Claw toes, where the tips of the toes claw down to the floor, cause the ball of the foot – the metatarsal heads to be driven down into the ground. This causes lots of pain in the ball of the foot with pinched tendons, and stress across the joints.
The cause is an imbalance between the two tendons that move the toes down. Their fancy names are Flexor Digitorum Longus and Flexor Digitorum Brevis, but they are simply described as the long one and the short one. The long one goes to the end of the toe and the short one to the first joint of the toe. The imbalance is when the long one becomes overactive and stronger than the short one and this claws the toes. The net effect is then to drive the metatarsal joint (ball of foot) downwards. If you do this for a long time then the tendons on the top of the foot become short and tight as do the joints.
Treatment is to mobilise the joints and the tendons and to re-educate and strengthen the tendons to resolve the imbalance. It takes time but it can be done.