Claw toes, hammer toes, and mallet toes

Claw toes, hammer toes, and mallet toes all are most commonly related to wearing shoes that squeeze your toes, such as shoes that are too short or that have high heels. These deformities can also however occur because of other issues, such as nerve damage caused by diseases like diabetes or alcoholism, which can weaken the muscles in your foot. Having claw toe means your toes "claw," digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time. Most patients have pain at the sites of the abnormal contracture or bending of their toes. This is different with each condition (claw, hammer, etc) but in the areas of irritation, painful calluses, corns, and even skin ulcerations and breakdown may occur.

Treatment may require ruling out an underlying neurological disorder in some circumstances. The mainstay of treatment involves avoiding the irritation at the sites of deformity in the forefoot and toes. This can be accomplished with the use of soft, roomy toe box shoes with the avoidance of heels. Claw toe deformities are usually flexible at first, but they harden into place over time. When the deformity is flexible conservative treatment may suffice. If surgery is necessary, tendon transfers may be beneficial. If the deformity of the toes become rigid in a fixed in position, special pads can be utilized to redistribute your weight and relieve pressure on the ball of your foot and special "in depth" shoes that have an extra 3/8" depth in the toe box may be beneficial. If these treatments do not provide relief, surgery to correct the bone that are fixed in the abnormal rigid positions may be considered.

This may require the use of small screws or pins that are sometimes inserted through the skin and easily removed in the office after a period of 4 to 6 weeks. Weight bearing is usually allowed immediately in a rigid orthopaedic shoe and increased progressive activity is allowed but return to shoe wear cannot be performed until the pins are removed. Return to regular shoe wear is allowed at 6 weeks. The surgery can be performed as an outpatient and with regional (ankle block) anesthesia. Surgery of the forefoot (bunion and claw toes) requires a careful technique requiring skillful balance of the foot and toes to maximize both function, appearance, and pain relief and treatment with a skilled specialist for the treatment of such disorders should be considered.

Modified from the AAOS