Toe Deformities in Hallux Valgus and Claw Toes – Treatment of Hammer Toes and Other Toe Deformities

Toe misalignments, medically known as toe deformities, often affect the big toe, which typically tilts toward the other toes. As a result, the adjacent toes may develop what are known as hammer toes or claw toes.

Toe deformities also contribute to osteoarthritis, which damages and eventually destroys the metatarsophalangeal joints. Over time, this results in limited mobility or pain in the toes and feet when walking.

Toe deformities often result from an imbalance in the muscles of the feet. The cause may be ill-fitting shoes that put pressure on the toes. Shoes that are too tight or walking in high stiletto heels places additional strain on the foot’s skeletal structure, which contributes to toe deformities.

Another cause of toe deformities is changes resulting from neuromuscular disorders. Genetic predispositions also play a role. For example, people with splayfoot are more prone to toe deformities. 

Essentially, there are four toe deformities that are very common:

• Hammertoe (Digitus malleus),
• claw toe (digitus flexus),
• Mallet toe (mallet toe),
• fifth-toe varus (Digitus quintus varus).

Hammer toes most commonly affect the second toe Hammer toe. Tendon © Henrie | AdobeStock

A hammer toe is a hammer-like bending of the toe, which most commonly affects the second toe. This causes hyperextension at the metatarsophalangeal joint, causing the toe to bend toward the other toes.

In a claw toe, the affected toe is deformed into a claw-like shape. A mallet toe refers to a hammer-like deformation of the toe’s distal phalanx. A tailor’s bunion affects the little toe.

The symptoms of toe deformities are usually functional in nature. Due to pressure caused by ill-fitting footwear or a genetic predisposition, the affected toes increasingly bend or change shape. Shoes rub against the toes, creating visible pressure points along the affected areas that are accompanied by pain.

In more advanced cases, patients are often limited in their ability to walk. Improper weight-bearing and compensatory postures lead to further changes in the skeletal system. This is accompanied by additional pain and changes in gait.

The diagnosis of a toe deformity is primarily based on visual examination. The increasing curvature and changes in individual toes are usually clearly visible in more advanced stages of the condition.

To check for joint involvement and assess the extent of the toe deformity, the doctor orders an X-ray. 

Treatment for toe deformities is usually conservative. In many cases—especially when there are no symptoms—the condition is left untreated. However, if pressure points or pain while walking develop, doctors generally recommend that patients wear

• comfortable footwear,
• special insoles or splints, as well as
• physical therapy,

to alleviate the symptoms.

However, in cases of very severe deformities, surgical correction can provide relief. This is particularly advisable for hammertoes and claw toes in advanced stages.

Doctors treat toe deformities by

• correcting or replacing the bone structure, as well as
• reconstructing the muscles and ligaments.

The surgery, for example for a hammertoe, is usually performed on an outpatient basis under local anesthesia. However, special caution should be exercised in patients with diabetes mellitus (diabetes). Since diabetes—or high blood sugar levels—damages the nerves, these patients have difficulty sensing pain and pressure points on their feet.

As a result, toe deformities can lead to severe symptoms, inflammation, and impaired wound healing.

Depending on the type and severity of the deformity, the prognosis for this condition varies greatly. In the early stages of the disease, physical therapy and assistive devices—such as comfortable shoes and splints—are often sufficient.

In general, however, surgery becomes more likely as the condition progresses and symptoms worsen.

In older patients, complete correction of the toe deformity is more difficult. Problems with wound healing, other comorbidities, and limited mobility can hinder the healing process following surgical correction.

The best preventive measures against claw toes and other toe deformities are:

• Wear comfortable shoes that are not too tight.
• Heels should not be higher than three centimeters.
• Roll your feet properly when walking so that your toes do not curl inward.
• Regular toe exercises or physical therapy, as well as foot care, help keep your feet and toes healthy.

Foot and toe deformities belong in the experienced hands of orthopedic surgeons and specialists in foot surgery. It’s best to look for sufficient expertise in the field or actively seek out recognized specialty clinics and practices.