Hammer Toe & Claw Toe

Hammer toe, claw toe, and mallet toe are all variations of toe deformities where one or more joints in a smaller toe gets stuck in a bent position. Hammer toe is the most common — the toe bends down at its middle joint, like a hammer. Claw toe involves both the middle and end joints curling under, often from a muscle imbalance tied to a neurologic condition or a high-arched foot. Mallet toe is just the end joint that bends down. Each deformity can be flexible (you can still straighten it manually) or rigid (it's stuck) — that distinction guides the treatment.

The second toe is most often affected. Long-standing deformities lead to painful corns on top of the bent joint (where the toe rubs the shoe) and calluses on the bottom of the foot under the base of the toe.

The bent toe rubs on the top of your shoe, forming a painful corn right over the prominent middle joint. You may also feel a burning ache under the ball of your foot (the base of the bent toe) from altered weight distribution. The second toe is the one most often affected, especially when a bunion pushes the big toe over and crowds it.

Early on the toe is still flexible — you can straighten it with your hand, even though it curls on its own when relaxed. Over time the tendons and joint capsule tighten and the deformity becomes rigid, the toe locked in a bent position. Once rigid, the corn and callus tend to worsen because the toe can no longer flatten inside the shoe.

The exam assesses how flexible the deformity is (can your surgeon manually straighten the bent joints?) and checks the nerves and circulation of the toe. Standing X-rays show the bony alignment. Your surgeon will also look at the big toe and first foot bone, since bunions and big-toe arthritis often coexist with smaller-toe deformities.

1. Metatarsal pad

   A small pad placed just behind the ball of the foot offloads the bone behind the bent toe — eases the burning ache many patients feel there.

Surgery is offered for painful rigid deformities, or for flexible deformities that haven't been comfortable in the right footwear and padding. The procedure releases tight tendons, removes any prominent bone, and either pins the toe straight or fuses the joint depending on severity.

External patient-education references and related OSI pages for additional background:

• Britannica — Foot (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language