Why Are My Toes Curling Down? Causes and Treatments

Toes that curl downward are almost always the result of an imbalance between the muscles and tendons that pull your toes up and those that pull them down. When the flexor muscles overpower the extensors, or when certain small intrinsic foot muscles weaken, the toes buckle at one or more joints and stay bent. The specific cause ranges from tight shoes and high arches to nerve damage, arthritis, and diabetes, and the right treatment depends entirely on which of those forces is doing the bending.

How Muscle Imbalance Drives the Problem

Your toes are controlled by two sets of muscles: the long muscles that run up into your calf and the small intrinsic muscles that sit within the foot itself. In a healthy foot, these groups balance each other. One set curls the toes, the other straightens them, and neither dominates. When that balance tips, the toes get stuck in a flexed position. A study comparing people with hammer toes to those without found that the ratio of extensor-to-flexor strength in the affected group was roughly two to three times higher than normal, and that this strength imbalance alone accounted for about half to two-thirds of the abnormal joint angle seen in the bent toes.¹ In plain terms, the muscles that should hold the toe straight had weakened relative to the ones pulling it down.

This imbalance can develop gradually. Spending years in shoes that cramp the forefoot, especially heels that shift weight forward, slowly weakens the small stabilizing muscles while the long flexor tendons tighten. Over time, the toe joints stiffen into a curled position. Initially, you can still manually straighten the toe (a “flexible” deformity), but once the joint capsule and surrounding soft tissues contract, the curl becomes rigid.

Hammer Toes, Claw Toes, and Mallet Toes

Not all curled toes are the same, and doctors distinguish between three patterns based on which joint is bent. A hammer toe bends at the middle joint so the toe looks like an upside-down V. A claw toe bends at both the middle joint and the joint closest to the ball of the foot, curling the toe under like a claw. A mallet toe bends only at the joint nearest the tip. The distinction matters because each type responds differently to treatment and tends to arise from different mechanical problems. Claw toes, for instance, are more commonly linked to neurological conditions and high-arched feet, while hammer toes are more often associated with footwear and straightforward tendon tightening.

High Arches and Foot Structure

If you have a naturally high arch (pes cavus), you are more prone to toe curling. A high arch shortens the effective length of the foot, which increases tension on the plantar fascia and the long flexor tendons. That extra tension pulls the toes into a clawed position. One surgical study examined whether correcting the high arch itself could relieve claw toe deformity even without directly operating on the toes, and found that a bone-cutting procedure on the metatarsals did improve the claw toe angle on X-rays.² That finding underscores how tightly connected foot architecture is to what happens at the toes: fix the arch, and the toes sometimes follow.

Nerve Damage and Neurological Conditions

When the nerves supplying your foot are damaged, the small intrinsic muscles that stabilize the toes are usually the first to weaken. The longer muscles in the calf, which have more robust nerve supply, keep working and pull the toes into a curled position without opposition. This is why toe curling can be an early visible sign of a nerve problem you might not otherwise feel.

Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy and a well-known cause of progressive toe deformities. More than 70 percent of people with CMT develop a high-arched, inward-turned foot shape that typically includes hammer or claw toes.³ The disease starts in the distal muscles, meaning the feet and hands are affected first, with weakness gradually creeping upward over years.⁴ Physical examination typically reveals foot and hand muscle wasting along with the characteristic claw and hammer toe deformities.⁵

CMT is not the only neurological culprit. Diabetic neuropathy, spinal cord injuries, stroke, and Parkinson’s disease can all produce toe curling through the same basic mechanism of unbalanced nerve signals reaching the foot muscles. In Parkinson’s disease, the curling is often classified as dystonia, where involuntary muscle contractions force the toes into painful positions, particularly during “off” medication periods.

