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Definition
A hammertoe is a toe that's curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. Otherwise, any differences between hammertoe and mallet toe are subtle.
Both hammertoe and mallet toe are commonly caused by shoes that are too tight in the toe box or shoes that have high heels. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a hammer-like or claw-like appearance.
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 may need surgery to experience relief.
Symptoms
Signs and symptoms of hammertoe and mallet toe may include:
- A hammer-like or claw-like appearance of a toe
- In mallet toe, a deformity at the end of the toe, giving the toe a mallet-like appearance
- Pain and difficulty moving the toe
- Corns and calluses resulting from the toe rubbing against the inside of your footwear
Both hammertoe and mallet toe can cause pain with walking and other foot movements.
When to see a doctor
See your doctor if you have foot pain that's persistent and that affects your ability to walk properly and carry out other motions with your foot. Also, see your doctor if one or more of your toes has developed a clenched or claw-like appearance.
Causes
A common cause of hammertoe and mallet toe is wearing improper footwear — shoes that are too tight in the toe box or shoes that have high heels. Wearing shoes of either type can push your toes forward, crowding one or more of them into a space that's not large enough to allow your toes to lie flat.
Hammertoe and mallet toe deformities can also be inherited and may occur despite wearing appropriate footwear.
The result is a toe that bends upward in the middle and then curls down in a hammer-like or claw-like shape. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses. The bottom of the affected toe can press down, creating the mallet-like appearance of mallet toe.
At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff.
Other causes of hammertoe and mallet toe may include:
- An injury in which you jam or break your toe
- Abnormal foot mechanics because of nerve and muscle damage to your toe resulting from diabetes (diabetic neuropathy)
- Other diseases that affect nerves and muscles, such as arthritis or stroke
Preparing for your appointment
If you're having problems with your feet, you're likely to start off by seeing your primary care doctor. In some cases, however, your primary care doctor may refer you to a foot specialist (podiatrist).
What you can do
Your time with your doctor is often limited, so preparing a list of questions will help you make the most of your time together. Some questions you might want to ask your doctor include:
- What's the likely cause of my foot problems?
- Is this condition likely to be temporary or permanent?
- What treatment approach do you recommend?
- Am I a candidate for surgery? Why or why not?
- Are there any additional self-care steps that might help?
Also, don't hesitate to ask questions during your appointment if you're unclear about what your doctor is telling you.
What to expect from your doctor
Some questions your doctor may ask of you include:
- When did you first begin having foot problems?
- How much pain are your feet or toes causing you?
- Where is the pain located?
- How rigid are your toes?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- What type of footwear do you normally use?
What you can do in the meantime
While you're waiting for your appointment, avoid wearing shoes or doing activities that seem to make your foot problems worse. Wear shoes that are comfortable, have a low heel and a good arch support, and provide enough room for your toes.
If you have calluses on the tops of your affected toes, you may want to try using over-the-counter pads that protect your toes from rubbing against your shoe. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others), may help relieve your pain.
Tests and diagnosis
Your doctor can diagnose hammertoe or mallet toe by examining your foot.
Treatments and drugs
If your toe is still flexible, your doctor may recommend that you change to roomier and more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Wearing inserts or pads can reposition your toe and relieve pressure and pain.
If your toe has become tight and inflexible, your doctor may recommend surgery. The specific procedure depends on how much flexibility is left in your toe:
- If your toe has some flexibility, your doctor may straighten it by making an incision in the toe and releasing the tendon.
- If your toe is rigid, your doctor may not only cut or realign tendons but also remove some pieces of bone to straighten your toe. This procedure may require that the bones be fixed temporarily with pins while your toe heals.
Usually, you can go home from the hospital on the day of your toe surgery.
Lifestyle and home remedies
Wearing proper footwear may ease your foot pain. Low-heeled shoes with a deep toe box and flexible material covering the toes may help. Make sure there's a half-inch of space between your longest toe and the inside tip of your shoe. Allowing adequate space for your toes will help relieve pressure and pain.
In addition, your doctor may suggest exercises you can do at home or at work to strengthen your toe muscles. These may include:
- Picking up marbles with your toes
- Stretching your toe muscles
Don't try to remove a corn yourself using such methods as over-the-counter acid treatment, cutting or shaving. Home treatments can cause serious problems, especially if you have diabetes or poor circulation. Breaking the skin could result in an infection — in some cases, an infection serious enough to require amputation.
Prevention
You can avoid many foot, heel and ankle problems with shoes that fit properly. Here's what to look for when buying shoes:
- Adequate toe room. Avoid shoes with pointed toes.
- Low heels. Avoiding high heels will help you avoid back problems.
- Adjustability. Laced shoes are roomier and adjustable.
- Comfort. Select comfortable athletic shoes, strapped sandals or soft, roomy pumps with cushioned insoles.
- Breathability. Avoid vinyl and plastic shoes. They don't breathe when your feet perspire.
These additional tips may help you buy the right shoes:
- Buy shoes at midday. Your feet are smaller in the morning and swell throughout the day.
- Measure both feet. Your feet may not be the same size.
- Don't assume your shoe size hasn't changed. As you age, your shoe size may change — especially the width.
- Ask for just the right fit. Have your shoe store stretch shoes in tight spots.
Last Updated: 2010-08-21
