Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is Claw Toe?

A claw toe is a lesser toe deformity characterized by extension at the metatarsophalangeal (MTP) joint — the knuckle at the base of the toe — combined with flexion at both the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. This combination of hyperextension at the base and double-flexion at the middle and tip creates the claw-like appearance that gives the condition its name. Unlike hammertoe (which affects only the PIP joint) or mallet toe (which affects only the DIP joint), claw toe involves deformity at all three toe joints simultaneously.

Why Claw Toes Develop

Claw toe deformity results from an imbalance between the intrinsic foot muscles (the small muscles within the foot that stabilize the MTP joints) and the extrinsic muscles (the long flexor and extensor tendons from the leg). When intrinsic muscles weaken — from peripheral neuropathy, Charcot-Marie-Tooth disease, compartment syndrome, or long-standing flatfoot — the extrinsic flexors and extensors act without appropriate counterbalance, creating the characteristic deformity. Tight footwear that compresses toes into flexion can also drive claw toe development or progression. Unlike simple hammertoes, claw toes are more commonly associated with underlying neurological or systemic conditions.

Flexible vs. Rigid Claw Toes

Early claw toe deformity is flexible — the toe can be manually straightened to a neutral position. At this stage, conservative care and relatively minor surgical procedures are most effective. As the deformity progresses, the soft tissues and joint capsules contract around the deformed position, creating a rigid deformity that cannot be manually corrected. Rigid claw toes require more extensive surgical correction including joint release and often bony procedures to achieve a lasting straight position.

Conservative Management

Wider footwear with a high toe box reduces pressure on the dorsal PIP and DIP joints, where painful corns (hyperkeratosis) develop from shoe contact. Toe-straightening splints and taping can slow progression in flexible deformities. Metatarsal pads address the plantar forefoot pain from elevated metatarsal heads — a common consequence of MTP dorsiflexion. Intrinsic foot muscle strengthening (toe curls, marble pickups, short-foot exercises) addresses the muscle imbalance contributing to deformity in patients with sufficient muscle function remaining.

Surgical Correction

Surgical correction of flexible claw toes involves flexor-to-extensor tendon transfer — the flexor digitorum longus tendon is detached from its distal insertion and sutured to the dorsal extensor hood of the toe. This converts the previously deforming flexor force into a correcting extension force, straightening the MTP and PIP joints simultaneously. The procedure is elegant and effective for flexible claw toes and is typically combined with MTP release if that joint is also contracted.

Rigid claw toes require resection arthroplasty or arthrodesis of the PIP joint to achieve a straight toe that remains straight without tendon tethering. PIP resection arthroplasty — removing the joint and allowing fibrous healing in a straightened position — is the most common procedure, with a pin holding the toe straight for 3 to 4 weeks post-operatively. PIP fusion provides a more permanent correction but creates a stiff joint. MTP release and extensor lengthening are combined with the joint procedure as needed.

Recovery and Outcomes

Most lesser toe procedures are performed as outpatient surgery with immediate weight bearing in a surgical shoe. The pin used to hold the toe in position during healing is removed in-office at 3 to 4 weeks. Swelling may persist for 3 to 6 months. Overall satisfaction with claw toe surgery is high when appropriate expectations are set — toes may not look perfectly normal after surgery, but pain relief and ability to wear regular shoes are reliably achieved.

If claw toe deformity is causing painful corns, difficulty with footwear, or pressure ulceration, contact Balance Foot & Ankle for evaluation and surgical consultation.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Claw Toe Correction at Balance Foot & Ankle

Claw toe deformity causes painful curling of the toes and difficulty wearing shoes. Dr. Tom Biernacki performs minimally invasive and traditional claw toe correction surgery at Balance Foot & Ankle in Howell and Bloomfield Hills.

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Clinical References

1. Coughlin MJ. “Lesser toe deformities.” Orthopedics. 1987;10(1):63-75.
2. Dhukaram V, et al. “A comparison of correction obtained with minimally invasive and open procedures in the treatment of lesser toe deformities.” Foot Ankle Int. 2012;33(2):150-157.
3. Myerson MS, Shereff MJ. “The pathological anatomy of claw and hammer toes.” J Bone Joint Surg Am. 1989;71(1):45-49.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.