Bird like toes may be a symptom of an underlying disorder

Dr Pradeep Moonot, Orthopaedic Surgeon & Podiatrist, Nanavati Hospital, Mumbai.

Ananya, with the increasing age, noticed her toes bending like an inverted V. She thought it to be normal with age as there was no pain. Though it was very difficult to walk and she felt very uncomfortable. She made a visit to Dr Pradeep Moonot’s clinic to verify if something was serious. After conducting several tests, the doctor told that she is suffering from claw toe which is a result of rheumatoid arthritis and corns were observed in the toe. With passing time, corns eventually lose their ability to protect the toe and breakdown, forming skin ulcers. This may lead to infection. The corns that became too large were shaved off and exercises were provided to her in addition to specially designed shoes to relieve the pressure.
What is a Claw toe?
Claw foot is a condition in which your toes bend into a claw-like position. Claw foot can appear from birth, or your feet can become bent later on. It’s usually not a serious problem on its own, but it can be uncomfortable. It can also be a sign of an underlying medical condition, such as cerebral palsy or diabetes. Some contracted toes are due to muscle weakness, arthritis or congenital problems but most are due to tight shoes.
Claw toes are classified based on the mobility of the toe joints. There are two types - flexible and rigid. In a flexible claw toe, the joint has the ability to move. This type of claw toe can be straightened manually. A rigid claw toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.
A corn is the thickened skin that forms where the shoe rubs on the toe. A hard corn forms where the skin is dry and a soft corn forms when it is moist, as between the toes. Beneath every corn there is a prominence of the bone. Pressure and friction from the shoe causes the skin to thicken at this point. Corns in the foot are like calluses in the hand – the skin thickens to resist pressure or friction.
Unrelieved pressure on the toes can cause complications. With time, a flexible toe deformity becomes a stiff claw toe, which is more difficult to treat. The second toe may cross over the first and eventually dislocation may occur at the base of the second toe. Corns may eventually lose their ability to protect the toe and breakdown, forming skin ulcers. This may lead to infection.
Statistics in India
Prevalence of claw toes deformity gradually increases with advancing age and upto 20% of the Indians are affected. This is observed most often in patients in their 7th or 8th decade of life. Shoes with high heels and narrow pointed toe boxes bunch up the toes, causing contracted joints and pressure areas in the skin. According to Indian Statistical survey women in India are affected four to five times more than men. And no such data is available regarding these deformities in non-shoe-wearing populations.
Rheumatoid Arthritis (RA) is one of the leading causes for claw toe in India especially in women. Many people with RA develop bunions, calluses, or claw toes. The sheer number of problems from the ankle to the toes causes pain throughout the foot. Over time, a person with RA may be inclined to avoid standing or walking.
Identifying claw toes
If you observe your toe joints adjoining the ankle point up while the other joints bend down, which makes your toes look like claws.
In some cases, claw foot doesn’t cause any pain. In other cases, your toes might hurt, and you might develop corns or calluses or ulcers on parts that rub against your shoes.
Claw toes are sometimes mistakenly referred to as “hammer toes,” but they’re not the same thing. While the two conditions share many similarities, they’re caused by different muscles in your foot.

What leads the toes to become claws
There may be several reasons and conditions to develop claw foot. Ankle surgery or injuries may be one of the reasons. Nerve damage weakens the foot muscles and leads to imbalances that force the toes to bend awkwardly. Inflammation can also cause your toes to bend into a claw-like position. Few disorders may also result in claw toes:-

1. Rheumatoid Arthritis – the lining of the joints become inflamed as this autoimmune disorder causes the immune system to attack the healthy tissues in the joints leading to joint deformities like claw toes.
2. Cerebral Palsy – This may be a congenital condition, due to abnormal brain development the muscle tone gets affected resulting in either too loose or stiff muscles.
3. Diabetes – Diabetes can cause nerve damage in the feet which may lead to such deformities.
4. Stroke - This condition occurs when blood stops flowing to an area of your brain due to a blood clot or weak blood vessels. Strokes can cause serious nerve damage and affect your muscles, including muscles in your feet.

Consult a Doctor if..
Immediately consult a Knee, foot and ankle specialist if your toes show signs of becoming clawed. It may be flexible at first but can permanently become struck in a claw like position over time. Early diagnosis and treatment may prevent serious complications and improve your quality of life. Doctor will also ensure other underlying disorders such as diabetes and RA.
Is Surgery the only way to treat?
A combination of medical intervention, physiotherapy and home care can be recommended to treat claw toes, depending upon the severity and rigidity of the deformity.
If the toes are flexible, they are more vulnerable to certain home care exercises to maintain the flexibility and alleviate the symptoms. The exercises may include moving toes towards their natural position using hands or picking up objects with the help of toes.
Specially designed shoes can also ease off the pressure while avoiding others as tight shoes or high heels will only make the toes more rigid. Wearing shoes with plenty of room can help alleviate discomfort. The design will be in such a manner that the toe can be accommodated in the extra depth area, and a special pad to help ease off the pressure from the ball of the foot.
Surgery is opted only in rare cases, when this deformity is unnoticed and in extreme condition with rigid toes. The bone at the base of the toe is shortened, so that more room is available to straighten out. After surgery, the toes may take upto six to eight months to heal.