Hammertoes, mallet toes and claw toes

What happens

The small muscles and tendons that balance each toe fall out of balance, and the toe buckles. At first the joint is flexible: you can straighten the toe with your fingers. Over time it can become rigid. Shoes that crowd the toes, injury, inherited foot shape, a bunion pushing on the second toe, inflammatory arthritis, and nerve conditions such as diabetic neuropathy all contribute.^[3,1]

Why it matters

Beyond the pain of a corn on top of the toe, a rigid, clawed toe can push the ball of the foot down, causing pain there, and in people with diabetes or poor circulation a pressure point on a toe can break down into a wound.^[2] See diabetic foot care.

How we evaluate it

We check whether each joint is flexible or rigid, look for a bunion or a problem at the joint at the base of the toe, and examine corns, calluses and the ball of the foot. X-rays at the practice show the joints and any arthritis.^[1,2]

Treatment at the practice

• Shoes with a deep, roomy toe box and a low heel.^[1]
• Pads, cushions, toe sleeves and straps that take pressure off the top or tip of the toe.^[1]
• Splints or taping for a toe that is still flexible.
• Toe exercises, such as picking up a towel or marbles with the toes.^[1]
• Careful trimming of corns and calluses in the office, which people with diabetes should never do themselves.
• Orthotics when the ball of the foot is overloaded. See custom orthotics.

Our article hammertoes: why toes curl has more on prevention.

Common questions

Can a hammertoe be straightened without surgery?

A flexible hammertoe can be held straighter with splints or taping and kept comfortable with roomy shoes and pads, but these don’t permanently change the shape of the toe. A rigid hammertoe can only be straightened with surgery.^[1]

Will it get worse?

Often, over years: a toe that starts out flexible can become rigid.^[3,1] Treating it while it is still flexible gives the most options, which is why it is worth having a bending toe checked early.

My second toe is drifting and the ball of my foot hurts. Is that a hammertoe?

It may be a tear of the plantar plate, the strong ligament under the joint at the base of the toe. Plantar plate injuries are common but easily missed, because they feel like other causes of forefoot pain; examination and imaging help tell them apart.^[4] Our Center for Lower Extremity Surgery has a guide to plantar plate tears (external site).

When surgery is considered

If the joint has become rigid, or non-surgical care doesn’t relieve pain, surgery may be considered. The right operation depends on which joints are involved and whether the toe can still be straightened by hand: releasing or lengthening a tendon for a flexible toe, or removing a small piece of bone or fusing the joint for a rigid one.^[1,3,2]

When to seek care