Toes that curl under are among the most common foot deformities, and they stem from an imbalance between the muscles and tendons that control toe movement. The good news is that most cases respond to some form of treatment, from simple changes in footwear and padding to minor surgical procedures. The right fix depends on what type of curling you have, how long it has been developing, and whether the toe can still be straightened by hand.
Why Toes Curl in the First Place
Your toes stay straight because of a tug-of-war between tendons on top of the toe (extensors, which pull it up) and tendons underneath (flexors, which pull it down). When the flexor side wins, the toe buckles and curls. This imbalance can develop for several reasons, and understanding yours matters because it shapes which treatment will actually work.
Poorly fitting shoes are the single most common external driver. Footwear that crowds the toes, particularly pointed-toe and high-heeled styles, forces toes into a bent position for hours at a time. Over months and years, the tendons and joint capsules adapt to that shortened position and eventually hold it on their own. Research consistently links high-heeled footwear to bunions, hammer toes, claw toes, and mallet toes.1Health Problems of Civilization. The effect of high-heeled footwear on the induction of selected musculoskeletal conditions and potential beneficial uses in prophylaxis and management Pointed shoes place especially high pressure on the medial (inner) toes, which accelerates deformity on that side.2PubMed Central. The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females
But shoes are far from the only cause. Genetic predisposition plays a role, as does trauma to the foot, and underlying medical conditions such as neuromuscular disorders and diabetic neuropathy.3Journal of the American Academy of Orthopaedic Surgeons. Hammertoes: Anatomy, Pathophysiology, and Comprehensive Treatment Strategies Diabetes deserves special attention: nerve damage in the feet gradually weakens the small intrinsic muscles that stabilize the toes, allowing the longer flexor tendons to overpower them and pull the toes into a curled position. This is one reason diabetic foot care places such emphasis on checking toe alignment regularly. In rarer cases, neurological conditions like dystonia can cause toe contractures that initially mimic a simple mechanical deformity but require a very different treatment approach.4PubMed Central. Functional Neurological Disorder: A Case of Twisted Toes and Dystonia
Foot deformities in general are more common in older adults and affect women at higher rates, likely reflecting both the cumulative effects of footwear choices and hormonal changes that affect connective tissue over time.
Hammer Toe, Claw Toe, Mallet Toe, and Curly Toe Are Not the Same Thing
People tend to lump all curling toes together, but there are distinct patterns, and knowing which one you have affects what treatment makes sense. Each toe has three joints stacked in a row, and the name of the deformity depends on which joint or joints are buckling.
- Hammer toe: The middle joint bends downward while the tip of the toe may point straight or slightly up. This is the most common type and usually affects the second toe.
- Claw toe: Both the middle and end joints curl under, giving the toe a claw-like appearance. Claw toes often affect multiple toes at once and are more commonly linked to neurological conditions.
- Mallet toe: Only the joint nearest the tip of the toe bends down. This tends to cause problems at the very end of the toe, where it presses into the ground or the shoe.
- Curly toe: The toe curls under and rotates slightly inward, tucking beneath the neighboring toe. This is the pattern most often seen in children and is frequently present from birth.
All four share the same underlying problem of tendon and muscle imbalance, but the details matter for treatment planning. A claw toe affecting all the lesser toes in someone with diabetes, for instance, calls for a different strategy than a single hammer toe caused by a tight shoe.
Flexible Versus Rigid Changes Everything
The single most important thing a clinician checks when evaluating a curled toe is whether the deformity is flexible or rigid. If you can manually straighten the toe with your fingers and it bends back without resistance, the deformity is flexible. The tendons are shortened and pulling, but the joint itself has not yet stiffened. If the toe is locked in place and cannot be manually straightened, the joint capsule and surrounding tissues have contracted permanently, making it rigid.
This distinction is not just academic. Flexible deformities respond to conservative treatments like padding, taping, and stretching, and they can be corrected surgically with simpler soft-tissue procedures. Rigid deformities generally require bone work, such as removing a small section of the joint or fusing it in a corrected position. Every curled toe starts flexible and can become rigid over time, which is why early intervention matters more than most people realize. Waiting until a toe is painful enough to see a doctor often means waiting until the easier fixes are off the table.
When Children Have Curly Toes
Congenital curly toes are surprisingly common in infants and toddlers. The toes, usually the third, fourth, or fifth, curl under and rotate inward from birth. Parents often worry, but the condition resolves on its own in a substantial number of cases. Studies put the spontaneous improvement rate at roughly one in four children.5Paediatrics & Child Health. Prospective study of a noninvasive treatment for two common congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes) A systematic review of the pediatric literature found spontaneous resolution rates between 25% and 50%, meaning that while many cases sort themselves out, a meaningful portion do persist and may need treatment.6PubMed Central. Congenital Curly Toes in the Pediatric Population: A Management Algorithm and Systematic Review
For children whose curly toes do not improve, the first-line approach is usually taping the affected toe to its neighbor in a corrected position. If taping fails and the child is experiencing pain, skin irritation from the toe pressing into the ground, or difficulty with shoes, a minor surgical procedure called a flexor tenotomy (releasing the tendon pulling the toe down) is typically recommended. In children, this is a quick procedure with generally excellent results, and it is far simpler than the surgeries adults sometimes need after decades of progressive deformity.
