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ICD-9-CM CODES

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  • 735.5 Claw toe (acquired)

  • 755.66 Other anomalies of toes

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ICD-10-CM CODE

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  • M20.5X9 Other deformities of toe(s) (acquired), unspecified foot

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PREFERRED PRACTICE PATTERN

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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PATIENT PRESENTATION

A 33-year-old female presents with pain in her right foot. Patient states ever since she was 16 years old she has worn high heels and shoes that come with a point. She said over the last year she has noticed a cramping in her toes and a difficulty straightening out all of her toes. She is having difficulty with closed-toe shoes and standing for long periods of time. Upon examination it was found that she has a shortened flexor digitorum musculature with hyperextension (dorsiflexed) of the MTP joint with flexion (plantar flexed) of the proximal interphalangeal (PIP) joint, and the distal interphalangeal (DIP) joint is plantar flexed.

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KEY FEATURES

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Description
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  • Toe is bent into a claw-like position

  • Flexor digitorum brevis contraction/shortening

  • Hyperextension (dorsiflexed) of the MTP joint with flexion (plantar flexed) of the PIP, DIP is plantar flexed

  • Flexor muscles, fascia, tendons shorten

  • Most commonly affects the second toe; can also affect the third to fifth

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Essentials of Diagnosis
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  • Diagnosis is usually made by clinical examination or X-ray.

  • Can be an independent diagnosis and not associated with a disease process.

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General Considerations
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  • Swelling

  • Inflammation around the joint

  • Can be associated with medical conditions

  • Can be a flexible or fixed deformity

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Demographics
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  • Infants

    • Congenital

  • Children

    • Wearing footwear that is too small

  • Adults

    • Poor footwear: Improper fit/toe comes to a point/narrow forefoot/high heels

    • Dancers

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FIGURE 205-1

Claw toe. (From American Society of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00156. Accessed April 16, 2013)

Graphic Jump Location
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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Pain in metatarsal with walking

  • Corn on top of the toe

  • Altered joint position

  • Decreased extension or dorsiflexion of the toe

  • Joint redness and pain

  • Callus formation under the metatarsal head

  • Difficulty finding shoes that fit properly

  • Limited motion of the MTP joint

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Functional Implications
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  • Pain with standing

  • Pain with ambulation at the affected toe

  • Inability to wear stiff shoes

  • Need to wear larger shoes to accommodate bunion, large toe box

  • Alteration of gait pattern and mechanical issues of the forefoot

  • Altered mechanics during the push-off phase of gait

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Possible Contributing Causes
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  • Muscle imbalance

  • Trauma

  • Tibia fracture

  • Pes planus (flat foot)

  • Improper footwear

  • Commonly seen in conjunction of bunions

  • Joint arthritis/injury

  • Muscle atrophy

  • Nerve damage

  • Spinal cord injury

  • Friedreich ataxia

  • Osteoarthritis

  • Rheumatoid ...

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