Non-surgical Treatment of Claw Toe
Initial treatments favor non-surgical options in most cases. Patients with claw toe deformities often benefit from wearing comfortable shoes that include a wide toebox and increased depth to prevent rubbing of the toes. A curved sole on the shoe or sneaker — often termed a rocker-bottom sole — can assist with walking and rolling off the foot during gait.
Typically, taping or strapping of multiple toes can be cumbersome and ineffective, particularly if the toes are quite stiff. Instead, the surgeon may recommend simple cushioning or padding of the prominent knuckles to relieve pain and prevent calluses or ulcers. A pad behind the ball of the foot may take pressure off those sore areas, likewise relieving pain.
An alternative is a full-length prescription orthotic insole designed in a similar manner. Patients may have some relief with use of anti-inflammatory medications, particularly if the claw toe deformities result from an arthritis condition. Physical therapy is not routinely effective for these types of toe deformities.
Surgical Treatment of Claw Toe
In cases with severe deformities or if non-surgical methods have failed, surgery may be considered. It is important to determine if the toes are flexible or stiff, which impacts surgical decision making.
If the toes remain flexible, surgery consists of releasing tight or scarred tissue and transferring affected tendons to straighten the toes.
In most cases, however, the toes are relatively stiff and surgery involves bone procedures to remove the affected knuckles and straighten the toes. This often requires placement of metallic pins or wires protruding from the toes to maintain alignment while they heal. The patient often has to wear a specialized type of surgical shoe or boot afterward during recovery. It is also important to surgically correct any associated disorders of the big toe or remainder of the foot at the same time in order to improve the overall odds that the toe surgery will be successful.
After claw toe surgery most patients are able to resume wearing a comfortable walking shoe or sneaker but many have difficulty with tight fitting dress shoes or high heels. Likewise, most patients are able to function well during walking and daily activities but may have limits with more aggressive activities such as running, sports, or standing on tiptoe.