Some asked me to share the responses:
Original Q: orthosis for the severe claw toes. (I was actually looking for orthotic treatment and not shoes)
I have made custom toe crest pads with pediplast in the past. generally it will mold to the pt and then I try to leave it high enough that I can slide a piece of paper under the toes. This usually unweights enough during ambulation. I would say that I had about 70% success with that. Pt compliance is always a big problem.
If the toes can be straightened, they a custom sulcus pad would be in order, if not, custom molded shoes.
1. Toe crest. Works for some
2. Met bar to ekevate metheads and sulcus trim. Then, nothing under the toes. Basically, elevate foot all the way to sulcus and leave void under the toes
3. Shoe with strong toe pitch sole.
Otherwise, nothing really works.
Often times the orthotic correction to this problem cannot be resolved with an orthosis. However, the resolution may lie in the shoes themselves. I cannot recall brand names,(I’m retired for a while now!) but perhaps Dr Comfort has a soft vamped shoe that accommodates to those elevated MP joints. I used that style of shoe on a variety of those patients with significant relief.
How about a soft silicone arch support or just a soft silicone insole
The patient may benefit from custom molded extra depth shoes with plastazote /Eva / PPT inner soles with whiteman base. May also use a met bar
I have had good luck with several patients with hammer toes and claw toes by putting a fixed crescent pad under the top cover of my insoles as long as they can work their toes over the pad as they go into them. I have left the pad off at the first (big) toe. It has stopped the walking on the toes and has helped enough to get the patients back to being able to do their daily routine.
Fully custom made footwear done by a scan or cast of the foot to make last
with enough space.
Insoles with holes for toe tips
Rocker shoes so that the toes don’t move out of these holes.
crest toe props (only if shoe uppers are deep enough)
I’ve never seen an effective orthosis. I’d accommodate with a super depth shoe and “shelf” insert and do manual stretching anytime the shoes are off.
Are there fixed contractures involving toes? Have you tried cast shoes/sandals which are cut off at metatarsals (or you could get a cheap pair of athletic shoes and cut them off like cast shoes mentioned previously. Lace up shoes to maintain on feet.
What we have done is – Rocker toe shoes to ease the pressure of toeing off. Some athletic type shoes now have a additional depth toe box and a mesh top. Some sandals might work. A custom accommodative insert made with a posterior toe crest to off load the tips of her toes should help. Rocker toe shoes and off load the tips of the toes with a custom insert and also get a shoe that doesn’t hurt the tops of the toes. That’s what we have done.
With inability to wear shoes, all may be difficult. Not a traditional orthotics solution but tell her to check our “yoga toes” for stretching. She can put them on and then stand on top of them, if tolerable. Likely may need tendon release and other pharmaceutical treatment of nerve pain.
I have done some reverse rocker shoes/sole mods to dorsiflex the ankle and orthotics shifting wt bearing to the hindfoot. Or you could try pediplast and customize toe crests to lift the toes.
Custom molded shoes.
I’ve added wheelchair type foam before cut into wedges for the patient to
place between two socks. The patient donned this before donning his AFO.
This has been the most successful in my experience.
A well lined and padded foot orthotic with a good metatarsal pad, and lots of padding, diabasheet 1/8/1/8. Also leave base material to the end of the toes, and once marks are made grind in pockets.
Claw toe straps may work, or a custom molded silicone toe crest they can put into their socks..
Orthoses for severe claw toes are primarily “high toe box” shoes or open-toe shoes. Today, there are good stretch upper footwear options. Met pads, toe crests, dispersions under points of high pressure, and change toe box to accommodate deformities are all viable options.
Double depth shoes, Stretchable leather,or neoprene. Dr. Comfort, Anodyne, and Pilgrim all have shoes to accommodate claw toes. The distal portion of the inserts can also be tapered, and shearban can be placed on top. If the patient doesn’t have diabetes, a toe-crest crest pad can be used. Custom toe crests pads can also be added into the insert after they are fabricated. I usually have the patient come back after they have worn the inserts for a week, or so. This way I can see where the foot settled on the insert, and precisely place the toe crest pads in the correct location.The shearban also allows the foot to slide past the toe crest while reducing friction. I also sometimes add an extra 70 durometer 2mm eva to the forefoot and excavate with a dremel where the distal plantar aspect of the dip’s are which reduces pressure.
Thank you all for your time!
