Toes that curl under are usually a sign that the tendons pulling the toe down have won out over the ones holding it straight. That imbalance most often builds slowly from everyday causes like shoes, but it can also be the first visible clue to a nerve or joint condition elsewhere in the body. The most useful thing to know early is whether the toe still straightens when you push it, because that decides how much simple measures can do.
Hammer Toe, Claw Toe or Mallet Toe
- Hammer toe: the toe bends down at its middle joint, so the knuckle sticks up and rubs on shoes.
- Claw toe: the toe bends up at the base and down at the middle and tip joints, often in several toes at once.
- Mallet toe: only the joint nearest the toenail bends down, so the tip presses into the ground.
Even foot specialists don’t always agree on what to call a given toe, especially claw toe, though they agree more on mallet toe.1Foot. Deformities of the lesser toes – how should we describe them? So don’t worry too much about the exact name. Describe which joint bends and whether it hurts.
Claw toe usually affects several toes on a foot, while hammer toe and mallet toe more often show up in a single toe, most often one of the smaller ones. If you notice the bend in more than one toe, or in both feet, mention that when you describe it, because the pattern says more about the cause than the label does.
The other thing that matters is stage. A flexible toe can be pushed straight by hand. A rigid one stays bent, and toes tend to stiffen over time if left alone. Flexible toes respond to shoes, pads and exercise, while rigid toes usually don’t straighten without a procedure, so acting early keeps more options open.
You can check at home in about two minutes. Sit and look at each toe from the side to see which joint bends. Then gently press the bent toe flat with a finger and see whether it straightens. Look for corns on top of the knuckles or calluses under the ball of the foot. Finally, compare both feet: curling on one side only can be a clue to an injury or nerve cause, though shoes and foot shape often affect one foot more than the other.
Shoes and Foot Shape
Shoes that are too short or narrow force the toes into a curled position.2Softstar Shoes. Shoes for Hammer Toes: Are High Heels Deforming Your Feet? Over months, the toe tendons adapt to that position, and the toe holds its bent shape even barefoot.3Softstar Shoes. Shoes for Hammer Toes: Are High Heels Deforming Your Feet? Heels make it worse by pushing the foot forward and jamming the toes into the toe box.4Softstar Shoes. Shoes for Hammer Toes: Are High Heels Deforming Your Feet?
The second toe is often the first to go. When it is longer than the big toe, it hits the front of the shoe first and gets pushed into a bend more than its neighbours. That is why one toe can curl while the others stay straight.
To see whether your shoes are part of the problem, stand up in them and check for about a thumb’s width beyond your longest toe. Feet spread and lengthen under your weight, so a shoe that feels fine sitting down may be tight standing. Your toes should be able to spread and wiggle in the toe box. Look at its shape as well as its length: if the front tapers to a point while your toes fan out wide, they are being squeezed together whatever the size says.
Feel for a seam or the upper pressing on top of a bent toe, since a toe box that is too shallow presses on the raised knuckle and irritates it. Remember that feet often grow longer and wider with age, so an old size may no longer fit.
Arch shape plays a part too. People with high-arched feet have more hammer and claw toes and more prominent bones under the ball of the foot.5PubMed. Biomechanical differences among pes cavus, neutrally aligned, and pes planus feet in subjects with diabetes A high arch tips the toes upward at the base, which can set up the claw shape. In flat feet, weak small foot muscles leave the larger leg muscles doing extra work, changing how the foot is held.6Physical Therapy Korea. Effect of Weight-Bearing Posture on Abductor Hallucis and Tibialis Anterior Activation During Foot Core Exercises in Functional Flatfoot
Weak Foot Muscles
In a healthy foot, small muscles inside the foot act like fine adjusters, holding the toes flat and the arch lifted while you stand and walk. Long tendons run from the calf muscles down to the toes. They are powerful and are meant to do the big work of pushing off, not the fine steadying. When both sets are working, the pull on each toe is balanced and the toe stays straight.
When the small muscles weaken, the long ones take over and the foot loses its active support.7Physical Therapy Korea. Effect of Weight-Bearing Posture on Abductor Hallucis and Tibialis Anterior Activation During Foot Core Exercises in Functional Flatfoot The unopposed long tendons can then pull the toes into a curl. Several things weaken these muscles: years in stiff or supportive shoes that do the work for the foot, less walking and activity with age, and nerve damage, covered next, which can starve the muscles of signals. That’s why strengthening, not just stretching, is part of treatment.
