Differential Diagnoses

Workup

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Media Gallery

Claw toe is named for its similarity to animal claw or talon.
Claw toe.
Plastic model of claw toe.
Hammer toe.
Plastic model of hammer toe.
Curly toe.
Mallet toes 3 and 4.
Mallet toe.
Multiple claw toes.
Claw toe. Extensor tendon connecting with extensor hood.
Claw toe. Extensor tendon splits into 3 parts distally.
Claw toe. Plantar plate stretches out, and proximal phalanx is dorsiflexed.
Callus at tip of second claw toe.
Pad beneath multiple claw toes to reduce pressure at tips.
Claw toe. Silicone cap on second toe and sleeve on third toe, with sleeve reversed to show silicone inside.
Claw toe. Extensor tendon exposure.
Claw toe. Z lengthening of extensor tendon.
Claw toe. Capsulotomy.
Claw toe. Collateral ligament release.
Claw toe. Repaired extensor tendon.
Claw toe. Make longitudinal incision across the plantar metatarsophalangeal joint.
Claw toe. Split tendon sheath to expose flexor tendons.
Claw toe. Isolate flexor digitorum longus tendon from flexor digitorum brevis, and place it under tension.
Claw toe. Cut flexor digitorum longus tendon just proximal to its attachment.
Claw toe. Pull flexor digitorum longus tendon loose from its attachment.
Claw toe. Separate 2 raphes of the flexor digitorum longus tendon.
Claw toe. Grasp each side (raphe) of flexor digitorum longus tendon with small hemostat.
Claw toe. Make dorsal incision to grasp flexor digitorum longus tendon.
Claw toe. Through dorsal incision, curve hemostat around proximal phalanx, avoiding neurovascular bundle, and grasp tip of same-side flexor digitorum longus tendon.
Claw toe. Repair each end of raphe to other raphe and split extensor tendon.
Final repair of claw toe.
Multiple repaired claw toes; Kirschner wires added for stability.
Claw toe. Elliptical outline of skin incision.
Claw toe. Redundant skin being excised.
Claw toe. Isolate distal portion of proximal phalanx.
Claw toe. Remove distal portion of proximal phalanx.
Claw toe. Feather edges of proximal phalanx to ensure no prominent edges.
Claw toe. Remove articular cartilage of middle phalanx.
Claw toe. Drill pin retrograde from middle phalanx out of tip of toe.
Claw toe. After pin has been drilled back into proximal phalanx and metatarsal head, repair skin and extensor tendon over proximal interphalangeal joint.
Claw toe. Bent pin at end of toe; proximal incision has been used for Z-lengthening of extensor tendon.
Claw toe. Dorsal approach to proximal interphalangeal joint and extensor tendon.
Claw toe. Z-lengthened extensor tendon with end of proximal phalanx exposed.
Claw toe. Remove distal portion of proximal phalanx.
Claw toe. Grasp end of proximal phalanx for removal.
Claw toe. Remove articular cartilage of middle phalanx.
Claw toe. Bone ends of proximal interphalangeal joint.
Claw toe. Place wire in middle of proximal phalanx.
Claw toe. Drill wire out of tip of toe, then back through proximal phalanx and metatarsal head.
Claw toe. Toe in straightened position, with dorsal incision used to expose dorsal metatarsophalangeal capsule for release.
Claw toe. Algorithm to determine appropriate surgical procedure and postoperative treatment.
Claw toe. Video shows flexor-to-extensor tendon transfer with extensor Z-lengthening tenotomy and dorsal capsular release in 54-year-old man with multiple claw toes following brain injury. Toe is pinned with 0.54-mm Kirschner wire just prior to transferring tendon dorsally (not shown in video). Remaining lesser toes, 2 and 4, underwent identical procedure after this video was made. In addition, fifth toe had flexor digitorum longus release with extensor tendon lengthening, and great toe underwent interphalangeal fusion with extensor hallucis longus Z-lengthening.

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Author

James K DeOrio, MD Professor of Orthopedics, Director, Duke Foot and Ankle Fellowship, Duke University Medical Center, Duke University School of Medicine; Associate Professor, Mayo Clinic College of Medicine; Clinical Assistant Professor, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Association of Graduates, United States Air Force Academy, Doctors Mayo Society, Mayo Clinic Alumni Association, Society of Air Force Clinical Surgeons, Society of Military Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Exactech; Treace Medical; Additive; Mirus; Crossroads Orthopedics<br/>Serve(d) as a speaker or a member of a speakers bureau for: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics<br/>Received income in an amount equal to or greater than $250 from: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.

Additional Contributors

John S Early, MD Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship, Baylor University Medical Center

John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Medical Association

Disclosure: Received honoraria from AO North America for speaking and teaching; Received consulting fee from Stryker for consulting; Received consulting fee from Biomet for consulting; Received grant/research funds from AO North America for fellowship funding; Received honoraria from MMI inc for speaking and teaching; Received consulting fee from Osteomed for consulting; Received ownership interest from MedHab Inc for management position.

Deformity	MTP Joint	PIP Joint	DIP Joint
Hammer toe	Dorsiflexed* or neutral	Plantarflexed	Neutral, hyperextended, or plantarflexed*
Claw toe	Dorsiflexed	Plantarflexed	Plantarflexed
Mallet toe	Neutral	Neutral	Plantarflexed
Curly toe	Neutral or plantarflexed	Plantarflexed (>5°)	Plantarflexed (>5°)
*Cannot coexist

Claw Toe Differential Diagnoses

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

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