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Hammer, Claw, and Mallet Toes

What are hammer, claw, and mallet toes?

Hammer, claw, and mallet toes are toes that do not have the right shape. They may look odd or may hurt, or both. The muscles that control your toes get out of balance and cause the toe to bend into an odd position at one or more joints. These toe problems almost always happen in the four smaller toes, not the big toe.

If you notice that your toe looks odd or hurts, talk to your doctor. You may be able fix your toe with home treatment. If you do not treat your toe right away, you are more likely to need surgery.

These toe problems develop over years and are common in adults. Women have more of these problems than men because of the types of shoes they may wear, such as high heels.

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 (contract). This makes it harder to straighten the toe. Over time, the toe muscles cannot straighten the toe, even if you are not wearing shoes.

Less common causes include:

• Problems in foot structure at birth. This may run in families.
• Joint diseases, such as rheumatoid arthritis.
• Brain, spinal cord, or nerve injury (especially in the case of claw toe). Examples include stroke, cerebral palsy, and degenerative disc disease.
• Not using your toe. Having to stay in bed for a long period of time may cause muscles to shorten (contractures). This may lead to toe problems.
• Poor blood flow to your feet (peripheral arterial disease).
• Having little or no "feeling" in your feet (peripheral neuropathy). This is common in people with diabetes.
• Injury, such as breaking a toe.

What are the symptoms?

Pain and a toe that looks odd are symptoms of hammer, claw, and mallet toes. The toe may rub against your footwear, and you may have trouble finding shoes that fit.

• A hammer toe is a toe that bends down toward the floor at the middle toe joint. It usually happens in the second toe. This causes the middle toe joint to rise up. Hammer toes often occur with bunions.
• Claw toe often happens in the four smaller toes at the same time. The toes bend up at the joints where the toes and the foot meet. They bend down at both 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 often happens in the second toe, but it may happen in the other toes as well. The toe bends down at the joint closest to the tip of the toe.

In more severe cases, these toe problems may affect your balance and make it hard to walk. You may get calluses or corns where a bent toe presses against your shoe.

How are hammer, claw, and mallet toes diagnosed?

Your doctor will diagnose your toe problem by looking at your toes and asking you questions about your symptoms. People rarely need tests. Your doctor may suggest an X-ray to look at the bone structure, especially if you are thinking about having surgery.

How are they treated?

You can treat hammer, claw, and mallet toes at home by wearing footwear with lots of room for your toes, using pads and supports in the shoe, and doing toe exercises. Doing these things will give the toe room to straighten, cushion the toe and hold it straight, and make the toe muscles stronger and more flexible. You can use over-the-counter medicine to treat pain.

If your pain is too great or you cannot easily do daily activities, then surgery is possible. But there is not much research on surgeries for these toe problems. Talk to your doctor about the types of surgeries and how much they may help you.

Surgery may not help how your foot looks, and your toe problem may also come back after surgery. This is more likely if you continue to wear the types of shoes that cause toe problems.

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