Hammertoe and mallet toe

Hammertoe and mallet toe are foot deformities that occur due to an imbalance in the muscles, tendons or ligaments that normally hold the toe straight. The type of shoes you wear, foot structure, trauma and certain disease processes can contribute to the development of these deformities.

A hammertoe has an abnormal bend in the middle joint of a toe. Mallet toe affects the joint nearest the toenail. Hammertoe and mallet toe usually occur in your second, third and fourth toes.

Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you might need surgery to get relief.

Symptoms

Hammertoe and mallet toe feature an abnormal bend in the joints of one or more of your toes. Moving the affected toe may be difficult or painful. Corns and calluses can result from the toe rubbing against the inside of your shoes.

When to see a doctor

See your doctor if you have persistent foot pain that affects your ability to walk properly.

Causes

Hammertoe and mallet toe have been linked to:

Certain shoes. High-heeled shoes or footwear that’s too tight in the toe box can crowd your toes into a space in which they can’t lie flat. This curled toe position might eventually persist even when you’re barefoot.
Trauma. An injury in which you stub, jam or break a toe can make it more likely for that digit to develop hammertoe or mallet toe.
Abnormal balance of the toe muscles. The imbalance leads to instability, which can cause the toe to contract.
Risk factors

Factors that can increase you risk of hammertoe and mallet toe include:

Age. The risk of hammertoe and mallet toe increases with age.
Sex. Women are much more likely to develop hammertoe or mallet toe than are men.
Toe length. If your second toe is longer than your big toe, it’s at higher risk of hammertoe or mallet toe.
Certain diseases. Arthritis and diabetes might make you more prone to developing foot deformities. Heredity might also play a role.
Complications

At first, a hammertoe or mallet toe might maintain its flexibility. But eventually, the tendons of the toe can contract and tighten, causing your toe to become permanently bent. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.

Diagnosis

Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor might order X-rays to further evaluate the bones and joints of your feet and toes.

Treatment

If your toe is still flexible, your doctor might recommend that you change to roomier, more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Inserts or pads can reposition your toe and relieve pressure and pain.

In addition, your doctor might suggest exercises — such as picking up marbles or crumpling a towel with your toes — to stretch and strengthen your toe muscles.

If conservative treatments don’t help, your doctor might recommend surgery to release the tendon that’s preventing your toe from lying flat. In some cases, the surgeon also might remove a piece of bone to straighten your toe.