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Hammer, claw, and mallet toes

Hammer, claw, and mallet toes are deformities. The muscles that control toe movement go out of balance, causing the toe to bend into an odd position at one or more joints.

• A hammer toe occurs when the longest toe (usually the second toe, next to the big toe) bends down toward the floor at the middle toe joint. The toe may bend up at the joint where the toe and foot meet, causing the middle toe joint to be raised slightly.
• Claw toe often affects all toes (except the big toe) at the same time, causing them to bend downward at the middle joints and at the joints nearest the tip, so that the toes curl down toward the floor. The toes bend up at the joints where the toes and the foot meet.
• A mallet toe often affects the second toe, but it may affect the other toes as well. The toe bends down at the joint closest to the tip.

These conditions can be painful and uncomfortable, especially while a person walks, as the toe presses and rubs against the shoe. These conditions almost always affect the lesser toes (those other than the big toe), and each condition involves a different toe joint or combination of toe joints.

The conditions are most often caused by tight, poorly fitting shoes, often in combination with a muscle imbalance. Several muscles work together to straighten and bend the toes. If a shoe forces a toe to stay in a bent position for long periods of time, the muscles tighten and the tendons shorten (contract). This makes it more difficult to straighten the toe. Eventually, the toe muscles cannot straighten the toe.

Home treatment, including properly fitting footwear, cushions, shoe inserts, toe splints, toe stretches, and pain relievers, is often all that is needed to relieve the discomfort. Hammer toes and mallet toes require surgery only when nonsurgical treatment fails. Claw toe is more likely to require surgery, but nonsurgical treatment can be effective. Surgery may not completely return the toes to their normal positions, and toe joint problems may come back after the surgery.

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