Conservative Treatments and What They Can Realistically Do
If your curled toes are still flexible and you are catching the problem relatively early, non-surgical approaches can relieve symptoms and slow progression. They will not permanently reshape the toe, and it is worth being honest about that limitation upfront. But for people who want to avoid surgery or who are not good surgical candidates, these measures make a real difference in comfort.
Shoe modifications come first. Switching to shoes with a rounder, deeper toe box reduces the pressure that drives toes into curled positions.2PubMed Central. The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females This single change relieves the most common source of pain: friction between the curled toe and the shoe. You do not necessarily need special shoes. Any shoe with a wide, tall toe box that does not press the toes together can work.
Silicone toe pads, cushions, and sleeves are widely available over the counter and can protect bony prominences on curled toes from rubbing against the shoe. Metatarsal pads placed just behind the ball of the foot can redistribute pressure away from the area under the curled toes. One review found that a metatarsal pad positioned just behind the second metatarsal head reduced peak plantar pressure by about a third, and that thicker insoles offered additional relief.7PubMed. The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature Custom silicone orthoses molded to the toe can also help, particularly with rigid deformities where the goal is pressure relief rather than correction.
Toe stretches and exercises that strengthen the small intrinsic muscles of the foot are often recommended. Picking up small objects with your toes, scrunching a towel under your foot, and manually stretching the toes into a straight position daily can help maintain flexibility and slow stiffening. The human foot’s intrinsic muscles play an active role in stabilizing the arch and controlling toe position during walking.8PubMed Central. The functional importance of human foot muscles for bipedal locomotion Strengthening these muscles counteracts the overpull of the longer tendons that cause curling.
One thing worth knowing: a literature review on orthotic treatments for toe deformities concluded that while shoe modifications and orthotics are often beneficial, none are permanent solutions to the deformity itself. They work best for managing symptoms in people with advanced-stage deformities who are older, less active, or simply prefer to avoid surgery.7PubMed. The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature For younger, active people with flexible deformities that are not responding to conservative care, surgery tends to offer a more durable fix.
Surgical Options From Simple to Complex
When conservative measures fail or the deformity is rigid and causing real problems, surgery enters the conversation. The procedures range from a five-minute office visit to a more involved operating room case, depending on the severity and flexibility of the deformity.
Flexor Tenotomy
This is the simplest surgical option and the one with the fastest recovery. The surgeon makes a tiny incision (sometimes just a needle puncture) on the underside of the toe and cuts the flexor tendon that is pulling it down. The toe relaxes into a straighter position. It can be done under local anesthesia and often takes just minutes.
Flexor tenotomy works well for flexible deformities. A study of percutaneous flexor tenotomy for claw toes found it to be a simple, rapid, and efficient method, though it did note a small rate of recurring deformity and some loss of active toe-gripping strength afterward.9PubMed Central. Clinical outcome after percutaneous flexor tenotomy in forefoot surgery Despite that trade-off, patient dissatisfaction was low. For curly toes specifically, open tenotomy of the flexor tendon corrected the overlapping in every case in one series, though some residual flexion remained in the most severe cases.10PubMed. Surgical correction for curly toe using open tenotomy of flexor digitorum brevis tendon
Tenotomy is also particularly valuable for people with diabetes. Curled toes in diabetic feet tend to develop pressure sores and ulcers at the tip of the toe or under the toe joint, and these ulcers are notoriously slow to heal because of poor circulation. A study of flexor tenotomy in a group that included diabetic patients found that all ulcers healed, with a mean healing time of about four weeks and only one recurrence. Patient satisfaction scores nearly doubled after the procedure.11PubMed. Functional outcome and patient satisfaction after flexor tenotomy for plantar ulcers of the toes
Joint Arthroplasty and Arthrodesis
For rigid deformities where the joint itself has stiffened, cutting the tendon alone will not straighten the toe. The joint needs to be addressed directly. The two main approaches are arthroplasty (removing a small piece of bone from the joint to allow the toe to straighten) and arthrodesis (fusing the joint in a corrected position, usually with a small pin or implant).
