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Claw Toes: An Early Sign of Lumbar Diskogenic Disease

Gerald E. Rubacky, MD
JAMA. 1970;214(2):375. doi:10.1001/jama.1970.03180020093028.
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To the Editor.—  After a recent review of a large number (over 300) of preoperative and postoperative patients with lumbar disk disease or claw toes, or both, I feel I have excellent clinical evidence to support my thesis that lumbar diskogenic disease is now the most common cause of clawing of the toes. For reasons of simplicity and clarity, I make no clinical distinction between claw toes and hammer toes. I do, however, differentiate between functional and true claw toes, the former being apparent but with no fixed deformity.More than 75% of our patients with claw toes had lumbar disk disease as proved by myelogram or surgery. Moreover, there was an 83% side correlation, that is, the foot exhibiting the most severe clawing of the toes was on the same side as the most severe sciatica.Clawing of the toes is due to weakness or atrophy of the lumbricales,


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