Claw Toe

Many survivors report that their toes begin curling under their feet post stroke. As a consequence, walking becomes painful. This condition is called Claw Toe. This, and a similar condition called Hammertoe, are caused by an imbalance of muscles in the feet and toes. In the case of claw toe, muscles in the foot over-contract due to a neurological abnormality. Because toe muscles are typically not very strong, the contracting muscle overpowers the muscles in the toe. This tightens the tendons, causing the joints of the smaller toes to buckle or curl in an unnatural way. Claw toe most often strikes the stroke-side foot. Painful blisters may develop on the affected toes. Added pressure from the imbalance may also cause calluses or corns to form on the ball of the foot. Claw toe also affects patients with joint diseases such as rheumatoid arthritis, cerebral palsy, nerve damage due to poor circulation, as with diabetes, and those confined to bed for a long period of time.

Claw toe is classified in two ways — “flexible” or “rigid” — based on the severity and progression of the condition. “Flexible claw toe” describes the earlier stages in which, as the name suggests, the toes are still flexible at the joint. For flexible claw toe, the American Academy of Orthopedic Surgeons(link opens in new window) (AAOS), in conjunction with the American Orthopedic Foot and Ankle Society,(link opens in new window) offers these suggestions for helping to correct the imbalance:

• Follow the instructions of your doctor and use a splint or athletic tape to reposition the toes.

• Avoid shoes with heels over two inches.

• Wear soft shoes with plenty of room for the toes.

• Give your toes a workout by using them to pick up small objects, such as marbles, or a crumpled towel.

“Rigid claw toe” designates the later stages in which the toes are fixed in this unnatural position. As the tendons tighten and the deformity becomes fixed, fewer options are available. Non-surgical treatments are confined more to pain-management than to correction. To minimize discomfort for rigid claw toe, the AAOS recommends trying specialized shoes that have an extra 3/8" depth in the toe box. Some patients turn to surgery. This usually involves cutting the tightened tendons. Other possible procedures include lengthening or repositioning tendons, or shortening the bone of the toe. Inserting a steel pin into the toe is often recommended, as well. As with all surgeries, infection is a risk, and swelling and pain are common in the weeks following. Botulinim toxin (Botox®) has proven effective, also. Botox injections work by blocking the nerve endings. This keeps the neurotransmitters that signal the muscle to contract from reaching the nerve. The effects aren’t usually noticed for five to 10 days and last only three to four months.

Although claw toe is not widely known, there is help for this painful condition. If your doctor doesn’t know much about it, seek more help, and ask more questions.