Therapy of the claw toes

introduction

The treatment of claw toes can generally be done in two different ways. A distinction must be made between conservative and surgical therapy. Conservative therapy encompasses all options for treating the disease without surgical intervention. However, there is no cure, only an improvement in the symptoms. The claw toes can be healed through surgical measures.

Conservative therapy

Conservative therapy refers to non-surgical therapy. By using insoles that are placed in the shoes, an attempt can be made to counteract the misalignment of the toes and the shortening of the tendon. So-called night splints or rein bandages go even further, which are supposed to improve tendon shortening through regular use. Toe gymnastics can also help improve the mobility of the toes and the associated muscles. In addition to the conservative therapeutic measures aimed at healing the claw toes, there are also methods that can be used to improve the unpleasant symptoms that are usually associated with claw toes. So-called corns (medical: clavus) often develop due to the deformed feet, which can be improved through targeted foot care and relief measures for the shoes. However, experience has shown that conservative therapy for claw toes quickly reaches its limits. As a rule, it is not possible to achieve a strong improvement in the symptoms or the underlying cause simply by carrying out conservative treatment once the disease has passed a certain initial stage.

These splints can help

Under certain circumstances, claw toes can be treated with a splint. As with all other non-surgical procedures, however, only further progression of the malalignment can be counteracted. Claw toes that have already existed cannot be remedied by wearing a splint. There are different forms of splints that are often intended to be worn at night. Regular use should counteract a further shortening of the vision, which is essentially responsible for the development of claw toes. Since a bunion (hallux valgus) is often present at the same time, the use of a suitable splint can also be useful, as this also has a positive effect on the further development of claw toes. There is the possibility of equipping these so-called Hallufix splints with a loop for the remaining toes. If necessary, the need for an operation can be prevented or at least delayed in this way. Whether or not it makes sense to use a splint when treating the claw toes can be discussed with your family doctor or orthopedic surgeon, for example. There are different rails, for example, in medical supply stores or in drugstores.

insoles

In addition to bandages or tapes, insoles can also be used for the non-surgical treatment of claw toes. Custom-made insoles for the shoes are best. These contain a so-called perlotte. This is a padded elevation that relieves and supports the toes. The best thing to do is to seek advice from a medical supply store about insoles for treating claw toes and possible alternatives. A custom-made product can be made there with the help of a footprint. It is not recommended to use insoles that are not individually made, as a good support function is not guaranteed and additional pressure points can occur. In general, the use of insoles with claw toes can only be expected to relieve symptoms such as pain. A regression of the malformation cannot be achieved in this way.

Taping

In the non-surgical treatment of clawed toes, taping with so-called rein bandages is an option. The adhesive strips are applied under tension from the back of the foot to the tip of the toe. The best thing to do is to have a trained person show you the correct taping method or to do it straight away. This is intended to counteract any further shortening of the tendons and thus the worsening of the toe misalignment. This can reduce pain due to claw toes. However, if taping and other non-operative measures do not provide sufficient relief from the symptoms, the last resort is often only a surgical intervention to correct the claw toes.

Can exercises or gymnastics help?

Exercise and gymnastics can help both prevent and prevent the deterioration of claw toes. The simplest and least hassle-free option is to frequently run barefoot. This is the best way to strengthen the foot muscles and thus maintain the natural shape of the feet and toes. An exception is made for people who suffer from diabetes (“diabetes”) and who already have damage to the nerves in the foot (diabetic foot). Frequent barefoot walking in such cases can lead to minor injuries that are overlooked. Special toe exercises can also counteract the development or deterioration of clawed toes by improving the function of muscles and tendons. For example, you can try to grab a marble or a towel with your toes, hold it for a while, stop it, and then grab it again. It can also be helpful to passively loosen your toes with your hands on a regular basis and carefully bring them into their natural position. However, this must not be done against resistance so as not to cause injuries. Exercises and gymnastics as well as walking barefoot should be performed with clawed toes if possible. However, once existing malpositions cannot be remedied. If necessary, symptoms such as pain can be alleviated to such an extent that an operation is not necessary.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Operative therapy

The aim of the operation of the claw toe is to correct the misalignment and the stiffening, as well as the relief of the passive tendon tension by shortening the bone length. This involves removing part of the toe bone. The Hohmann operation is most often used. It usually consists of a resection (distance) of the upward protruding head of the base toe at the point where the corn sits.

Care must be taken that the toe is shortened enough so that no recurrence (recurrence of the deformity) develops. In the follow-up treatment, care should be taken to ensure that the straight position of the toe is fixed for 2 weeks either with a wire or a plaster bandage. After 2 weeks, the foot can be fully loaded again.

The most frequently performed surgical techniques at the moment are:

• Tendon displacement
• Resection arthroplasty according to Hohmann
• Joint-preserving displacement osteotomy according to Weil

For information about claw toe surgery, we recommend our website: Claw toe surgery

Tendon displacement

If the deformity is mild, it may be sufficient to move the shortened tendon on the sole side to the back of the toe. This eliminates the flexion in the middle and end joints.

Further information on this topic can be found at: Claw toe surgery

Resection arthroplasty according to Hohmann

The resection arthroplasty according to Hohmann requires the removal of the joint head of the metatarsophalangeal joint. Depending on how severe the disease is, the capsule surrounding the joint must also be removed. Then the tendon, which is responsible for the appearance of the claw toes due to the shortening, can be stretched. After the operation, the operated structures must be fixed. This can be done either with the help of a special plaster bandage or by inserting a wire. It is possible to put weight on the foot immediately after the operation. The inserted fixation wire can be removed after complete healing.

Read more on this topic at: Claw toe surgery

Joint-preserving displacement osteotomy according to Weil

If there are dislocations in the area of ​​the metatarsophalangeal joints, a shortening displacement osteotomy of the metatarsal bones can be used to correct the position. In addition, the extensor tendon is lengthened and the capsule is removed. The stabilization is done with mini screws, which usually do not have to be removed.

Further information on this topic can be found at: Claw toe surgery