Hammer & Clawed Toes: Diagnosis & Treatment

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)

Has your Podiatrist or Orthopaedic Surgeon has told you that you have ‘hammer toes’ or ‘clawed toes’? What exactly does this mean and how are the two toe conditions different? Chief Podiatrist Michelle Champlin lends us some insight into these toe conditions and your treatment options.

What are ‘hammer toes’?

Hammer toes mean your toes are permanently contracted. In detail, it is a deformity affecting the proximal joint of the interphalangeal joint. Let’s just call this joint the ITP joint from now on! Proximal means it is the toe joint closest to your body (PIPJ). There is another, similar condition that also involves the distal (or further away) ITP joint of the toes (DIPJ), called clawed toes.

Your 4 smaller toes each have three small bones in them, called phalanges. The 1st and 2nd, then the 2nd and 3rd are connected by hinge joints – the ITP joints. Your toes are connected back at your forefoot to your metatarsals by the MTP joint.

How are hammer toes different from clawed toes?

Hammer toes involve both the MTP joint connecting your smaller toes to your foot and the first joint after that. Your MTP joint is angled upwards, and then your proximal ITP joint is then angled downwards. This gives the toe a ‘hammer’ like appearance. Clawed toes do this as well as angling the last joint, the distal ITP joint, downwards too, therefore affecting all three joints.

Hammer toes can affect any of the 2nd, 3rd or 4th toes. Clawed toes can affect all of the smaller toes, from the 2nd to 5th.

Symptoms of hammer and clawed toes
• Pain to the tops of the bent toes when putting on shoes
• Corns or bursas at the top of the bent toes, from friction within footwear
• Swelling and redness at the affected ITP joint(s)
• Difficulty and pain moving the joints of the toes
• Callous and pain to the metatarsals (forefoot) behind the affected toes

What causes hammer toes and clawed toes?

The most common cause of hammer toes is wearing ill-fitting shoes – especially shoes that are too short, squashing the toes and forcing them to curl. Stilettoes can cause toes to do this particularly. Hence, more women than men are affected by hammer toes. Flip flops and even ballet pumps can also encourage your toes to claw to keep the footwear on.

Both hammer and clawed toes also tend to occur at the same time as other biomechanical issues with your feet – particularly bunions (hallux valgus). Clawed toes can also occur with patients with high arches, as the whole foot retracts, shortens and becomes more rigid. Hammer toes can be caused by excessive over-pronation, with the muscles that curl the toes being used to stabilize the foot, curling the toes over time. Weak muscles in either the front of the lower leg or in the calf can also contribute to hammer toes developing. Hammer toes and clawed toes can also be more likely to develop if your mum or dad had them (genetic).

It is important also to rule out other underlying causes of clawed or hammer toes, including nerve, muscle or joint damage; osteo or rheumatoid arthritis; diabetic complications; stroke etc.

What happens if I don’t treat it?

Hammer toes can either be flexible or rigid – in the early stages, hammer toes will tend to be flexible and treatment options are wider at this time. Over time, you may notice a worsening in condition with retraction / clawing of toes progressing, pain increasing to the toes and cramping and fatigue of the foot and leg.

What can be done to help hammer and claw toes?

Seeking treatment from a Podiatrist early on is advisable – a change of footwear and custom orthotics can alleviate before the contracture is fixed, which may require surgery.

Mrs Champlin advises that “In mild to moderate cases, the symptoms can be alleviated with custom corrective orthotic therapy, worn in your shoes to correct how your foot functions. This corrects the underlying cause of the hammer or clawed toes, and takes weight away from the MTP and ITP joints, rather than just superficially treating the pain with steroid injections or anti-inflammatory medication, which will not fix the issue in the longer term.

Additionally, you may be advised foot and toe exercises (such as picking up a towel off the floor with your toes), gently massaging your toes, icing to alleviate pain and wearing cushioned, well fitting shoes with adequate room in the toe box and a low heel to prevent your foot being forced downwards and forwards into the toe box.

In more severe cases, surgery by a specialist Orthopaedic Surgeon with expertise in foot surgery may be advised. After surgery (there are different procedures for hammer and claw toes depending on severity, which the surgeon will discuss after consulting with you), the Orthopaedic Surgeon will refer you back to your Podiatrist for a post-surgical custom orthotic to maintain his/her work re-aligning the joints in the operating theatre and to stop the foot posture reverting, supporting your correct foot posture and alleviating pressure from the MTP and ITP joints.

Which health professional should I speak to about clawed / hammer toes?

Diagnosing and treating either hammer or clawed toes is an area of very specific and detailed expertise in the musculo-skeletal structure of the body, an understanding of the nervous system, neurological disorders, diabetes and how your foot, ankle and leg function. Only once the cause is correctly understood can the appropriate treatment and action plan be put in place to address the clawed / hammer toes. A Podiatrist is the appropriately trained and experienced professional who can assess all of these factors and either implement conservative, non-surgical treatment, or refer you to the appropriate orthopaedic surgeon if appropriate.

If you are experiencing any pain at all in any of your toes or joints, you should always seek advice from a Podiatrist without delay. Early intervention is best, and there is always a way forward to reduce or eliminate the pain.

Contact the foot experts at Dubai Podiatry Centre on +971 4 3435390 | WhatsApp: +971 50 3553024 for friendly informative diagnosis, explanation and treatment options for any toe issue.