Claw, Hammer, and Mallet Toes

Claw, mallet and hammer toes are painful deformities of the joints that cause the toes to bend into odd positions. These conditions, which typically affect only the four smaller toes, can result in muscle imbalances that make it difficult to walk.

hammer toes

With hammer toe, the middle joint bends down toward the floor while the other two joints bend up. The result is the middle portion of the toe lifts up. Hammer toe most commonly occurs in the second toes, but can appear in the third or fourth as well.

Claw toe is a condition in which the final two joints flex to curl the toe downward, causing the first joint to extend and bend upward where it meets the foot. In most cases, claw toe affects all four small toes.

A mallet toe points downward and cannot straighten, due to the joint at the end becoming permanently flexed. The second toe is most often affected, but mallet toe can occur in the other small toes too.

Causes of Claw, Mallet and Hammer Toes

These toe problems are often the result of wearing tight shoes that force the toes to stay bent. Over time, this leads to the muscles and tendons in the toes tightening and becoming shorter.

As many women commonly wear shoes with high heels and narrow toes, they are at greater risk. These conditions generally develop slowly, so they are most often seen in older adults.

Certain diseases and conditions also may contribute to the development of these deformities. Some cases may be the result of damage from diabetes, arthritis or alcoholism, for example.

Morton’s toe, a common condition in which the second toe is longer than the big toe, may also play a part in causing these painful problems.

Claw, Mallet and Hammer Toe Diagnosis

The orthopedic surgeon will take a detailed medical history, asking about the patient’s footwear and daily activities. A physical exam comes next, in which the level of deformity and scope of pain will be assessed.

To further evaluate the bones and joints of the feet and to confirm a diagnosis, X-rays or other imaging tests may be ordered.

Treatment of Claw, Mallet and Hammer Toes

In their early stages, these deformities often can be corrected with conservative treatment measures.

Wearing flat shoes with a wide toe box and good arch support is generally recommended. Some patients also may benefit from shoe inserts or products that cushion the affected areas, such as moleskin. Splinting or taping the affected toe into a straight position is considered in some cases. The orthopedic surgeon may also suggest exercises to strengthen and stretch the muscles.

If conservative treatments fail to control pain or if the toe joint is immobile, orthopedic surgery may be recommended. Surgery may involve releasing the tendon or removing a piece of the joint or hammer toe bone.

Traske Muir, MD
Orthopedic Surgeon, Foot and Ankle Specialist at Center of Orthopedics and Rehabilitation Excellence
Dr. Traske Muir is a fellowship-trained and board-certified lower extremity orthopedic surgeon. He specializes in treatment of injuries and arthritis of the knee, ankle and foot. He is an active Fellow of the American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society. Dr. Muir has done extensive research on Achilles tendinopathy and orthopaedic injury associated with ATV crashes.