Common Toe Deformities

Anatomically, the foot is divided into the forefoot, midfoot and hindfoot. The forefoot has 4 small (or lesser) toes called phalanges and 1 big toe called the hallux. Lesser toes have 3 bones and 3 joints, while the big toe has 2 bones and 2 joints. The midfoot and hindfoot have different structures, that are responsible for bearing your body weight, and performing activities such as walking and running.

Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate biomechanics and diseases such as arthritis, which affects the bones and tissues of the foot. Toe deformities not only affect the alignment of the bones, joints and tissues in the foot, but may also affect the alignment of the weight-bearing joints such as the hips or knees, resulting in further problems. The most common toe deformities are hammertoes, claw toes, mallet toes and bunions.


Toe deformities can be congenital (present at birth) or can occur later in life from wearing improperly fitted shoes or high-heeled shoes. Certain diseases, such as diabetes, stroke, osteoarthritis and rheumatoid arthritis, affect the functioning of the muscles and nerves, and can cause tightening of the ligaments and tendons, resulting in these deformities.

In some cases, accidents or injuries can result in fractures and lead to toe deformities.

Signs and symptoms

The symptoms associated with a hammertoe, claw toe and mallet toe are similar, and include feeling pain while wearing shoes and having difficulty finding proper fitting and comfortable shoes. Improper fitting footwear can result in hard skin outgrowths from high pressure and friction.

At the onset of the problem, the deformed toe is usually flexible; however, if left untreated, it can become rigid and immovable, requiring surgical treatment. Therefore, it is recommended to see your doctor for early treatment measures.

Characteristics of common toe deformities

In the case of hammertoes, the toe is bent at the middle joint, leading to curling of the toe to resemble a hammer. Hammer toe is commonly seen in the second toe, but can affect other toes as well. Another related condition, called a bunion, is often seen along with hammertoe, and involves a bony outgrowth along the side of the foot, at the base of the big toe and deviation of the great toe toward the lesser toes.

A claw toe exhibits an upward bending of the toe joint at the ball of the foot, followed by the toe bending downward in a claw-like fashion at the middle joint and sometimes end joint. Claw toe can occur in any toe except the big toe.

Mallet toe is similar to hammer toe except that the joint involved is the upper joint instead of the middle joint, giving the toe a mallet-like appearance at the end of the toe.


Toe deformities are simply diagnosed by a physical examination of the toe, and usually, no diagnostic test is required. However, in cases where the physician suspects nerve involvement, special tests may be ordered.


Initially, toe deformities are treated by conservative treatment measures to restore or maintain your walking ability, relieve pain and also delay progression of the deformity.

Conservative treatment includes wearing specially-designed shoes with cushions or pads with an enlarged toe box area to prevent skin breakdown. You will be instructed to avoid wearing tight, narrow or high-heeled shoes. Splints or tape may be applied to reposition the toes, and regular toe stretching exercises are recommended.

Surgical treatment is recommended if conservative treatment fails to relieve symptoms, or the deformed toes become rigid and immovable. The main objective of surgery is to restore the normal toe alignment and return the foot to its normal pain-free function.

The surgical procedure is chosen based on the stability of the deformed toe, whether it is flexible or not.

If some flexibility exists in the toe, the surgeon will make an incision over the deformed toe joint and realign the tendons and ligaments. Pins may be placed to keep the toe in position while healing. The incision is then closed with sutures and covered with a sterile dressing.

In cases where the deformity is rigidly fixed, the surgeon will make an incision over the joint of the deformity, realign the tendons and ligaments, and also perform an osteotomy, which involves the removal of bone pieces. Pins are inserted to keep the toes aligned while healing. Finally, the incision will be closed with sutures and covered with a sterile dressing.

Risks and complications

Apart from the general complications linked with any surgical operation, other specific complications include inadequate correction of the deformity and stiffness of the toe. Loss of blood supply to the toe and damage of the surrounding nerves (rare, but may also occur).

Postoperative care

Apart from general guidelines given by the surgeon after any surgery, specific instructions following toe deformity surgery include wearing a special post-op shoe for at least 2-6 weeks, to prevent bending the operated toe.


Toe deformity is a condition where there is misalignment of the toe bones. The common toe deformities include hammertoe, claw toe and mallet toe. Most toe deformities are flexible, but if untreated they may become rigid and can only be treated by surgical methods. Treatment of toe deformities starts with conservative methods, but if no effective response is seen, then surgery is recommended.