Hammer Toe & Claw Toe

Overview

what it is and why it matters

Hammer toe, claw toe, and mallet toe are all variations of toe deformities where one or more joints in a smaller toe gets stuck in a bent position. Hammer toe is the most common: the toe bends down at its middle joint, like a hammer. Claw toe involves both the middle and end joints curling under, often from a muscle imbalance tied to a neurologic condition or a high-arched foot. Mallet toe is just the end joint that bends down. Each deformity can be flexible (you can still straighten it manually) or rigid (it is stuck). That distinction guides the treatment.

The second toe is most often affected. Long-standing deformities lead to painful corns on top of the bent joint (where the toe rubs the shoe) and calluses on the bottom of the foot under the base of the toe.

Symptoms

what you may notice

The bent toe rubs on the top of your shoe, forming a painful corn right over the prominent middle joint. You may also feel a burning ache under the ball of your foot (the base of the bent toe) from altered weight distribution. The second toe is the one most often affected, especially when a bunion pushes the big toe over and crowds it.

Early on the toe is still flexible: you can straighten it with your hand, even though it curls on its own when relaxed. Over time the tendons and joint capsule tighten and the deformity becomes rigid, the toe locked in a bent position. Once rigid, the corn and callus tend to worsen because the toe can no longer flatten inside the shoe.

Diagnosis

exam first, imaging second

The exam assesses how flexible the deformity is (can your surgeon manually straighten the bent joints?) and checks the nerves and circulation of the toe. Standing X-rays show the bony alignment. Your surgeon will also look at the big toe and first foot bone, since bunions and big-toe arthritis often coexist with smaller-toe deformities.

How We Treat It

what we try first, in order

Most hammer toes and claw toes respond to simple changes in footwear and padding, and the goal of non-operative care is to take pressure off the bent joint so the corn and callus settle down. The steps below are listed in the order we usually introduce them, each one added on top of the ones before. Stretching only helps while the toe is still flexible; once it becomes rigid, the focus shifts to relieving pressure rather than straightening the toe.

Toe-Stretching Exercises

Daily passive stretching of the toe, only useful while the deformity is still flexible.

Wider Footwear

Shoes with a wider, deeper toe box reduce pressure on the bent joint, the most useful change for daily comfort.

Toe Pad or Sleeve

A small gel or fabric pad worn over the prominent joint cushions it from rubbing inside the shoe.

Metatarsal Pad
A small pad placed just behind the ball of the foot offloads the bone behind the bent toe and eases the burning ache many patients feel there.

Surgical Options

if non-operative care isn't enough

Surgery is offered for painful rigid deformities, or for flexible deformities that haven't been comfortable in the right footwear and padding. The procedure releases tight tendons, removes any prominent bone, and either pins the toe straight or fuses the joint depending on severity.

Frequently Asked

questions we hear in clinic

What is the difference between hammer toe, claw toe, and mallet toe?

They are variations of the same kind of toe deformity, named for which joints are bent. In a hammer toe, the toe bends down at its middle joint, like a hammer; it is the most common. A claw toe involves both the middle and end joints curling under, often from a muscle imbalance tied to a neurologic condition or a high-arched foot. A mallet toe is just the end joint bending down.

Do I need surgery?

Usually not. Most hammer toes and claw toes respond to wider, deeper footwear and padding that take pressure off the bent joint. Surgery is offered for painful rigid deformities, or for flexible deformities that have not been comfortable in the right footwear and padding.

Will stretching straighten my toe?

Daily passive stretching of the toe is only useful while the deformity is still flexible, meaning you can still straighten it with your hand. Over time the tendons and joint capsule tighten and the toe becomes rigid, locked in a bent position. Once rigid, the focus shifts to relieving pressure rather than straightening the toe.

Why does it hurt under the ball of my foot?

The bent toe changes how weight is distributed across the foot, which can cause a burning ache under the ball of the foot at the base of the bent toe. A small metatarsal pad placed just behind the ball of the foot offloads the bone behind the bent toe and eases that ache.

Which toe is usually affected?

The second toe is most often affected, especially when a bunion pushes the big toe over and crowds it. Bunions and big-toe arthritis often coexist with smaller-toe deformities, which is why the exam also looks at the big toe and first foot bone.