Hammer, Claw & Mallet Toes

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Hammer, claw and mallet toes are toes that are bent into an odd position. They may look strange or hurt or both. These toe problems almost always happen in the four smaller toes, not the big toe.

• A hammer toe bends down toward the floor at the middle toe joint. This causes the middle toe joint to rise up. It usually affects the second toe. Hammer toes often occur with bunions (a bony bump that forms on the joint at the base of your big toe).
• Claw toe often affects the four smaller toes at the same time. The toes bend up at the joint where the toes and foot meet. They bend down at the middle joints and at the joints nearest the tip of the toes. This causes the toes to curl down toward the floor.
• A mallet toe bends down at the joint closest to the tip of the toe. It often affects the second toe, but it may happen in the other toes too.

If you notice that a toe looks odd or hurts, talk to your doctor. You may be able to fix the toe with home treatment. If you don’t treat the problem right away, you are more likely to need surgery.

Tight shoes are the most common cause of these toe problems. Wearing tight shoes can cause toe muscles to get out of balance. If a shoe forces a toe to stay in a bent position for too long, the muscles tighten and the tendons shorten, or contract. This makes it harder to straighten the toe. Over time, toe muscles can’t straighten the toe, even when not wearing shoes.

These toe problems develop over years and are common in adults. Women are affected more often than men.

Less often, these toe problems are linked with other conditions, such as diabetes, rheumatoid arthritis, stroke or an injury to the foot or ankle.

Besides appearing disfigured, hammer, claw and mallet toes may:

• Hurt
• Make it difficult to find shoes that fit
• Rub against footwear, potentially causing calluses or corns where the bent toe presses against another toe, the shoe or where the toe’s tip touches the ground
• In more severe cases, balance can be affected, making it hard to walk 

Your doctor will ask questions about your symptoms and past health and do a physical exam. Your doctor will want to know:

• When the problems started, what activities or shoes make them worse and if other parts of the foot are painful
• What kind of shoes you wear and how much time you spend standing or walking every day
• Any previous foot problems 
• Any medical conditions that could be related, such as arthritis, diabetes or poor circulation

During the physical exam, the doctor will look at the foot to see if the toe joint is fixed or flexible. A joint that has some movement can sometimes be straightened without surgery. A fixed joint often requires surgery.

If thinking about having surgery to correct the problem, you may need:

• An X-ray to help the doctor decide what type of surgery would be most effective
• Blood flow testing, which may include Doppler ultrasound, if the foot seems to have poor blood flow
• Nerve testing if the doctor thinks nerve problems exist in the foot; in that case, you may need to see a neurologist who specializes in brain, spine and nerve problems

It’s usually possible to treat the toe joint problem at home. If you start right away, you may be able to avoid surgery. There are a number of things that can be done:

• Change footwear. Choose shoes with roomy toe boxes, low heels and good arch supports. Sandals or athletic shoes that don’t rub on toes may be a good option. Or try custom-made shoes or shoes made for people with foot problems.
• Use products that cushion the toe or hold the foot in a more comfortable position, such as moleskin, toe tubes, arch supports or other shoe inserts (orthotics). These are better for treating a flexible toe, but they can also provide some relief for a fixed toe.
• Care for any calluses or corns on feet. Moleskin and other over-the-counter treatments may help relieve pain. Never cut corns or calluses, as this can lead to infection.
• Take an over-the-counter pain medicine, such as acetaminophen, ibuprofen or naproxen. Check with your doctor before taking these medicines. Be safe with medicines. Read and follow all instructions on the label.

If the toe joint is flexible, there are a number of options to try:

• Tape the hammer toe. Wrap tape under the big toe (or the toe next to the hammer toe), then over the hammer toe and then under the next toe. This gently forces the hammer toe into a normal position temporarily; it will not straighten the toe permanently.
• Try toe caps, slings or splints. These hold toes in a normal position, much like taping does.
• Exercises such as the ones listed below can help keep toe joints flexible and strong. Your doctor or physical therapist may also be able to suggest additional exercises.
  • Stretch the bent joints: Working one joint at a time, pull the toe in the opposite direction of the bend and hold for several seconds until you feel a slow, gentle pull; repeat several times, morning and night.
  • Towel curls: Put a towel flat under your feet and use your toes to crumple it.
  • Marble pickups: Use your toes to pick up marbles and drop them in a cup.

In general, surgery is recommended only for severe toe problems. Surgery may be required if other treatments don’t control the pain, if the toe limits activity or if you can’t move the toe joint.

For fixed toe problems, doctors often do surgery on the bones. Doctors can often treat flexible toe problems by moving tendons to release tension on the joint and let the toe straighten. In some cases, surgery for a flexible toe problem will still include work on the bones.

Surgical options may include one or more of the following:

• Removing part of the toe bone (phalangeal head resection, or arthroplasty)
• Removing part of the joint and letting the toe bones grow together (joint fusion, or arthrodesis)
• Cutting supporting tissues or moving tendons in the toe joint
• Getting a toe implant to replace a bent joint or straighten a toe
• Removing the toe (amputation), in rare cases

Surgery for these problems has not been widely studied and may not be for everyone. Talk to your doctor about the types of surgery and how much they might help.

When thinking about surgery, keep in mind:

• Surgery can reduce the pain from a deformed toe; it may not help how the foot looks.
• Surgery has risks, including pain, swelling and infection.
• Toe problems may come back after surgery, especially if still wearing the types of shoes that cause toe problems.