Hammer, claw, and mallet toe refers to toes that are bent into an abnormal position. As the bone structure of the toes change, the muscles that control the toes get out of balance and cause the toes to bend into an odd position at one or more joints. Joints that connect the toe bones, and are affected by hammer, claw, and mallet toe include:
- Metatarsophalangeal joint, or MTP joint, which connects the toe to the foot
- Proximal interphalangeal joint, or PIP joint, located in the middle toe joint
- Distal interphalangeal joint, or DIP joint, which is the joint closest to the tip of the toe
Defining these three joints will help you understand the differences between hammer, claw, and mallet toe.
Hammer Toe deformity is when the first joint (MTP) shifts upward, and the middle joint (PIP) bends downward. Hammer toe usually affects the second toe, and they often occur with bunions.
Claw Toe deformity is when the first joint (MTP joint) shifts upward, and both the middle joint (PIP joint) and the joint closest to the tip of the toe (DIP joint) bend downward, like a claw.
Mallet Toe deformity is when the joint closest to the tip of the toe (DIP joint) bends downward. It most often affects the second toe, but can affect all four of the small toes.
COMMON CAUSES OF HAMMER, CLAW, AND MALLET TOE
Ill-fitting footwear is the most common cause of hammer, claw, and mallet toe. Wearing shoes that are too tight can negatively affect the muscles and tendons in the toe causing deformities. Toes that are squished day after day become fixed in that position and will not straighten out.Other common causes include:
- How much time you spend stand or walking each day can also be a factor
- Constantly wearing shoes that are point, especially combined with a high heel
- Anatomical deformities from birth
- Joint diseases, such as rheumatoid arthritis
- Hammertoe in the second toe is common in people with a bunion on their big toe
- Claw toe is common in people with high arches
- Nerve issues such as diabetes or neuropathy
Hammer, claw, and mallet toe are visibly noticeable conditions. In addition to the toes looking odd, symptoms may include:
- Unable to find shoes that fit properly
- Calluses or corns where the bent toes rub against one another or your shoe
- More severe cases can affect your balance or make it difficult to walk
Treatment depends on how far along in the process the toe deformity is. If caught early, conditions affecting the toe joints can be treated easily without surgery.
- Change in footwear – choose shoes with plenty of room in the toe boxes, low heels, and good arch support
- Add cushion and support to footwear – toe tubes, arch supports, and orthotic inserts can provide relief for fixed toe conditions
- Care for any calluses, corns, or bunions on your feet
- Exercises can help keep toe joints flexible and strong. Gently pull your toes in and hold for several seconds to stretch the toe joint. Do this several times a throughout the day.
- Towel curls: put a towel flat under your feet and use your toes to crumple the towel
- Marble pickups: use your toes to pick up marbles and drop them in a cup
If the toe deformity is severe enough, your physician may recommend surgery. Surgery is typically recommended if conservative treatment fails to control your pain, if the toe limits your daily activity, or if you are unable to move the toe joint. The type of surgery used to correct toe deformities is determined by the whether or not the toe joint is fixed or flexible. Surgery to correct fixed toe problems involve adjusting the bones in the toe. Surgery to correct flexible toe problems involve moving tendons to release tension on the joint, allowing the toe to straighten.Surgery procedures include one or more of the following:
- Phalangeal head resection, or arthroplasty, to remove part of the toe bone
- Joint fusion, or arthrodesis, to remove part of the joint so the toe bones can grow together
- Cutting supporting tissues or moving tendons in the toe joint