Mallet Toe, Hammer & Claw Toe

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Hammertoe and Mallet Toe are caused by a problem in one joint whereas in Claw Toe, all three toe joints are affected.

Toe deformities become more common with aging and affect approximately 10-15% of the population. Women are five times more likely to suffer from hammer, claw or mallet toe than men. They may also lead to other problems such as corns or calluses and long term stiffness in the toes.

What Causes Toe Deformities?

There are two joints in the big toe and three joints in the other four toes:

Muscles and tendons attach onto these foot bones and control the position and function of the toes. 

If tightness or weakness develops in the tendons, most commonly extensor digitorum longus (EDL), flexor digitorum longus (FDL) or the intrinsics, the joints are pulled into the wrong position resulting in either Claw, Hammertoe or Mallet toe. 

How Are They Different?

Let's look at how these three toe deformities differ from each other:

1. Hammer Toe

2. Mallet Toe

Causes Of Toe Deformities

There are a number of things that can cause Hammer, Claw and Mallet Toes to develop:

• Footwear: Claw, hammertoe and mallet toes are most commonly caused by wearing high heels or ill-fitting shoes that are too tight e.g. narrow toebox. If shoes like this are worn for long periods, the foot is held in a slightly bent position and gradually over time, the muscles tighten and shorten. If this continues for long enough, then the foot muscles become so tight that even when shoes are removed, the toe is still held in the bent position
  
  
• Toe Length: Another common cause is Morton’s Toe, where the second toe is longer than the big toe. In this case, the second toe is commonly squashed into a shoe into an unnaturally bent position, typically resulting in hammer toe or mallet toe

• Poor Blood Supply: conditions that affect the blood and oxygen flow to the feet e.g. peripheral vascular disease can lead to toe deformities
  
  
• Foot Biomechanics: Altered foot position e.g. bunions or flat feet pushes the toe joints out of place which can lead to hammer toe, mallet toe or claw toe
  
  
• Injury: Previous foot injuries e.g. stress fractures can affect toe joint position
  
  
• Neural Problem: problems in the central or peripheral nervous system e.g. nerve damage, brain damage or spinal cord injury
  
  
• Joint Disease: e.g. rheumatoid arthritis can lead to hammer toe, mallet toe or claw toe
  
  
• Peripheral Neuropathy: Damage to the nerves in the foot e.g. from Diabetes can shift the toe joints out of place
  
  
• Genetics: there is a strong genetic link here and hammer toe, claw toe and mallet toe are often hereditary

Toe Deformity Symptoms

Typical symptoms of Mallet Toe, Claw Toe and Hammertoe are: 

• Abnormal Toe Position: The most obvious symptom of hammer, claw or mallet toe is the abnormal toe positions as described above
  
  
• Toe Pain: the abnormal foot position leads to excessive friction on the toe as it rubs against any footwear which can be extremely painful
  
  
• Corns & Calluses: repeated friction can result in the formation of a foot corn or callus on top of the toes. Find out more in the foot corns section
  
  
• Toe Stiffness: the toe joints become increasingly stiff. In the early stages, the toes can usually be straightened out passively using your hands, but if allowed to progress, the toe stiffness may be permanent

Treatment For Toe Deformites

In the early stages, the deformities from mallet toe, claw toe and hammertoe can be corrected. But if treatment for toe problems is delayed too long, permanent stiffness can ensue which can only be corrected by surgery. The most effective treatment options for toe deformities are: 

1. Toe Exercises 

3. Good Fitting Footwear

Footwear is key when treating toe deformities. Shoes with a wide toe box will be more comfortable and will reduce the tension on the muscles and friction on the toes. 

If you are suffering from claw toe, hammer toe or mallet toe, avoid high heels as they push your feet forwards to the front of the shoes. This increases the pressure on the toes, forcing them to bend more than usual.  Shoes should ideally be half an inch longer than your longest toe.

4. Splints/Straps

5. Injections

Steroid injections can help to reduce pain and inflammation associated with mallet, claw and hammertoe. They should not be done in isolation but combined with other treatments for long term benefit.

Summary

Mallet toe, hammer toe and claw toe are common toe deformities. They are subtly different from each other and are distinguished by which toe joints are flexed and which are hyperextended.

Toe deformities are most typically caused by long-term wearing of tight, narrow shoes. They can also develop after foot injuries or joint, nerve or muscle problems. Treatment for hammer, claw and mallet toe often involves a combination of exercises, orthotics and changing footwear.

There are a number of other conditions that can cause problems aside from hammer, claw and mallet toe - visit the toe pain section to find out more.

Alternatively if you want help working out what is wrong and what you can do about it, visit the foot pain diagnosis section.

You may also be interested in the following articles:

• Pain On Top Of Foot
• Foot Arch Pain
• Nerve Pain In The Foot
• Foot & Ankle Stretches
• Foot Numbness
• Foot Lumps & Bumps

Page Last Updated: 02/28/23
Next Review Due: 02/28/25

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