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Toe Deformities

Toe deformities develop in all shapes and sizes, with genetics and footwear playing a large role in how your toes change shape over time. Toe deformities do not apply only to the big toe, they also affect the smaller toes, with the second toe most commonly affected. There are multiple types of toe deformities that can occur.

Types of toe deformities

Clawed toes – These are characterised by a claw-like appearance. This occurs when the middle and end joints of the toe become flexed. Clawed toes only occur in the lesser toes – i.e. your second toe through to your little toe – and the condition is more often associated with a highly arched foot type. However, people who don’t have highly arched feet can also develop clawed toes.

Hammer toes – This describes a toe that is flexed only at the middle joint, with the end of the toe positioned normally. As with clawed toes, this deformity can develop in any of the lesser toes.

Mallet toes – This describes a toe that is flexed only at the end joint, but the rest of the toe remains in a straight position.

Retracted toes – Similar to a clawed toe, this occurs when the middle and end joints of the toe become flexed AND the base of the toe (metatarsal-phalangeal joint) is extended. The end of the toe is lifted and no longer makes contact with the ground when standing.

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What causes toe deformities?

Most toe deformities are caused by genetics (i.e., inherited from family). However, there are other factors that can increase your risk of deformity or cause the deformity to become worse:

Inappropriate footwear – Shoes that are too small or tight can cause your toes to temporarily buckle, which gradually becomes permanent over time.
Foot anatomy – e.g., flat or highly arched feet, bunion deformity, a long second toe.
Medical conditions – e.g., rheumatoid arthritis and diabetes.

Can toe deformities cause problems?

In many cases, you may notice that you have developed a toe deformity but it doesn’t cause you any pain or concern. However, having a toe deformity can increase your risk of developing:

Pressure-induced skin lesions, such as corns or calluses. These usually form gradually over any prominent joint or on the end of your toe, when under increased pressure in footwear or weight-bearing.
Osteoarthritis. The toe deformity may become stiff and painful, indicating arthritic changes in the joint.
Bursitis – a fluid filled sack that sits over the joint can become red and inflamed if under too much pressure or friction due to toe deformities such as clawed, hammer and retracted toes.

Having a toe deformity can impact people in multiple ways. For example, some people may feel more self-conscious about the way their feet look, or feel frustrated that they can no longer comfortably wear their usual footwear.

Toe deformities can make it harder to find footwear that fit well and are comfortable. This is because often many of these toe deformities increase the depth of your foot, meaning that deeper and wider footwear is required in order to accommodate these changes. Shoes that are softer on the top surface of the toe box, can also be helpful in making sure your feet stay comfortable throughout the day.

Can toe deformities be treated?

There are various at-home treatment options for toe deformities, such as:

Do ✓

Wear deeper footwear with a soft toe box. This will provide adequate space for the deformity and reduce pressure/friction.
Use protective toe guards/sleeves, such as ZeroSole Toe Guards, to reduce pressure and friction at the joint. This can help to manage and prevent corns or calluses and inflamed bursae.
Stretch and strengthen your toes. If you still have some flexibility in the affected joints, it can be helpful to regularly stretch the toes (by holding them in a straightened position), and strengthen the toes (by practising picking up marbles or a piece of paper with your toes). This may help to prevent the deformity from getting worse or becoming fixed.

Don’t X

Do not wear tight shallow shoes or shoes that are too small. This will increase pressure at the prominent joints and cause the deformity to worsen.

Can toe deformities be corrected by surgery?

If conservative treatment fails to manage your condition, there are various surgical options available to straighten the toes. This usually involve breaking the toes and inserting temporary or permanent pins to fix the toes in a straightened position – which will be done under anaesthetic so you’re not in pain. General risks include infection, scar sensitivity, worsening pain or recurrence of the deformity. Surgical options, risks and benefits will be discussed with you in detail by the surgeon.

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