Claw Toe refers to a condition where the shape of one or more of your toes (usually your 2nd toe) becomes very flexed.
It is painful for 3 reasons:
The Plantar Plate is a tough piece of fibrous tissue that helps to hold each toe in the “neutral position” in relation to the rest of the foot.
In cases where the Plantar Plate endures high loads over many years it can eventually tear.
The wearing of high heels is a good example of “chronic overloading” of the Plantar Plate.
In the early stages the tear is associated with swelling and pain in the metatarsophalangeal joint (MTPJ). It’s possible that the toe will also start to drift towards the big toe.
It’s possible that the toe will also start to drift towards the big toe.
The torn Plantar Plate leads to instability. There is a resultant imbalance of the weaker “intrinsic” and stronger "extrinsic” muscles controlling movement of the toe. This results in a “claw toe”.
Claw Toes and MTPJ instability is often seen in patients with Bunions because of a phenomenon called “transfer metatarsalgia” where the weight that normally goes through the ball of the big toe is transferred to the ball of the second toe leading to “chronic overload.”
Although the “claw” is often easy to see with the naked eye, it is usually necessary to obtain a weight bearing x-ray to make a “functional” assessment”.
In addition, you may be required to have an Ultrasound or MRI scan to see the Plantar Plate Tear.
It might be possible to avoid surgery for this condition. Your Podiatrist may be able to assist with:
In situations where non-surgical treatment has failed then surgery should be considered.
The Plantar Plate Tear can be repaired back to the phalanx with very strong sutures via an incision on the top of the foot overlying the MTP joint.
There are two possible methods by which a Claw toe can be straightened.
The decision on which is best for you should be discussed at the consultation.
|Week||Exercises||Boot||Weight bearing||Returning to Pre-Surgical Function|
|0-2||Hip and knee active ROM exercises||Post-op shoe||Weight bear as tolerated||Staying home with the foot elevated above heart level for 23 hours a day|
|2-4||Hip, knee, ankle band resisted exercises. Toe AROM – wriggling, flexing, extending. Calf, shin muscles massage.||Post-op shoe||Weight bear as tolerated|
|4-6||Hip, knee, ankle band resisted exercises. Banded toe exercises – flexion, extension, toe squeezes, spreads, ball squeeze.||Post-op shoe||Weight bear as tolerated|
|6-8||Gentle ankle AROM DF and PF. Calf and shin massage and stretching. Physio guided PF and DF mobilisations. Start DL heel raises, progressing to SL.||Full weight bearing||Return to work – sedentary occupation.|
|8-10**||Physio guided gait and balance training. Continue exercises as above.|
|10-12*||Increase walking distance.||Return to light duties – labour intensive occupation|
|12+||Physio guided, gradual return to pre-surgery activities eg. running, cycling.||May return to full duties (clinical assessment required) Return to sport at ~6 months|
If you have any questions please do not hesitate to contact Mr Goldbloom’s rooms on 03 9928 6188.
This rehabilitation plan was developed by Mr Goldbloom in conjunction with Physiotherapists Brodie Leonard-Shannon and Brendan Mason from Back in Motion, Aspendale Gardens.
Surgery for Claw toes and Plantar Plate Tears is usually successful. Specific risks include:
Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Please contact Mr Goldbloom's rooms to discuss if surgery is appropriate for your situation.