Review Question - QID 213945

The clinical image in Figure A depicts a patient with claw toes. Claw toes are classically associated with neurological conditions. Claw toes involve the extension of the metatarsophalangeal (MTP) joint with flexion of the proximal (PIP) and distal (DIP) interphalangeal joints.

Claw toes are characterized by metatarsal-phalangeal (MTP) joint hyperextension with flexion of the proximal and distal interphalangeal joints. The MTP joint plantar plate eventually becomes attenuated resulting in dorsal migration of the proximal phalanx. The most common cause is synovitis. Other causes include trauma, delayed or missed compartment syndrome, cavus deformity, neurological conditions (i.e. Charcot-Marie Tooth, Friedrich's Ataxia, Myelodysplasia, Cerebral Palsy, Multiple Sclerosis, Stroke, or Diabetic neuropathy), or inflammatory arthropathy.

Mizel and Yodlowski reviewed pertinent forefoot anatomy. They discussed the pathophysiology of claw toes with dorsal subluxation of the proximal phalanx as a result of plantar plate attenuation, which leads to the cascade of intrinsic weakness (secondary to the change of loss of mechanical advantage) and extrinsic dominance causing the classic deformity (MTP extension and PIP and DIP flexion). Operative and non-operative management were discussed for claw toes. Also, discrete and diffuse plantar keratosis was discussed as well as Freiberg's Infraction and Cock-up fifth toe.

Shirzad et al. reviewed pertinent minor toe anatomy as well as the characteristic deformities of mallet toe, hammer toe, claw toe, curly toe, and MTP instability. In addition, they discussed non-surgical management and surgical management for both flexible and fixed deformities including their outcomes and complications.

Figure A is a clinical image demonstrating a claw deformity of the minor toes.

Incorrect Answers:
Answer 1: This describes curly toe.
Answer 2: This describes a mallet toe.
Answer 3: This describes a hammertoe.
Answer 4: This describes a cross-over toe.