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ICD-9-CM Code

  • 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

Key Features


  • Toe is bent into a claw-like position

  • Flexor digitorum brevis contraction/shortening

  • Hyperxtension of the MTP joint with Flexion of the proximal interphalangeal joint (PIP)

  • 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


  • Infants

    • Congenital

  • Children

    • Wearing footwear that is too small

  • Adults

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

    • Dancers

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

Differential Diagnosis

  • Mallet toe: different in that it is flexion of only the DIP

  • Hallux valgus

  • Gout

  • Osteochondrotic lesion of the first metatarsal head

  • Sesamoiditis, turf toe

  • Osteochondritis dissecans

  • Metatarsalgia

  • Metatarsal stress fracture

Means of Confirmation or Diagnosis


  • X-ray

Findings and Interpretation

  • Bone spur, location and size



  • To straighten out the toe

    • Cut or lengthen tendons and ligaments

    • Fusion of the joint

    • Tendon transfer1,2


  • Anti-inflammatory


  • For imaging, x-ray

  • For medication, anti-inflammatory or corticosteroid injection

  • For surgical consult1

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