Curled toes, also known as lesser toe deformities, occur when one or more small toes bend into an abnormal position. This condition affects the smaller toes and can cause pain, corns, and difficulty wearing shoes. The curling results from an imbalance in the muscles and tendons that keep the toe straight. If this muscle imbalance is not addressed, the deformity can progress from flexible to rigid, making non-surgical correction increasingly challenging.
Identifying the Cause of Curled Toes
Curled toes are categorized into three main types based on the affected joint: hammer toe, claw toe, and mallet toe.
A hammer toe bends at the middle joint, causing the toe tip to point downward and the middle joint to rise up. This often affects the second, third, or fourth toes and can lead to painful corns.
A claw toe involves a bend at two joints: upward at the connection to the foot and downward at the middle and end joints, creating a claw-like appearance. This deformity frequently affects all four smaller toes and is often linked to nerve damage from conditions like diabetes. A mallet toe involves a bend only at the joint closest to the toenail, causing the tip to curl downward.
The most frequent cause is wearing ill-fitting footwear, such as shoes that are too tight, too short, or have high heels. This constant pressure forces the toes into a bent position, causing muscle imbalance and tightening the tendons. Less common causes include trauma, foot structure abnormalities like high arches, and underlying medical conditions such as arthritis or nerve issues.
Daily Stretches and Footwear Adjustments
For flexible deformities, self-administered conservative care, including exercises and footwear changes, is the primary recommendation. Consistent stretching lengthens tight tendons and muscles to restore balance and flexibility.
Exercises for Flexibility and Strength
Effective exercises focus on strengthening the small intrinsic muscles of the foot:
- Toe extension stretch: Gently pull the bent toe down and back toward a straighter position, holding for several seconds.
- Towel scrunch: Use only the toes to grip and pull a small towel flat on the floor toward you.
- Marble pick-ups: Use the toes to grasp and lift marbles one at a time, encouraging active engagement and coordination.
These activities should be performed daily to maintain flexibility before the condition becomes rigid.
Footwear adjustments remove the external pressure that perpetuates the problem. Switching to shoes with a wide and deep toe box allows the toes to lie flat and spread out naturally. Low heels and a firm sole are also better choices, as they reduce pressure placed on the forefoot and toes.
Over-the-counter devices provide comfort and protection. Non-medicated toe pads, cushions, or splints cushion the area where the bent toe rubs against the shoe, reducing friction and the formation of painful corns or calluses. Taping the toe can also temporarily hold it in a straighter position when wearing shoes for an extended period.
Non-Surgical Professional Interventions
When self-care measures are insufficient, professional interventions offer targeted non-surgical options. A podiatrist can prescribe custom-made orthotic devices. These orthotics are molded to the exact contours of the foot, providing precise support to correct foot mechanics and redistribute pressure away from the affected toes.
Specialized physical therapy and prescription-strength splinting are also utilized. A physical therapist implements a targeted regimen of muscle strengthening and tendon stretching, often combined with therapeutic taping to encourage proper alignment. Custom toe crests or splints can be fabricated to gently stretch tight joints into a better position, which is most effective for flexible deformities.
Corticosteroid injections may be used if the deformity causes significant pain and inflammation around the joints. These injections deliver powerful anti-inflammatory medication directly into the affected joint or soft tissue to reduce swelling and alleviate discomfort. Although they do not correct the mechanical deformity, injections provide relief that allows the patient to participate more comfortably in physical therapy or use other conservative measures.
Surgical Options for Permanent Correction
Surgery is generally reserved for severe cases where the curled toe has become rigid, causes intense pain, or has failed conservative treatments. The goal is to permanently realign the toe and eliminate the deformity.
Surgical Procedures
Common surgical procedures include:
- Joint fusion (arthrodesis): This involves removing the joint surfaces and joining the two bones of the toe together with pins, screws, or a clip to stabilize it in a straight position.
- Joint resection (arthroplasty): A portion of the bone from the affected joint is removed, allowing the toe to straighten.
- Tendon transfer or lengthening: Performed for deformities caused by muscle imbalance, this procedure reroutes or releases a tight tendon to reduce the pulling force causing the curling.
Recovery time varies by procedure, but patients usually need to wear a special shoe or boot for several weeks and may require physical therapy to regain strength and range of motion.