Hammer, Claw, and Mallet Toes

Topic Overview

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 bunions.
• 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 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 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. 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 toes may:

• Hurt.
• 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 have had.
• 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:

• An X-ray to help the doctor decide what type of surgery would be most helpful.
• Blood flow testing, which may include 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, 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 your feet. Moleskin and other over-the-counter treatments may help relieve pain. Never cut corns or calluses, because 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 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 permanently.
• 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 crumple it.
  • 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 cellulitis or osteomyelitis, especially if you have diabetes or 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. Doctors can often treat flexible toe problems by moving tendons to release tension on the joint and let the toe straighten. In some cases, the surgery for a flexible toe problem will still include work on the bones.

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 or moving 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.
• Your toe problem may come back after surgery. This is more likely if you keep wearing the types of shoes that cause toe problems.