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205: CLAW TOE

Eric Shamus, PhD, DPT, PT, CSCS; Colin Brooks, MBA, SPHR

ICD-9-CM CODES

  • 735.5 Claw toe (acquired)

  • 755.66 Other anomalies of toes

ICD-10-CM CODE

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

PREFERRED PRACTICE PATTERN

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

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.

KEY FEATURES

Description

  • 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

Essentials of Diagnosis

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

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

General Considerations

  • Swelling

  • Inflammation around the joint

  • Can be associated with medical conditions

  • Can be a flexible or fixed deformity

Demographics

  • Infants

    • Congenital

  • Children

    • Wearing footwear that is too small

  • Adults

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

    • Dancers

FIGURE 205-1

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

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CLINICAL FINDINGS

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

Functional Implications

  • 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

Possible Contributing Causes

  • Muscle imbalance

  • Trauma

  • Tibia fracture

  • Pes planus (flat foot)

  • Improper footwear

  • Commonly seen in conjunction of bunions

  • Joint arthritis/injury

  • Muscle atrophy

  • Nerve ...

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