Definition

Claw foot, also known as claw toe, is a deformity where the toes curl into a claw-like shape. In claw foot, the joints at the base of the toes bend upwards, while the other joints bend downwards, giving the foot a claw-like appearance. Sometimes, claw foot is accompanied by a high arch, known as cavus.

Claw foot can be a congenital condition (present at birth) or acquired due to another underlying condition. While claw foot itself is not life-threatening, it can be a sign of more serious issues, such as cerebral palsy or diabetes. The deformity can cause pain due to calluses or sores forming on the affected joints. Another issue with claw foot is difficulty finding comfortable footwear. Though it is not life-threatening, claw foot should be properly managed to prevent the condition from becoming permanently rigid.

Causes

Claw foot can develop as a result of other underlying conditions. For example, it can occur after surgery in the ankle area. Nerve damage can weaken the muscles in the foot, creating an imbalance that causes the toes to curl. Chronic inflammation can also lead to the foot bending into this shape. Other conditions that may cause claw foot include:

• Rheumatoid arthritis (RA): An autoimmune disease where the immune system attacks healthy cells, including those in the joints, leading to long-term inflammation that can alter foot shape.
• Cerebral palsy: A neurological condition that affects muscle tone and strength, causing muscles to be too stiff or too weak, often due to brain development issues during pregnancy or birth.
• Diabetes: A condition where high blood sugar levels, due to insulin resistance or insufficient insulin production, can damage nerves (neuropathy) and lead to changes in foot shape, including claw foot.
• Stroke: A condition where the blood supply to the brain is disrupted by a blockage or hemorrhage, which can damage nerves and impair muscle function, including in the feet.
• Improper footwear: Wearing shoes that do not fit the shape of the foot can also lead to claw foot.

Risk factor

Claw foot is more likely to occur in individuals who:

• Have a family history of claw foot.
• Suffer from conditions such as rheumatoid arthritis, diabetes, and stroke (especially if these are not well-managed).
• Have high arches.
• Have a habit of turning their feet inward while walking.

Symptoms

Symptoms of claw foot include:

• Toes that are bent downwards, resembling claws.
• Calluses or corns due to repeated pressure and friction on the foot.
• Blisters.
• Pain.
• Swelling of the foot.
• Deep wounds or ulcers on the feet (less common).

There are two stages of claw foot:

• Flexible stage: The initial stage where the toes can still be moved at the joints, although with more stiffness compared to normal.
• Rigid stage: The later stage where the toes have become fixed in a claw-like position and can no longer move. Surgery is more effective if performed during the flexible stage.

Diagnosis

Your doctor will ask about the progression of the condition, your symptoms, past medical history, family history of similar conditions, previous treatments, and associated symptoms like calluses, pain, or numbness. During the physical examination, the doctor will touch and move your foot to determine the stage of claw foot. Since claw foot can be associated with nerve damage, a neurological exam may be conducted to assess sensations such as touch, heat, cold, and reflexes in the foot. If needed, an X-ray may be performed to view the alignment of the bones in your foot. General practitioners may refer you to an orthopedic specialist or podiatrist for further evaluation.

Management

The treatment approach for claw foot depends on its stage and severity to prevent worsening of the condition. If claw foot is still in the flexible stage, your doctor may suggest splinting the affected toe to a healthy toe. They may also recommend exercises to maintain your foot's shape

Home Care

Some home care measures include:

• Wearing shoes that provide enough room for your toes, have low heels, and support the arch of your foot.
• Using cushioned insoles.
• Adding padding inside your shoes.
• Strengthening and stretching toe muscles through exercises.
• Taping the toes to maintain their position.
• Avoiding high heels and tight shoes.
• Practicing exercises to move your feet using a towel, marbles, or a small ball.

Surgery

If home treatments do not show improvement or if your claw foot has become rigid, your doctor may suggest surgery. Surgical options include:

• Adjusting the position of tendons (the tissue connecting muscles to bones).
• Shortening the toe bones.
• Temporarily pinning the toes to correct their position.
• Toe fusion, where abnormal toes are fused to normal ones.

Recovery from surgery generally takes about 4–6 weeks.

Complications

Claw foot can hinder walking and running. However, this can be managed with consistent exercises and wearing comfortable shoes.

Surgery for claw foot carries risks of complications, such as nerve damage, foot stiffness, infection, and recurrence of claw foot. Discuss prevention strategies with your doctor to avoid recurrence.

Prevention

It is important to prevent claw foot, especially if you have conditions that could lead to claw foot, such as diabetes or arthritis. Preventative measures include:

• Exercising your toe muscles and movements. You can do this by trying to pick up small objects with your toes.
• Wear comfortable shoes that are not too tight and provide good support with a wide toe box.
• Using a pumice stone to gently remove calluses or corns on your feet in a circular motion.

When to see a doctor?

You should see a doctor if you experience pain while walking, notice changes in your foot's shape, or have difficulty moving the joints in your toes. Early treatment can help prevent the worsening of claw foot.

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