• Fixed flexion deformity of the lesser toes (claw toes are not fixed, and can be passively straightened)
  • Muscle imbalance in the foot causes the lesser toes of the foot become bent at the first interphalangeal joint.
  • It can result in bursitis, or hyperkeratosis over the joints or at the tip of the toe.
  • Commonly associated with poor biomechanics and hallux valgus.
  • Trauma (direct injury or overuse from walking or sport) is a predisposing factor.
  • Diabetes, rheumatoid arthritis, and neuromuscular conditions are risk factors. (motor neuropathy)
  • Common in women who wear tighter, narrower shoes with increased heel height.

Diagnostic tips

  1. Prominent fixed toe deformity, often with arthritis.
  2. Corn / Callous.
  3. Difficulty in shoes with deformity of the shoe upper.
  4. Difficulty in walking.

Tests and Imaging

  1. Clinical examination and detailed history.
  2.  X-rays often not required but can help to evaluate the extent of deformity and degree of arthritis within the joint.

Immediate Treatment

  1. Advise appropriate footwear.
  2. Analgesia for arthritic pain.

Possible Referral

  1. Podiatry for footwear advice/modification, splinting, protection, management of hyperkeratosis.
  2. Orthopaedic foot surgeon for possible tendon transfer, digital arthroplasty, digital arthrodesis.