Diabetes and Nerve Damage
Nerve damage in the feet is a common cause of claw toes, especially in people with diabetes. Yet wasting of the small foot muscles alone doesn’t explain which people with diabetic nerve damage get claw toes.8PubMed Central. Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed People with both nerve damage and claw toes tend to have smaller foot muscles and a thicker band of tissue under the sole than those with just one problem.9PubMed Central. Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet Several changes in the foot seem to work together rather than one single cause. Signs that your curling may be nerve related include numbness, tingling or burning in both feet, curling in several toes on both feet, and not feeling a stone in your shoe or hot water.
Diabetes raises the stakes. Claw toes push the ball of the foot and the toe tips into the ground, raising pressure there. Normally, pain warns you that a shoe is rubbing or a toe is taking too much pressure, so you shift or take the shoe off. Numb feet don’t feel that pressure, so a rubbing knuckle or a pressed toe tip can break the skin without any discomfort. A small sore can then go unnoticed for days and become serious before you feel anything. If you have diabetes and new curling toes, have a doctor or podiatrist check your feet soon.
If you have diabetes, look at the tops of your toes and the ball of each foot daily for redness or blisters. Use a mirror or ask someone if you can’t see the soles. Never cut corns yourself; see a podiatrist.
Arthritis, Injury and Nerve Conditions
In rheumatoid arthritis, the joints at the base of the toes swell and shift, making toes curl and overlap.10MyHealth.Alberta.ca. Rheumatoid Arthritis in the Feet The toes then touch the ground less, and pressure under the ball of the foot rises.11PubMed. Characterising the clinical and biomechanical features of severely deformed feet in rheumatoid arthritis Swollen, warm toe joints with morning stiffness can be a sign of arthritis and are worth getting checked.
Claw toes can also appear months after a broken lower leg, even in children.12PubMed Central. Claw toes after tibial fracture in children Pressure and poor blood flow in the calf can scar and shorten the muscle that bends the toes.13PubMed Central. Claw toes after tibial fracture in children If the toes curl more when the ankle is pulled up, that points to the shortened calf muscle.14PubMed. Flexor digitorum brevis tendon transfer to the flexor digitorum longus tendon according to Valtin in posttraumatic flexible claw toe deformity due to extrinsic toe flexor shortening Curling that started after a fracture or cast fits this picture.
After a stroke or with multiple sclerosis, muscles can become stiff and tight, which can claw the toes.15PubMed. Botulinum toxin-A injections for spastic toe clawing In Parkinson’s disease, toes can cramp and curl involuntarily, often painfully, which is called dystonia.16PubMed. Botulinum toxin for foot dystonia in patients with Parkinson’s disease having deep brain stimulation: A case series and a pilot study Rare inherited nerve conditions can cause toe curling along with tremor or nerve damage in younger adults.17PubMed Central. Dystonia Responsive to Dopamine: POLG Mutations Should Be Considered If Sensory Neuropathy Is Present Curling that comes and goes or cramps painfully may point to a problem with muscle or nerve signalling, and curling with tremor, slowness or weakness should be checked by a doctor, who may refer you to a neurologist.
Treatments You Can Start at Home
Choose shoes with a deep, wide toe box and a low heel, the reverse of the shoes that cause curling. Shop later in the day, when feet are at their largest, and try shoes standing, with the socks you usually wear. Pick a shape that follows the outline of your foot, with a rounded or square front rather than a tapered one. If a shoe is comfortable only after you break it in, it is probably too snug for a toe that is already bent.
Padding helps too. A pad placed just behind the ball of the foot can cut peak pressure there by about a third, and a thicker cushioned insole lowers pressure under the ball of the foot more than a thin one.18PubMed. The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature Silicone toe devices seem to ease pressure mainly in stiff toes, not flexible ones.19PubMed. The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature
Strengthening the small foot muscles appears effective for milder toe deformities and helps stop them worsening.20PubMed. Treatment of Lesser Toe Deformities Based on Physical Therapy The short foot exercise and spreading the toes work the small muscles that lift the arch.21Physical Therapy Korea. Effect of Weight-Bearing Posture on Abductor Hallucis and Tibialis Anterior Activation During Foot Core Exercises in Functional Flatfoot Plain toe curls lean more on the long calf tendons,22Physical Therapy Korea. Effect of Weight-Bearing Posture on Abductor Hallucis and Tibialis Anterior Activation During Foot Core Exercises in Functional Flatfoot so favour short foot and toe spreads over towel curls.
