eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Claw Toe: Workup

Author: James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
Contributor Information and Disclosures

Updated: Feb 28, 2009

Workup

Laboratory Studies

  • Depending on the clinician's diagnostic considerations, the following laboratory tests may be appropriate:
    • Fasting glucose to rule out diabetes
    • Sedimentation rate to determine the possibility of an underlying infection
    • Rheumatoid factor

Imaging Studies

  • Radiographs are obtained to determine or exclude the following:
    • Arthritic changes from old fractures or inflammatory arthropathies
    • Increased MTP joint space from synovitis
    • Osteomyelitis at the tip of the toe from an abscess with a callus
    • Position of the toes

Other Tests

  • Vascular pressure measurements, including ankle-brachial indices and absolute toe pressures, are helpful for the following reasons:
    • To assess toe viability
    • To determine whether the toe might reasonably be expected to heal following surgery
  • Electromyography findings provide information regarding the origin of the claw toe deformity and whether the patient has a neuropathy.

More on Claw Toe

Overview: Claw Toe
Workup: Claw Toe
Treatment: Claw Toe
Follow-up: Claw Toe
Multimedia: Claw Toe
References
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References

  1. Coughlin MJ. Lesser toe abnormalities. In: Chapman M, ed. Operative Orthopaedics. Philadelphia, Pa: JB Lippincott; 1988:1765-76.

  2. Coughlin MJ. Lesser toe deformities. Orthopedics. Jan 1987;10(1):63-75. [Medline].

  3. Coughlin MJ, Mann RA. Lesser toe deformities. In: Mann RA, ed. Surgery of the Foot and Ankle. 7th ed. St. Louis, Mo: Mosby; 1999:320-91.

  4. Mann R, Coughlin M. Lesser toe deformities. In: Jahss M, ed. Disorders of the Foot and Ankle. Philadelphia, Pa: WB Saunders; 1991:1208-9.

  5. Barnicot NA, Hardy RH. The position of the hallux in West Africans. J Anat. Jul 1955;89(3):355-61. [Medline].

  6. Engle ET, Morton DJ. Notes on foot disorders among natives of the Belgian Congo. J Bone Joint Surg. 1931;13:311-9.

  7. James CS. Footprints and feet of natives of the Solomon Islands. Lancet. 1939;2:1390-3.

  8. Wells LH. The foot of the South African native. Am J Physiol Anthropol. 1931;15:185-289.

  9. Scheck M. Etiology of acquired hammertoe deformity. Clin Orthop. Mar-Apr 1977;(123):63-9. [Medline].

  10. Arnold H. [Lesser toe deformities. Definition, pathogenesis, and options for surgical correction]. Orthopade. Aug 2005;34(8):758-66. [Medline].

  11. Marx RM. Anatomy and pathophysiology of lesser toe deformities. In: Foot and Ankle Clinics. Philadelphia, Pa: WB Saunders; 1998:. 199.

  12. Sarrafian SK. Correction of fixed hammertoe deformity with resection of the head of the proximal phalanx and extensor tendon tenodesis. Foot Ankle Int. Jul 1995;16(7):449-51. [Medline].

  13. Sarrafian SK, Topouzian LK. Anatomy and physiology of the extensor apparatus of the toes. J Bone Joint Surg Am. Jun 1969;51(4):669-79. [Medline].

  14. Myerson MS, Shereff MJ. The pathological anatomy of claw and hammer toes. J Bone Joint Surg Am. Jan 1989;71(1):45-9. [Medline].

  15. Claisse PJ, Binning J, Potter J. Effect of orthotic therapy on claw toe loading: results of significance testing at pressure sensor units. J Am Podiatr Med Assoc. May-Jun 2004;94(3):246-54. [Medline].

  16. Coughlin MJ, Thompson FM. The high price of high-fashion footwear. In: American Academy of Orthopaedic Surgeons, eds. Instructional course lectures. Vol 44. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1995:371-7.

  17. Lutter LD. Sexy shoes or sorry feet. Foot Ankle Int. Jan 2004;25(1):1-2. [Medline].

  18. Taylor RG. The treatment of claw toes by multiple transfers of flexor into extensor tendons. J Bone Joint Surg. 1951;33B:539-542.

  19. Taylor RG. The treatment of claw toes by multiple transfers of flexor into extensor tendons. J Bone Joint Surg Br. Nov 1951;33-B(4):539-42. [Medline].

  20. Steensma MR, Jabara M, Anderson JG, Bohay DR. Flexor hallucis longus tendon transfer for hallux claw toe deformity and vertical instability of the metatarsophalangeal joint. Foot Ankle Int. Sep 2006;27(9):689-92. [Medline].

  21. Lui TH. Arthroscopic-assisted correction of claw toe or overriding toe deformity: plantar plate tenodesis. Arch Orthop Trauma Surg. Nov 2007;127(9):823-6. [Medline].

  22. Nakamura S. Temporary Kirschner wire fixation for a mallet toe of the hallux. J Orthop Sci. Mar 2007;12(2):190-2. [Medline].

  23. Pyper JB. The flexor-extensor transplant operation for claw toes. J Bone Joint Surg Br. Aug 1958;40-B(3):528-33. [Medline].

  24. Frank GR, Johnson WM. The extensor shift procedure in the correction of clawtoe deformities in children. South Med J. Aug 1966;59(8):889-96. [Medline].

  25. McCluskey WP, Lovell WW, Cummings RJ. The cavovarus foot deformity. Etiology and management. Clin Orthop. Oct 1989;(247):27-37. [Medline].

  26. Barbari SG, Brevig K. Correction of clawtoes by the Girdlestone-Taylor flexor-extensor transfer procedure. Foot Ankle. Sep-Oct 1984;5(2):67-73. [Medline].

  27. Cyphers SM, Feiwell E. Review of the Girdlestone-Taylor procedure for clawtoes in myelodysplasia. Foot Ankle. Apr 1988;8(5):229-33. [Medline].

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Further Reading

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Keywords

lesser toe deformity, hammertoe, hammer toe, curly toe, mallet toe, toe deformity, toe disorders, foot disorders, metatarsalgia, metatarsophalangeal joint flexibility, MTP joint flexibility, proximal interphalangeal joint flexibility, PIP joint flexibility, distal interphalangeal joint flexibility, DIP joint flexibility, PIP flexibility, DIP flexibility, MTP flexibility, toe calluses, toe erythema

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Contributor Information and Disclosures

Author

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Medical Editor

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, and Texas Medical Association
Disclosure: Zimmer Inc Consulting fee Consulting; Smith Nephew Consulting fee Consulting; AO North America Honoraria Speaking and teaching; Osteotech Consulting fee Consulting; Stryker Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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