that the toes can heal completely.

Claw toes, like hammertoes, are a common foot deformity that should be taken seriously. If left untreated, they can not only cause severe pain but also lead to further deformities of the foot and toes or instability of the foot.

Be aware of this when choosing a doctor,

• that the orthopaedist or surgeon specialises in feet. 
• that appropriate experience is available for the treatment of small toe deformities: a foot surgeon can usually make the best diagnosis and then recommend the treatment option that is ideal for you personally.
• that the foot surgeon takes enough time to answer your questions.
• that the foot surgeon generally treats the whole foot, pays attention to the foot statics and also to the whole body statics.

If you notice a foot malposition, you should consult a foot specialist at an early stage.

• Wearing shoes with a wide toe box and using insoles are helpful to potentially bring the toes back into shape.
• Orthoses can help reduce the stress on the tendons and also support the alignment of the little toes.
• Foot exercises and physiotherapy are also very helpful in strengthening the foot muscles. They can possibly stop a deformity, but a correction is not possible.