Curled toes can be a sign of several things, from poorly fitting shoes to nerve damage, arthritis, or structural problems in the foot. Sometimes the cause is purely mechanical. Other times, curling toes are an early visible clue to a systemic condition like diabetes or rheumatoid arthritis. The specific pattern of curling, which toes are affected, and whether you can still straighten them manually all help narrow down the cause.
Types of Toe Curling
Not all curled toes look the same, and the differences matter. A hammertoe bends at the middle joint of the toe, creating an upside-down V shape. A mallet toe bends at the joint closest to the toenail, so the tip of the toe points downward. A claw toe curls at both joints, pulling the toe into a claw-like position. All three most commonly affect the second, third, or fourth toes.
One important distinction is whether the curl is flexible or rigid. A flexible deformity means you can still push the toe back into a straight position with your hand. A rigid one won’t budge. This matters because flexible deformities respond to conservative treatment like toe splints and footwear changes, while rigid ones typically require surgery to correct.
Nerve Damage and Diabetes
Toe curling is one of the more common foot changes in people with diabetes. Between 32 and 46 percent of diabetic patients develop clawed or hammered toes, largely due to peripheral neuropathy. When diabetes damages the nerves in your feet, the small muscles that help keep your toes straight weaken and waste away. The longer muscles connected to your toes through tendons keep pulling, but with nothing to counterbalance them, the toes gradually curl.
This isn’t just a cosmetic issue. Curled toes change the pressure points on your foot. The tops of bent toes rub against shoes, and the balls of your feet bear more weight than they should. For someone with diabetes who may also have reduced sensation, this combination creates a serious ulcer risk. Callus formation over these pressure points has been associated with an 11-fold increase in the relative risk of developing a foot ulcer.
Rheumatoid Arthritis
Rheumatoid arthritis affects the feet in roughly 90 percent of people with the condition, and claw toes are among the most common deformities. The process is driven by chronic inflammation inside the joints. Over time, the persistent swelling stretches and eventually ruptures the small ligaments that hold the toe joints in alignment. Once these stabilizing structures fail, the balance between the muscles that flex and extend the toes breaks down, pulling the toes into a curled position.
What starts as a flexible deformity can quickly become rigid without treatment. As the toes lock into their curled position, painful corns develop on top of the bent joints, and thick calluses form under the ball of the foot where the displaced joints press downward. About a quarter of people with rheumatoid arthritis eventually need surgery on their forefoot to address these changes.
Neurological Conditions
Toe curling can also signal problems in the brain or spinal cord, not just the peripheral nerves. Conditions like multiple sclerosis and stroke can cause spasticity in the muscles of the lower leg, which pulls the toes into a clawed position. In these cases, the curling is driven by overactive signals from the central nervous system rather than weakened muscles in the foot. The toe clawing tends to be tighter and more forceful than what you’d see from neuropathy or arthritis, and it often comes with other signs of spasticity in the leg or ankle.
High Arches
The structure of your foot itself can cause toes to curl. People with unusually high arches, a condition called pes cavus, are prone to developing claw toes and hammertoes over time. The exaggerated arch changes the angle at which tendons pull on the toes, creating tension that gradually forces them into a bent position. In the most common variation, the heel also tilts inward and the big toe points downward, making the arch even more pronounced. High arches can be inherited or develop secondary to neurological conditions like Charcot-Marie-Tooth disease.
Footwear and Mechanical Causes
Shoes with narrow toe boxes are a well-established, modifiable risk factor for toe deformities. When toes are consistently compressed into a space that doesn’t match the natural contour of the forefoot, they adapt to the shape of the shoe. Research on women’s footwear found that wearing shoes with narrow toe boxes between ages 20 and 39 is significantly associated with the development of forefoot deformities. The toes essentially mold themselves to the available space, and over enough years, the deformity becomes permanent. Changing to wider shoes later in life may not fully reverse the damage, particularly if the narrow footwear has been worn for a long period.
This is the most preventable cause of curled toes. Shoes with a roomy toe box that allows your toes to spread naturally reduce the mechanical forces that drive these deformities.
Treatment Options
Treatment depends almost entirely on whether the toe is still flexible. For flexible deformities, non-surgical approaches are the first step: toe splints or pads, exercises to stretch and strengthen the small foot muscles, and switching to shoes with adequate room in the toe box. These measures can slow progression and reduce pain, though they won’t reverse structural changes that have already occurred.
Rigid deformities that cause pain or interfere with walking typically need surgical correction. The options range from minimally invasive procedures (small tendon releases or bone reshaping done through tiny incisions) to traditional open surgery that may involve fusing the bent joint into a straight position. The choice depends on how severe and rigid the deformity is. After surgery, you’ll wear a protective shoe for 3 to 6 weeks and should expect it to take at least that long before you can comfortably stand or walk for extended periods.
What the Pattern Tells You
A single curled toe that developed gradually in your dominant foot, especially if you wear tight shoes, points toward a mechanical cause. Multiple toes curling on both feet, particularly if you also have numbness or tingling, suggests neuropathy and warrants a check for diabetes. Toe curling paired with joint pain and morning stiffness raises the question of rheumatoid arthritis. And toe clawing accompanied by leg stiffness, balance problems, or changes in walking pattern may indicate a central nervous system issue like MS or the aftermath of a stroke.
The toes themselves are rarely the whole story. They’re often the most visible part of a process happening elsewhere in the body, whether that’s in the nerves, the immune system, or the brain. Paying attention to what else is happening alongside the curling is the fastest route to identifying the underlying cause.