Arthroplasty of the proximal interphalangeal joint, which is the middle joint of the toe, is one of the most commonly performed procedures for rigid hammer toes. A review of 100 such cases found no serious complications and revision surgery was needed in just two cases. The most frequent issue was a “floating toe,” where the toe sits slightly elevated and does not press firmly on the ground. This bothered some patients cosmetically but did not cause pain or shoe problems.12PubMed. Review of proximal interphalangeal joint excisional arthroplasty for the correction of second hammer toe deformity in 100 cases
Arthrodesis, or joint fusion, provides a more definitive correction but involves a longer recovery period because the bone needs to heal across the joint. It is the go-to procedure when a toe is severely rigid or when arthroplasty has failed. In more advanced cases, tendon transfers, where a tendon is rerouted to pull the toe into a better position, may be added to the procedure.3Journal of the American Academy of Orthopaedic Surgeons. Hammertoes: Anatomy, Pathophysiology, and Comprehensive Treatment Strategies
What Recovery Looks Like
Recovery depends entirely on the procedure. After a flexor tenotomy, most people can walk in a stiff-soled shoe the same day and return to regular footwear within a few weeks. The incision site is tiny and heals quickly. After arthroplasty or fusion, expect to wear a surgical shoe or boot for several weeks, keep the foot elevated as much as possible in the first week, and avoid running or vigorous activity for about two months. A temporary wire or pin may protrude from the tip of the toe for four to six weeks to hold the correction in place while the tissue heals.
Complication rates are generally low. A study comparing surgical outcomes in older patients (65 and above) to younger patients found complications in about 10% to 14% of cases in both groups, meaning age alone is not a strong reason to avoid the surgery if it is otherwise indicated.13PubMed. Complication Rates and Short-Term Outcomes After Operative Hammertoe Correction in Older Patients The most common issues are swelling that lingers longer than expected, stiffness in the corrected toe, and the floating toe phenomenon mentioned above. Infection and recurrence are possible but uncommon.
One realistic expectation to set: a surgically corrected toe will function well and fit comfortably in shoes, but it may not look or move exactly like it did before the deformity developed. Some residual stiffness at the corrected joint is normal, especially after fusion. Most patients find this an acceptable trade-off for a toe that no longer hurts, no longer develops sores, and no longer limits their shoe choices.
The Footwear Factor After Treatment
Whether you treat curled toes conservatively or surgically, footwear habits going forward play a major role in preventing recurrence. The tendons and muscles that caused the original imbalance do not fundamentally change their anatomy after treatment. If you go back to cramming your feet into narrow, pointed shoes, the same forces that bent the toes in the first place will start working again.
Shoes with a wide, rounded toe box and a low heel are the single most protective measure. The toe box needs to be both wide enough and tall enough that your toes can lie flat without pressing against the top or sides of the shoe. Many athletic and walking shoe brands now offer models specifically designed with extra toe box room. If you are recovering from surgery, your surgeon will usually recommend a specific type of postoperative shoe before transitioning back to regular footwear.
For people with diabetes or peripheral neuropathy, ongoing vigilance is especially important. Because nerve damage reduces sensation in the feet, a recurrence can develop silently. Regular foot checks, either by yourself or a podiatrist, catch new curling before it becomes rigid. Diabetic shoe programs, sometimes covered by insurance, provide extra-depth footwear designed to accommodate toe deformities without creating friction points.
When the Cause Is Not Mechanical
Most curled toes result from the mechanical factors described above, but a small subset have neurological origins that require a completely different treatment path. Conditions such as Charcot-Marie-Tooth disease, stroke, spinal cord problems, and certain types of dystonia can all cause toe curling as part of a broader pattern of muscle imbalance. In these cases, the toes are a symptom of something upstream, and fixing them without addressing the underlying condition often leads to recurrence.
Clinicians have documented cases where toe contractures initially suspected to be simple mechanical deformities turned out to reflect a functional neurological disorder.4PubMed Central. Functional Neurological Disorder: A Case of Twisted Toes and Dystonia If your toe curling came on suddenly, is accompanied by weakness or numbness in the feet or legs, affects an unusual pattern of toes, or does not seem to match the typical slow progression of a shoe-related deformity, it is worth asking your doctor about a neurological evaluation before pursuing standard orthopedic treatment. Botulinum toxin injections, physical therapy for dystonia, and treatment of the underlying neurological condition are the usual approaches when a neurological cause is identified, and they tend to work better than mechanical fixes in these situations.
Strengthening the Foot’s Own Support System
One of the more promising areas in foot health is the growing recognition that the small intrinsic muscles of the foot do more than people used to think. These muscles, which live within the foot itself rather than in the calf, actively help stabilize the arch and control how the toes engage with the ground during walking and running.8PubMed Central. The functional importance of human foot muscles for bipedal locomotion When these muscles weaken from disuse, aging, or neuropathy, the longer extrinsic tendons from the calf dominate, and toes begin to curl.
This understanding has led some clinicians and physical therapists to incorporate “foot core” exercises into their approach to toe deformities, borrowing the concept from trunk core training. The exercises are simple enough to do at home: spreading the toes apart and holding, pressing each toe individually into the floor, and performing “short foot” exercises where you try to raise your arch without curling the toes. Whether these exercises can actually reverse an established deformity is still an open question, but the logic behind them is sound: strengthening the muscles that oppose the curling force gives your toes a better chance of staying straight, whether you are trying to prevent a first occurrence or protect a surgical correction.