Hammer toe, claw toe, mallet toe — the names are old-fashioned, but the problems are common, and they cause real misery out of all proportion to their size: rubbing on shoes, painful corns, and aching under the ball of the foot. This page explains what the deformities are, why they happen, what you can do without an operation, and an honest account of what surgery can and cannot achieve.
The three deformities, in plain terms
The lesser toes are the four smaller toes — everything other than the big toe. Each has two knuckle joints along its length. Which joint bends determines the name:
- Hammer toe — the toe bends at the first knuckle, so the middle of the toe lifts up. It most often affects the second toe, commonly alongside a bunion.
- Claw toe — the toe bends at both knuckles, curling like a claw. It more often affects several toes at once.
- Mallet toe — the bend is at the far knuckle, nearest the nail, so just the tip of the toe turns down. It usually affects the second toe, and can cause pressure on the nail itself.
The symptoms come mainly from rubbing: the top of a bent toe against the shoe, the tip against the sole or floor, and sometimes nail changes with a mallet toe. Hammer and claw toes can also cause pain under the ball of the foot — as the toe lifts, the long bones behind it (the metatarsals) take more pressure than they were designed for.
Why toes deform
Usually several factors together, rather than one villain:
- Family predisposition. Toe shape runs in families, and so do the deformities. This part cannot be prevented.
- Bunions. This is the big one for the second toe. Standing and walking rely on a tripod of the big toe, little toe and heel. When a bunion stops the big toe doing its share of the work, the second toe and its metatarsal are overloaded — the supporting structures stretch, the joint can become unstable, and the toe drifts into a hammer position.
- Footwear. Shoes that are narrow in the toe box crowd the toes, and shoes that are too short push a longer second toe into a bent position. Footwear does not fully explain toe deformities, but it can start them, and it certainly worsens established ones.
- Calf tightness. A tight calf muscle increases pressure under the ball of the foot and contributes to the overload that drives these deformities.
- Muscle imbalance, age and medical conditions. The fine balance of the small muscles and tendons that hold a toe straight can be disturbed by age, inflammatory conditions such as rheumatoid arthritis, and diabetes. The exact pattern of imbalance determines which deformity develops.
What you can do without surgery
An honest starting point: there is little evidence that anything reliably stops a toe deformity progressing. Non-surgical treatment is about controlling symptoms — and for many people that is enough.
- Shoes with a wider, deeper toe box — the measure that helps most people most. Room for the toes removes the rubbing that causes most of the pain.
- Shoes that are long enough, particularly if your second toe is longer than your big toe.
- Silicone toe protectors and sleeves to cushion the top or tip of a rubbing toe.
- Pads or cushioned insoles under the ball of the foot to offload pressure there.
- Toe spacers or bunion splints where the deformity is associated with a bunion — helpful for some, though they take up room in the shoe.
- Calf stretching, and an insole if you have a flat foot, to address the mechanical background.
When surgery is worth discussing — and an honest note about appearance
Surgery is for symptoms that persist despite sensible footwear and the measures above — not for how the toe looks. I say this directly because it matters: patients who have toe surgery purely for appearance are often disappointed. A surgically corrected toe is straighter and more comfortable in shoes, but it rarely looks or behaves like it did before the deformity began, and it may end up stiffer.
What the operation involves depends on the deformity:
- Flexible deformities — where the toe can still be straightened by hand — can often be treated with soft-tissue procedures such as tendon releases or transfers.
- Fixed deformities — where the joint has stiffened in the bent position — need bony surgery, usually removing a small segment of the joint or fusing it straight, sometimes held temporarily with a small wire or implant.
- When the ball of the foot is overloaded, the operation may include shortening the metatarsal bone to rebalance pressure.
- When a bunion is driving the problem, the second toe often cannot be reliably corrected without correcting the bunion at the same time — because the underlying cause is the overload, not the toe itself.
- A calf muscle release is sometimes added where calf tightness is a significant contributor.
Like all foot surgery, toe correction carries risks — infection, numbness, swelling that persists for months, stiffness, a toe that sits slightly off the ground, and recurrence over time. Which risks matter most depends on the procedure, which is a conversation to have properly in clinic.
Next steps
If a toe deformity is causing pain that footwear changes have not solved — or the ball of your foot aches with every step — a consultation and examination can establish which deformity you have, what is driving it, and the full range of options, surgical and not. You can book a consultation at my clinic in Southampton. Self-pay and insured patients are welcome.
This article is general information and does not replace an individual consultation. Independent patient information is available from the British Orthopaedic Foot and Ankle Society (BOFAS) at bofas.org.uk.