Rheumatoid Arthritis and Inflammatory Disease

Chronic inflammation in the toe joints can erode cartilage and stretch or destroy the ligaments that hold the joint in alignment. Once those stabilizing structures give way, the pull of the tendons goes unopposed and the toes drift into hammer or claw positions. Rheumatoid arthritis is a particularly aggressive driver. A case report described an 86-year-old man with severe rheumatoid arthritis who developed bilateral claw and hammer toes along with extensive joint destruction in both feet, resulting in significant pain and difficulty walking.⁶ His disease progressed despite multiple biologic medications, illustrating how relentless joint inflammation can be in reshaping the foot.

Rheumatoid toe deformities tend to affect multiple toes simultaneously and often come with other forefoot changes like bunions and the balls of the feet dropping out of alignment. If you notice your toes gradually curling and you also have morning stiffness or swelling in your hands, it is worth getting evaluated for inflammatory arthritis rather than assuming the problem is purely mechanical.

Diabetes and the Risk of Ulcers

Diabetes can cause toe curling in two ways. First, diabetic neuropathy weakens the intrinsic foot muscles, leading to the same imbalance described earlier. Second, chronically elevated blood sugar can stiffen connective tissues in the foot, restricting joint mobility. What makes curled toes especially dangerous in diabetes is the pressure problem they create. When a toe is bent, the tip or the top of the buckled joint presses against the shoe, and the metatarsal head beneath the toe bears more weight than it should. A study measuring plantar pressure in people with diabetic toe deformities found that peak pressures under the ball of the foot were significantly higher than in people without deformities.⁷ Those elevated pressures, combined with the reduced sensation from neuropathy, set the stage for foot ulcers that the person may not feel forming.

Regular monitoring of foot pressure and early correction of toe deformities are considered part of diabetic foot care precisely because catching these changes early can prevent wounds that are difficult to heal and may eventually lead to amputation.

Compartment Syndrome and Trauma

A less common but serious cause of toe curling is compartment syndrome in the lower leg. When pressure builds up inside the muscle compartments of the calf, usually after a fracture, crush injury, or surgery, the blood supply to the muscles can be cut off. If the pressure is not relieved quickly, the muscles die and are replaced by scar tissue, which contracts and pulls the toes into a permanently clawed position. This ischemic contracture is a recognized complication of leg compartment syndrome.⁸ Unlike most other causes on this list, compartment-syndrome-related toe curling tends to develop quickly after the initial injury rather than gradually over months or years.

Curly Toes in Children

Parents sometimes notice that a baby or toddler has one or more toes that curl under and overlap the neighboring toe. Congenital curly toes are quite common and are thought to result from a tightness in the flexor tendons that is present from birth. The good news is that a substantial proportion resolve on their own: estimates suggest that roughly a quarter to half of congenital curly toe cases straighten out without any treatment.⁹ For those that persist and cause problems, such as rubbing against shoes or difficulty walking, a simple surgical release of the tight flexor tendon has been shown to be effective.¹⁰

It is also worth distinguishing congenital curly toes from the plantar grasp reflex, which causes all newborns to curl their toes when the sole of the foot is pressed. This reflex is a normal part of brain development, present from about 25 weeks of gestational age, and typically disappears by around six months.¹¹ It is controlled by a spinal reflex center that the maturing brain gradually learns to suppress.¹² If the reflex persists well past six months, that can be a clue to a neurological issue such as cerebral palsy, and warrants evaluation by a pediatric neurologist. But in the first few months, toe curling during a foot rub is completely normal and not a sign of a deformity.

Conservative Treatments That Actually Help

If the deformity is still flexible, meaning you can manually push the toe straight, several non-surgical approaches can slow progression and reduce pain. The evidence is strongest for well-chosen shoe modifications and orthotic devices.

Wider toe box: Switching to shoes with a roomy, rounded toe box takes direct pressure off the bent joints. This alone can eliminate the corns and calluses that form where the curled toe rubs against the shoe.
Metatarsal pads: A small pad placed just behind the ball of the foot redistributes weight away from the overloaded metatarsal heads. One study found that a metatarsal pad positioned about 6.5 millimeters behind the second metatarsal head reduced peak pressure there by about a third.¹³
Thicker insoles: A cushioned insole of adequate thickness can further reduce pressure. The same review found that a 12.5-millimeter insole cut metatarsal head pressures by an additional 23 percent compared to a thinner insole.¹³
Silicone toe sleeves: Custom-molded silicone devices placed over the affected toe can reduce peak pressure at the joint in rigid deformities, though the evidence for benefit in flexible deformities is less clear.

