Tight and high heel shoes can weaken the muscles in the foot and lead to the imbalance that causes problems like claw toes, a common deformity of the forefoot that can leave toes curled down at the end joint making them resemble little claws.
In India, up to 20 per cent people are affected by claw toes. According to different studies, women in India are affected four to five times more than men. Prevalence of claw toes deformity gradually increases with advancing age and it is observed most often in patients in their seventh or eighth decade of life.
The general cause of this toe condition is a muscle imbalance that leaves muscles and tendons abnormally tight, which pulls the toe and causes these to curl. Ill-fitting shoes are the most frequent cause for the development of this problem. Although certain foot deformities, diabetes, and arthritis are also responsible in some cases. Shoes with high heels force all of the body’s weight onto the balls of the feet and toes and tight, pointed toe boxes that squeeze toes are just not great for the feet. These types of shoes can weaken the muscles in the foot and lead to the imbalance that causes a problem like claw toe. This condition gets worse over time and could become a permanent deformity.
According to Dr Raju Vaishya, senior orthopaedic surgeon, Indraprastha Apollo Hospitals, “Many foot-related problems can be avoided with shoes that are appropriate for an individual’s feet, body, and lifestyle. Over time, wearing high heels with a narrow toe box can cause the foot to take the shape of the shoe, causing claw and hammer toes, bunions, corns, and in some cases even knee and back pain. High-heeled shoes are responsible for putting significant pressure on the fat pad under the ball of the foot, forefoot. Hence, the higher the heel, the more pressure it creates on the ball of the foot and a higher likelihood for the injury. The ideal shoe should have a wide toe box and two-inch or lower heel. A platform under the toe box should be preferred if higher heels are the choice as it would decrease the overall stress on the foot.”
Claw toes are not only unsightly, but they can also cause significant discomfort and difficulty wearing shoes. They often start flexible but ultimately progress to rigid deformity, with minimal movement. “Rheumatoid Arthritis (RA) is another leading cause for claw toes, especially in women. Many people with RA develop bunions, callus 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” adds Dr Vaishya who is president of Indian Cartilage Society & Arthritis Care Foundation.
Claw toes can appear from birth, or the feet can become bent later on. 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.
Unrelieved pressure on the toes can cause complications. With time, a flexible toe deformity becomes a stiff claw toe, which is more challenging 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. It may lead to infection
According to Dr Vaishya, 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. 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 up to six to eight months to heal.