Mallet Toe, Hammer & Claw Toe

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

• Metatarsophalangeal Joint (MTP): where the toes start, like your knuckles on your hand
  
  
• Proximal Interphalangeal Joint (PIP): the middle toe joint
  
  
• Distal Interphalangeal Joint (DIP): the end toe joint

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. 

1. Hammer Toe

Hammertoe is caused when the middle joint (PIP) bends down towards the floor (flexion). To compensate, the joints above and below (MTP, DIP) bend up (hyperextend). The result is that the middle part of the toe lifts up.

Hammertoe is the most common deformity of the lesser toes i.e. not the big toe.  It tends to only affect one toe, most commonly the second.

2. Mallet Toe

Mallet toe occurs when the end toe joint (DIP) flexes on a permanent basis.  This prevents the toe from being able to straighten and causes the tip of the toe to point downwards. 

Mallet toe problems most commonly occur in the second toe.

3. Claw Toe

Claw Toe occurs when the final two toe joints (DIP, PIP) flex to curl the toe downwards. To compensate, the first toe joint (MTP) hyper-extends so the toe bends up where it meets the foot.

Claw Toe problems often affects the four outer toes at the same time.

Common 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.

• Poor Blood Supply: conditions that affect the blood and oxygen flow to the feet e.g. peripheral vascular disease
  
  
• Foot Biomechanics: Altered foot position e.g. bunions or flat feet
  
  
• Injury: Previous foot injuries e.g. stress fractures
  
  
• 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
  
  
• Peripheral Neuropathy: Damage to the nerves in the foot e.g. from Diabetes
  
  
• Genetics: there is a strong genetic link here and hammer, claw and mallet toe are often hereditary

1. Toe Exercises 

Exercises to strengthen and stretch the muscles can be really helpful for hammertoe, mallet toe and claw toe. 

Simple foot and toe exercises, things like trying to pick marbles up with your feet or scrunching up a towel underneath your foot can work well as they help to strengthen and stretch the foot.  Visit the foot exercises section to find out more.

2. Orthotics

Anyone suffering from Claw, Hammer or Mallet Toes should see an orthotist or podiatrist. Orthotic inserts in your shoes can be used to help relieve pressure on the toes from the joint deformity, thus reducing toe pain and inflammation.

4. Splints/Straps

These simple devices can be used to help re-align and stretch your toes and correct the muscle imbalance and tendon shortening. One of the most common types used are toe stretchers such as the yoga toe. They really can make a massive difference.

You can find out more about how they work and read user reviews in the Toe Stretchers section

6. Surgery

In some cases, toe deformities from claw, hammertoe and mallet toe can get severe enough that foot surgery may be recommended.

The type of surgery required will depend on how limited the toe joint movement is.  Foot surgery may be done on the tendons to length them or small fragments of bone may need to be removed to allow for relignment

7. Chiropody

A chiropodist can remove calluses or corns, areas of hard skin that have formed with hammer, claw or mallet toes to make the foot more comfortable