Hammer, Claw, or Mallet Toe: Should I Have Surgery?

Hammer, claw, and mallet toes are toes that do not have the right shape. They may look odd or may hurt, or both. Tight shoes are the most common cause of these toe problems.

• A hammer toe is a toe that bends down toward the floor at the middle toe joint. It usually happens in the second toe. This causes the middle toe joint to rise up. Hammer toes often occur with bunions.
• Claw toe often happens in the four smaller toes at the same time. The toes bend up at the joints where the toes and the foot meet. They bend down at both the middle joints and at the joints nearest the tip of the toes. This causes the toes to curl down toward the floor.
• A mallet toe often happens to the second toe, but it may happen in the other toes as well. The toe bends down at the joint closest to the tip of the toe.

Hammer, claw, and mallet toes can cause discomfort and pain and may make it hard to walk. Shoes may rub on your toes, causing pain, blisters, calluses or corns, or sores. Sores can become infected and lead to cellulitis or osteomyelitis, especially if you have diabetes or peripheral arterial disease. If you have one of these health problems and sores develop, contact your doctor.

You can treat hammer, claw, and mallet toes at home by doing the following:

• Wear roomy shoes.
• Use pads and supports for protection and comfort.
• Do toe exercises. These will make the toe muscles stronger and more flexible.
• Limit activities that cause pain.
• Use over-the-counter medicine to treat pain.

If your hammer, claw, or mallet toe gets worse, or if nonsurgical treatment does not help your pain, you may think about surgery. The type of surgery you choose depends on how severe your condition is and whether the toe joint is fixed (has no movement) or flexible (has some movement). A fixed toe joint often requires surgery to be straightened. A flexible toe joint can sometimes be straightened without surgery.

Surgery choices include:

• Phalangeal head resection (arthroplasty), in which the surgeon removes part of the toe bone.
• Joint fusion (arthrodesis), in which the surgeon removes part of the joint, letting the toe bones grow together (fuse).
• Cutting supporting tissue or moving tendons in the toe joint.

How well surgery works depends on what type of surgery you have, how experienced your surgeon is, and how badly your toes are affected.

Surgery may not help how your foot looks. And your toe problems may also come back after surgery. This is more likely if you keep wearing the kinds of shoes that cause toe problems.

Your expectations will play a large role in how you feel about the results of surgery. If you are only having surgery to improve the way your foot looks, you may not be happy with how it turns out.

Generally, surgery is used only if your symptoms do not improve with nonsurgical treatment.

Think about surgery if you have:

• Bad toe pain that interferes with your daily activities, and nonsurgical treatments have not worked.
• A badly deformed foot that interferes with your daily activities.
• A fixed toe joint deformity. This condition typically requires surgery to relieve pain and correct the deformity.

Surgery may not be an option if your toe deformity is caused by a problem with your nervous system or if you have a condition that affects your blood vessels, such as diabetes.