Toe-strengthening exercises can also help, particularly if the underlying issue is intrinsic muscle weakness. A small study of people with forefoot pain found that two weeks of targeted intrinsic foot muscle exercises combined with toe-bending exercises reduced contact pressure under the ball of the foot and increased pain tolerance.¹⁴ Common exercises include towel scrunches with the toes, marble pickups, and spreading the toes against resistance. These are unlikely to reverse a rigid deformity, but they can stabilize a flexible one and reduce the pain associated with abnormal pressure distribution.

Botulinum Toxin Injections

When toe curling is driven by muscle spasticity or dystonia rather than structural joint changes, botulinum toxin injections can offer meaningful relief. The toxin temporarily weakens the overactive flexor muscles, allowing the toes to relax. Research on people with spastic toe clawing found that injecting botulinum toxin into the long and short flexor muscles of the toes, guided by electrical stimulation, was well tolerated and effective.¹⁵

The approach has also been studied specifically in Parkinson’s disease, where painful foot dystonia can persist even in people who have had deep brain stimulation surgery. A pilot study found that botulinum toxin injections significantly improved dystonia severity, pain, walking speed, and functional outcomes in these patients within three weeks of treatment.¹⁶ The effect wears off after a few months, so repeat injections are typically needed, but for people whose toe curling is painful and neurologically driven, the temporary relief can significantly improve daily function.

When Surgery Makes Sense

Surgery enters the conversation when the deformity is rigid, conservative measures have failed, or the curled toes are causing recurrent wounds or significant functional limitations. The specific procedure depends on severity. Flexible deformities can often be corrected with a tendon release or transfer, where the surgeon cuts or reroutes the tight flexor tendon. Rigid deformities usually require removing a small piece of bone at the affected joint to allow the toe to straighten, sometimes with a temporary pin to hold the correction while it heals.

One concern people have about foot surgery, especially older adults, is whether the results justify the risks. A study comparing operative hammer toe correction in patients over 65 with younger patients found that both groups showed significant improvement in pain and quality-of-life scores at six and twelve months after surgery. The complication rate was actually slightly lower in the older group, at about 10 percent compared to roughly 14 percent in the younger cohort.¹⁷ Age alone, in other words, is not a reason to rule out surgery if the deformity is causing real problems.

Recovery from hammer or claw toe surgery varies. Most people spend a few weeks in a stiff-soled shoe and gradually return to normal footwear over six to eight weeks. Swelling can linger for months. Recurrence is possible, particularly if the underlying cause, such as continued wear of tight shoes or progressive neuropathy, is not addressed.

Figuring Out Which Cause Applies to You

Because the list of possible causes is long, the first step in treatment is identifying why your toes are curling. A few patterns can help narrow things down. If only one or two toes are affected and you have a history of wearing pointed or high-heeled shoes, mechanical causes are most likely. If multiple toes on both feet are curling and you also have numbness, tingling, or weakness, a neurological evaluation is warranted. If the curling came on after a leg injury, compartment syndrome deserves consideration. If you have diabetes, the concern shifts toward ulcer prevention even before the deformity becomes severe.

Your doctor will typically examine the flexibility of the affected joints, check your reflexes and sensation, look at your foot arch, and review your footwear. In some cases, nerve conduction studies, blood work for inflammatory markers, or X-rays will be ordered. The answers shape everything that follows, from whether a simple shoe change will do the trick to whether you need neurological care or a surgical referral. Getting evaluated sooner rather than later matters, because flexible deformities are far easier to manage than rigid ones, and once a toe joint has stiffened into its curled position, your options narrow considerably.