Hammer, Claw, and Mallet Toes

Treatment Overview

You can often use nonsurgical methods to treat hammer, claw, and mallet toes. These include wearing roomy footwear, using pads and supports in your shoe, and doing toe exercises. These measures provide room for the toe to straighten, cushion the toe and hold it in a straightened position, and strengthen the toe muscles so that they are more flexible. You can take medicine to treat pain. Surgery is an option if nonsurgical treatment does not control pain, your toe joint deformity limits your activity, or you cannot move the toe joint.

The goals of treatment are to relieve pain so that your hammer, claw, or mallet toe does not limit your activities and to prevent the problem from getting worse. Even if your toes remain bent, your doctor will consider the treatment a success if he or she can relieve or reduce your pain enough to make you comfortable.

Initial and ongoing treatment

It is usually best to use nonsurgical treatment for hammer, claw, or mallet toes first. Treatment options for both fixed and flexible toe joint deformities include:

• Changing footwear. Shoes should be roomy, with wide and deep toe boxes (the area that surrounds the toes), low heels, and good arch supports. This provides room for your toe to straighten and prevents your toe deformity from rubbing or pressing against the shoe. One option is to wear custom (orthotic) shoes.

  Foot problems: Finding the right shoes

• Wearing moleskin, pads, arch supports, or other orthotic shoe inserts. These products may cushion the toe or hold the foot and toes in a more comfortable position. They are better for treating a flexible deformity, but they also provide some relief for a fixed deformity. Your health professional can show you how to put pads or inserts in the shoe.
• Taking nonprescription pain relievers. Examples include acetaminophen, such as Tylenol, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin , or naproxen. Check with your health professional before taking these medicines.
• Taking prescription pain relievers, which you may need if you have severe pain.
• Getting a corticosteroid injection, which may reduce pain and inflammation for a period of time. But this does not change the joint structure causing the toe pain and is not commonly used. Your toe joint may be more painful for several days after the injection than it was before the injection.
• Caring for any calluses or corns on your toes or feet. Moleskin and other nonprescription treatments for corns or calluses may help relieve pain and burning. Never cut corns or calluses by yourself, because this can lead to infection. See home treatment for calluses or corns.

Nonsurgical treatment specifically for flexible toe joint deformities includes:

• Taping or splinting hammer toes into place. Wrap tape under the big toe (or the toe next to the hammer toe), then over the hammer toe, and then under the next toe, gently forcing the hammer toe into a normal position. You may use a splint for the same purpose. Wrapping a toe does not straighten the toe permanently.
• Using toe caps or toe slings. These hold toes in a normal position, much like wrapping the toes with tape.
• Doing stretching exercises that help keep the toe joints flexible so that you can bend and straighten them. To do stretching exercises, gently pull on your toes to stretch the bent joints in the other direction, and hold the stretch for several seconds at a time. For example, if a joint bends up, gently stretch it down. Work on just one joint at a time. You should feel a long, slow, gentle pulling. Do this stretching several times in the morning and several times in the evening. To work on strength, try, putting a towel flat under your feet and using your toes to crumple it, and using your toes to pick up things, such as marbles. Your doctor, nurse, or physical therapist may be able to recommend more exercises.

Treatment if the condition gets worse

If your hammer, claw, or mallet toe gets worse or if nonsurgical treatment fails to reduce pain or discomfort, surgery may be an option. Generally, surgery is used only for severe toe deformities. Surgery may not completely return your toes to their normal positions, and toe joint problems may return after the surgery.

Surgical options may include one or a combination of:

• 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 or moving tendons in the toe joint. This can relax the tension on the joint and allow the toe to straighten out.

Doctors often use surgery on the bones for fixed toe problems, and they move tendons for flexible toe problems.

Should I have surgery for hammer, claw, or mallet toes?

What To Think About

Doctors generally advise everyone, especially athletes, children, and people with health problems such as diabetes, to take a conservative, careful approach when considering foot surgery.

If you have surgery for a toe problem, your surgeon may also operate on other toe joints to improve your symptoms.

Whether you have surgery generally depends on:

• The type and degree of your deformity. Claw toe may be more likely to cause pain and limit activities, and your doctor may suggest surgery. Hammer toe or mallet toe may respond better to nonsurgical treatment. Surgery is only used when pain and discomfort disrupt your daily life or other treatments have not worked.
• Whether the toe problem is fixed or flexible. With a flexible deformity, you have more options for treatment. For a severe fixed deformity, surgery may be the only solution when nonsurgical methods fail to control pain.
• Whether you have more than one toe problem. For example, if a bunion is pushing the second toe into a hammer toe position, surgery to correct the bunion can make room for the second toe. At the same time, surgery can correct the hammer toe.

A person typically has foot surgery as an outpatient, so you probably will not have to spend a night away from home. But other factors, such as your overall health, may make a hospital stay necessary.

Recovery from surgery often takes 4 to 8 weeks, although it may take longer. How long it takes depends on the procedure you use and how many problems your surgeon repairs. You may need follow-up X-rays. You may be able to walk on the affected foot right after surgery, possibly with a special shoe. How soon you can start wearing your own shoes depends on how quickly you recover.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: July 11, 2007
Medical Review:	William M. Green, MD - Emergency Medicine Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
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