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Diagnosed with hammer or claw toe? | What does this mean? | Find Your Stride

Updated: Mar 16, 2023

What is a toe deformity?

There are several types of deformity that affect the smaller toes, depending on the shape, we call these hammer, clawed or retracted toes. In the average person, there are three small bones (phalanges) in each of your four small (lesser) toes on each foot. These bones are connected by ligaments and have small muscles and tendons within the foot that control their movement and stabilise them against the ground when you walk. The larger muscles and tendons within the leg move these toes. Toe deformities can occur when there is an imbalance between the muscles located our feet and those found in our legs. Other contributing factors include external pressures from shoes and direct injury, that can cause buckling of the joint(s) and result in toe deformity. Some inflammatory and neurological conditions can also cause toe deformity..

What causes the problem?

Like bunions, there is no single cause of small toe deformity. They are most often caused by a the unique mechanical structure of our feet, which can be linked to genetics; because some foot types make a person prone to development of toe deformities. Altered position of your lesser toes commonly results in pressure from shoes or the next toe along which results in painful hard skin forming. It is very common to see corns and calluses around the tips of toes or on the small toe joints when a deformity is present.

Poorly fitting footwear tends to aggravate the problem as it can squeeze the forefoot, crowding the toes together and exacerbating the underlying condition, causing pain and further deformity of the joint(s). With advancing age, existing toe deformities may progress. Associated medical conditions like arthritis can alter the shape and position of your toes, as can trauma.

Is it serious?

Some people have significant toe deformities that are painless but cause difficulties with footwear, while others have relatively subtle toe deformities that can be very painful. Although some treatments can ease the pain, only surgery can correct a deformed toe permanently. In some cases, pressure from the surrounding toes can lead to a domino effect which results in further toe deformities and/or pain in the metatarsals (long bones in the forefoot). An example of this is when deformities of the small toes are made worse by progressive bunion deformities. People who have altered nerve supply or blood supply to their feet and are deemed to be at risk of lower limb loss often first present with ulcers on their smaller toes. If left untreated, these seemingly small issues can progress rapidly to limb threatening problems.

Who gets it?

Anyone can have a foot structure that means they are prone to problems with their smaller toes, but they tend to be more common in women. If your parents or grandparents have toe deformities, you may also be more prone to developing them. People who have medical conditions such as diabetes or inflammatory arthritis may also develop severe toe deformities as the disease progresses, however the severe deformities seen in inflammatory arthritis years ago are far less likely because the medication has improved so much.

How do I prevent toe deformities?

Wearing sensible shoes that fit well is a good preventative measure. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort. The following also serves as a useful guide:

  • If you want to wear heels, vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels

  • Wear backless, high-heeled shoes in moderation. Backless shoes force your toes to claw as you walk

  • Wearing a shoe with a strap or lace over the instep holds the foot secure and stable reducing the need for you to try to stabilise your foot with your toes

  • If you already have toe deformities, try to accommodate your toes by selecting shoes with a wider/deeper toebox

Your podiatrist may recommend the following:

  • No treatment (you can elect to live with your toe problems)

  • Regular review by a podiatrist who will reduce the callus build-up periodically

  • Advice on foot cream and topical medication for associated problems

  • Splints, shields, off-loading devices and shoe alterations/footwear advice

  • An opinion from a foot and ankle surgeon

Non-surgical treatments may help to relieve symptoms but there is no evidence that they can correct the underlying deformity. A surgeon will typically evaluate the extent of your deformity. They can remodel the shape of your toes so they have a greater chance of fitting inside the average shoe. Deformities of the small toes can occur in any one of the three joints found in each small toe and in any direction so surgery can be complex and intricate due to the size of the bones and joints.

The aim of surgery is to address the underlying deformity and to prevent recurrence. As with all surgery, there are risks and complications, so it is important to balance any potential risk against any perceived reward when you are considering foot surgery. You should certainly consider getting an opinion about surgery or surgical options from a surgeon or experienced podiatrist if you are in pain or have a deformity that is worsening.

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