Toes that curl under, often called hammertoe, mallet toe, or claw toe, are a common foot condition. This deformity involves an abnormal bend in the toe joint, leading to discomfort and painful walking. Understanding its causes and treatment options is important for relief and improved foot health.
What Causes Toes to Curl Under
Toes can curl under for various reasons, often due to mechanical and physiological factors. Ill-fitting footwear, especially shoes that are too tight in the toe box or feature high heels, can force toes into a bent position. Continuous pressure from such shoes can lead to muscle and tendon imbalances, causing toes to buckle or contract.
Muscle imbalances within the foot and ankle, where certain muscles overpower others, also contribute to curling. Nerve damage (neuropathy) can disrupt signals to toe muscles, causing involuntary contractions and tightening of tendons; this is common in individuals with conditions like diabetes. Genetic predisposition, inherited foot structure, or underlying medical conditions like arthritis (particularly rheumatoid arthritis) can also promote curling. Severe foot injuries or neurological events like a stroke can result in muscle spasticity and contractures, leading to curled toes.
Non-Surgical Solutions
Addressing curled toes often begins with conservative, non-surgical approaches. A fundamental step involves footwear adjustments: choosing shoes with a wide toe box, low heels, and ample arch support. Shoes that provide sufficient space allow toes to lie flat and spread naturally, reducing pressure and friction.
Orthotic devices, such as custom or over-the-counter inserts, toe pads, and splints, can help align and support the toes. These devices redistribute pressure across the foot, which can relieve pain and prevent further deformity progression. Taping or splinting a flexible curled toe to an adjacent straight toe can also help maintain a straightened position and reduce friction.
Specific stretching and strengthening exercises can improve flexibility and muscle balance in the foot and toes. Exercises like “towel scrunches,” where you use your toes to pull a towel, or picking up small objects with your toes, can strengthen intrinsic foot muscles. These movements help counteract muscle imbalances that contribute to toe curling.
Pain management strategies include applying ice to reduce inflammation and taking over-the-counter anti-inflammatory medications like ibuprofen. Using moleskin or specialized padding on affected areas can protect against corns and calluses that develop from friction against footwear. These non-invasive methods aim to manage symptoms and prevent the condition from worsening.
Surgical Options
When non-surgical treatments do not provide sufficient relief or the toe deformity becomes rigid and painful, surgical intervention may be considered. Surgery aims to correct toe alignment and alleviate pain. The specific procedure chosen depends on the type and severity of the curled toe, and whether it is flexible or rigid.
Common surgical procedures include tendon lengthening, where tight tendons pulling the toe into a curled position are released or lengthened. This is often used for flexible toe deformities to restore a more natural position. For rigid deformities, joint fusion (arthrodesis) may be performed, involving the removal of damaged joint surfaces and fusing bones to create a straight, stable toe. Bone removal (arthroplasty or cheilectomy) involves removing a section of bone from the affected joint to allow the toe to straighten.
Most hammertoe correction surgeries are outpatient procedures, allowing patients to return home the same day. Recovery times vary, but stitches are typically removed within 2-3 weeks, and temporary pins, if used, within 3-6 weeks. Full recovery, including the resolution of swelling and return to normal activities, can take 6 to 12 weeks. Patients may need to wear a special surgical shoe or boot during the initial recovery period and may be advised to elevate their foot to reduce swelling.
When to Consult a Specialist
Consult a specialist if you experience persistent pain that does not improve with home remedies and footwear adjustments. Seek professional evaluation if you notice increasing toe rigidity or a worsening deformity, where the toe becomes fixed in its curled position.
Difficulty walking, maintaining balance, or engaging in daily activities due to the condition warrants a specialist’s assessment. The development of open sores, corns, calluses, or signs of infection on the affected toes also necessitates prompt medical attention. If you notice numbness, tingling, or weakness in your feet, it could indicate nerve involvement. Early intervention can often lead to better outcomes and may help prevent the need for more invasive treatments.