Hammer, Claw, and Mallet Toes
Hammer, Claw, and Mallet Toes
What are hammer, claw, and mallet toes?
Hammer, claw, and mallet toes are
toes that are bent
into an odd position. They may look strange or may 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
- Claw toe often affects the
four smaller toes at the same time. The toes bend up at the joint where the
toes and the 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
- 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 your toe looks odd or hurts, talk to your doctor. You may be able to fix
your toe with home treatment. If you don't treat the problem right away, you are
more likely to need surgery.
What causes hammer, claw, and mallet toes?
Tight shoes are the
most common cause of these toe problems. Wearing tight shoes can cause the toe
muscles to get out of balance. Two muscles work together to straighten and bend
the toes. 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, the toe muscles can't straighten the toe, even
when you aren't wearing shoes.
These toe problems form over years
and are common in adults. Women are affected more often than men because they are more likely to wear shoes with narrow toes or high heels.
Less often, these toe problems are linked with other conditions, such as diabetes, rheumatoid arthritis, stroke, or an injury to the foot or ankle.
What are the symptoms?
Besides looking odd, hammer, claw, and mallet
- Make it hard to find shoes that fit.
- Rub against your footwear. You may get
calluses or corns where a bent toe presses against
another toe or your shoe or where the toe's tip touches the ground.
In more severe cases, these toe
problems may affect your balance and make it hard to walk.
How are hammer, claw, and mallet toes diagnosed?
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 you
- Any medical conditions you have that could be related, such as arthritis, diabetes, or poor circulation.
During the physical exam, your doctor will look at your
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 you are thinking about having surgery to correct your
problem, you may need:
X-ray to help the doctor decide what type of surgery would be most helpful.
- Blood flow testing, which
Doppler ultrasound, if your foot seems to have poor blood flow.
- Nerve testing if your doctor thinks you have nerve problems
in your foot. If this is the case, you may need to see a neurologist, a doctor who specializes in brain, spine, and nerve problems.
How are they treated?
You can probably treat your toe joint problem at
home. If you start right away, you may be able to avoid surgery.
- Change your footwear. Choose shoes with roomy toe boxes, low heels, and good arch supports. Sandals or athletic shoes that don't rub on your toe may be a good option. You could also try custom-made shoes or shoes made for people who have foot problems.
- Use products that cushion the toe
or hold the foot in a more comfortable position, such as
moleskin, pads, arch supports, or other
shoe inserts (orthotics). These are better for
treating a flexible toe, but they can also provide some relief for a
- Care for any
calluses or corns on your feet.
Moleskin and other over-the-counter treatments may help
relieve pain. Never cut corns or calluses, because this can lead to
- Take an over-the-counter pain medicine, such as acetaminophen, ibuprofen, aspirin, or naproxen. Check with your doctor before
taking these medicines.
If your toe joint is flexible, you can also try:
- Taping a 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. But it doesn't straighten the toe
- Toe caps, slings, or splints. These hold toes in a
normal position, much like taping does.
- Exercises that help
keep the toe joints flexible and strong, such as the ones listed below. Your doctor or physical therapist may
be able to suggest more exercises.
- Gently pull on your toes to stretch the bent joints. For
example, if a joint bends up, gently stretch it down. Hold for several seconds. You should feel a long, slow, gentle pull. Work on one joint at
a time. Do this several times, morning and evening.
- Do towel curls . Put a
towel flat under your feet and use your toes to
- Do marble pickups . Use your toes to pick up marbles and drop them in a cup.
Call your doctor if your pain doesn't go
away or it gets worse after 2 to 3 weeks of home treatment, or if you get a sore
on your affected toe. Sores can get infected and lead to
osteomyelitis, especially if you have
peripheral arterial disease.
Will you need surgery?
In general, surgery is used only for severe toe problems. You may need surgery if other treatments don't control your pain, if your toe limits
activity, or if you can't move the toe joint. For fixed toe
problems, doctors often do surgery on the bones. For flexible toe problems, they move tendons. This can release tension
on the joint and let the toe straighten.
Your options may include one or more of the following:
- Removing part of the toe
bone. This is called phalangeal head resection, or arthroplasty.
- Removing part of the joint and letting the toe bones grow together. This is called joint fusion, or arthrodesis.
- Cutting supporting tissues
tendons in the toe joint.
- Getting a toe implant to replace a bent joint or straighten a toe.
- In rare cases, removing the toe (amputation).
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 you.
When thinking about surgery, keep in mind that:
- Surgery can reduce the pain from a deformed toe. But it may not help how your foot looks.
- Surgery has risks, including pain, swelling, and infection.
toe problem may come back after surgery. This is more likely if you
keep wearing the types of shoes that cause toe problems.
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Barry L. Scurran, DPM - Podiatry and Podiatric Surgery
January 4, 2013
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