ConditionBones, joints & muscles
Toe Deformities
Toe deformities are abnormal bends or shifts in the toes, most commonly hammer toe, claw toe, mallet toe and bunions. They usually develop slowly from tight or high-heeled shoes, muscle imbalance, inherited foot shape, arthritis or nerve problems such as diabetes. Early on, the toes are flexible and can be straightened by hand; over time they can become rigid, causing corns, calluses, pain and difficulty with shoes. Roomy footwear, pads, exercises and orthotics help most people, and surgery corrects painful, rigid deformities.
Also called: Lesser toe deformities, hammer toe, claw toe, mallet toe, crooked toes
At a glance
- Main types
- Hammer toe, claw toe, mallet toe, bunion (hallux valgus), bunionette, overlapping toes.
- Common causes
- Tight, narrow or high-heeled shoes, inherited foot shape, muscle imbalance, arthritis, nerve damage, injury.
- Symptoms
- Bent toes, corns and calluses, pain in shoes, pain under the ball of the foot.
- Diagnosis
- Examination; x-rays to assess joints and plan surgery.
- Treatment
- Wide, deep shoes, pads, splints, toe exercises, orthotics; surgery for painful rigid deformities.
When to get help
See a doctor within a day or two
- An open sore, blister or ulcer on a toe, especially with diabetes or poor circulation
- A red, hot, swollen toe or foot with pus or fever
- A toe that turns pale, blue or black
Book a routine appointment
- Toes that are bending and becoming painful in shoes
- Painful corns or calluses on the tops or tips of toes
- Several toes curling at once, or toe deformities with numbness or weakness in the feet (possible nerve condition)
- A bunion that is growing or making shoes painful
Usually safe to manage at home
- Mildly bent, flexible toes without pain, managed with roomy shoes and stretching
Types of toe deformity
| Deformity | Joint affected | Appearance | Common causes |
|---|---|---|---|
| Hammer toe | Middle joint bends down | Toe bends upward then down, like a hammer; often the second toe | Tight shoes, a long second toe, bunion |
| Claw toe | Base joint bends up, middle and end joints bend down | Toe curls like a claw; often several toes | Nerve damage (diabetes, Charcot-Marie-Tooth), arthritis, high arches |
| Mallet toe | End joint bends down | Tip of the toe points down | Tight shoes, a long toe |
| Bunion (hallux valgus) | Big toe base joint | Big toe angles toward the second toe, bony bump at the inside of the foot | Inherited foot shape, narrow shoes |
| Bunionette (tailor's bunion) | Little toe base | Bump at the outside of the foot | Foot structure, tight shoes |
| Overlapping or underlapping toes | Various | Toes cross over or under neighbors | Inherited, bunions |
Causes and risk factors
- footwear: narrow toe boxes and high heels push toes into bent positions
- inherited foot shape: long second toe, flat feet, high arches
- muscle and tendon imbalance: the muscles that bend and straighten the toes pull unevenly
- arthritis: rheumatoid arthritis and osteoarthritis
- nerve conditions: diabetes, stroke, Charcot-Marie-Tooth disease and other neuropathies (often cause claw toes)
- injury: stubbing or breaking a toe
- age and female sex: more common, partly due to footwear
Symptoms
- bent or curled toes
- corns on top of the bent joints or at the tips of toes
- calluses on the ball of the foot (metatarsalgia)
- pain or rubbing in shoes
- redness, swelling or a burning sensation
- difficulty finding comfortable shoes
- stiffness and reduced toe movement as deformities become rigid
Flexible vs rigid deformities
- Flexible: the toe can be straightened by hand; usually earlier stage; responds well to non-surgical care.
- Rigid: the toe is fixed in a bent position; more likely to need surgery.
Diagnosis
A doctor or podiatrist examines the feet standing and sitting, checks flexibility, circulation, sensation and footwear, and looks for corns and calluses. X-rays show the joints and degree of deformity. Nerve tests may be done if a neurological cause is suspected.
Treatment
Footwear and padding
- shoes with a wide, deep toe box and low heels (under 5 cm or 2 inches)
- adjust shoe lacing to reduce pressure
- non-medicated corn pads, gel toe sleeves and cushions
- toe separators or crest pads under bent toes
- avoid medicated corn removers, which can cause skin injury, especially with diabetes
Exercises
- picking up marbles or a towel with your toes
- stretching toes by hand
- toe spreading and curling exercises
Orthotics and splints
- custom or off-the-shelf insoles to redistribute pressure
- splints or taping for flexible deformities
Corns and calluses
A podiatrist can safely pare thickened skin. Do not cut corns yourself, particularly if you have diabetes or poor circulation.
Surgery
Considered when pain persists despite these measures, or for rigid deformities:
- tendon release or transfer for flexible deformities
- joint resection or fusion (arthroplasty or arthrodesis) for rigid hammer or mallet toes
- bunion surgery (osteotomy) to realign the big toe
Recovery usually involves a special shoe for several weeks; swelling can last for months.
Prevention
- choose shoes with room for your toes and avoid high heels for long periods
- have feet measured, as size changes with age
- stretch and strengthen toes
- check feet regularly if you have diabetes
Frequently asked questions
What is the difference between hammer toe, claw toe and mallet toe?
Hammer toe bends down at the middle joint. Claw toe bends up at the base and down at the middle and end joints, curling like a claw. Mallet toe bends down only at the end joint, so the tip points down.
What causes toe deformities?
Common causes are tight, narrow or high-heeled shoes, inherited foot shape, muscle imbalance, arthritis and nerve damage from conditions like diabetes. Injury to a toe can also lead to deformity.
Can hammer toes be fixed without surgery?
Flexible hammer toes often improve with roomy shoes, pads, toe exercises, splints and orthotics. These measures relieve pain but may not fully straighten the toe. Rigid, painful hammer toes usually need surgery to correct.
When should I see a doctor about a toe deformity?
See a doctor or podiatrist if your toes are painful, the deformity is getting worse, you have corns or calluses that hurt, or you have diabetes or poor circulation. Seek urgent care for sores, infection or color changes in a toe.
What shoes are best for toe deformities?
Choose shoes with a wide, deep toe box, low heels, soft uppers and good cushioning. Avoid pointed toes and high heels. Stretchable or extra-depth shoes and custom insoles can also help.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Hammer toe; Claw toe
- American College of Foot and Ankle Surgeons: Hammertoes
- American Podiatric Medical Association: Hammertoes; Bunions
- NHS: Hammer toes, claw toes and mallet toes
- MedlinePlus: Hammer toe