For the short foot exercise, sit with your foot flat and toes relaxed. Draw the ball of the foot toward the heel without curling your toes, so the arch rises. Hold a few seconds, relax, and repeat several times a day. Once it’s easy, try it standing.
For toe spreads, lift and spread all your toes apart, hold, and relax. You can also gently press each bent toe straight and hold it to keep it supple. Stop if it causes sharp pain.
When to See a Doctor and What They Can Do
Book an appointment if a toe no longer straightens by hand, or if you have open sores, corns that bleed, or redness on a numb foot. Curling with numbness, weakness, tremor or swollen joints also warrants a visit, as does change over weeks rather than years.
It’s worth acting, because forefoot problems like these can reduce independence and raise the risk of falls.23PubMed Central / Elsevier. Treatment of Lesser Toe Deformities Based on Physical Therapy Treatment should target the underlying cause, starting with non-surgical options.24PubMed Central / Elsevier. Treatment of Lesser Toe Deformities Based on Physical Therapy
Tell the doctor when it started and whether it’s one foot or both, what shoes you usually wear, and about any past leg injury. Mention conditions like diabetes, arthritis or Parkinson’s.
The doctor will look at your toes and watch you walk, and test whether the toes can be straightened by hand. They may check for numbness, circulation and signs of joint or nerve conditions, since the cause shapes the treatment. Standing x-rays are usually the first test to see joint alignment,25Springer. The Ankle and Foot which helps decide between simple measures and a procedure.
For toe clawing from muscle stiffness, botulinum toxin injections into the toe muscles can relax them.26PubMed. Botulinum toxin-A injections for spastic toe clawing The effect wears off after about 3 months, so injections are repeated.27PubMed. Botulinum toxin treatment of adult spasticity: a benefit-risk assessment In Parkinson’s, these injections have eased painful toe cramping and improved walking within about 3 weeks.28PubMed. Botulinum toxin for foot dystonia in patients with Parkinson’s disease having deep brain stimulation: A case series and a pilot study Rigid toes may need surgery to release or move tendons.29PubMed. Flexor digitorum brevis tendon transfer to the flexor digitorum longus tendon according to Valtin in posttraumatic flexible claw toe deformity due to extrinsic toe flexor shortening
Can Curled Toes Come Back
Hammer toes can return after successful surgery if the same pressures or muscle imbalances persist.30Pivotal Foot and Ankle Surgeons. Recurrence Prevention After Hammertoe Surgery Surgery changes the shape of the toe but does not remove the cause, such as tight shoes, foot shape or a muscle imbalance.
So keep wearing roomy shoes and doing foot exercises after treatment. Don’t return to the narrow or high-heeled shoes that started the problem, and keep up strengthening even when the toe looks fine. Manage any underlying condition, such as diabetes or arthritis, and report any new bending early.
Curly Toes in Babies and Children
About 3 in 100 newborns have a curly or overlapping toe.31PubMed Central. Prospective study of a noninvasive treatment for two common congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes) The fourth and fifth toes are most often affected.32PubMed Central. Congenital Curly Toes in the Pediatric Population: A Management Algorithm and Systematic Review The toe usually tucks under its neighbour and can often be seen from the first days of life. It is typically in the same position on both feet or in more than one toe, and it is usually painless. Most babies are not bothered by it, and it rarely stops them standing or walking.
About a quarter improve on their own.33PubMed Central. Prospective study of a noninvasive treatment for two common congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes) Taping in the first weeks of life improved or cured almost all toes in one study, without complications.34PubMed Central. Prospective study of a noninvasive treatment for two common congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes) So ask the doctor about taping soon after birth, when it works best. Surgery is kept for moderate to severe curling that persists in older children.35PubMed Central. Congenital Curly Toes in the Pediatric Population: A Management Algorithm and Systematic Review
As your child starts walking, watch whether the toe causes pain or nail problems. If the toe stays curled and bothers your child, ask for a referral.