Why Do Toes Curl as You Age and How to Address It

Toes curl with age primarily because the small muscles inside the foot weaken and lose their ability to counterbalance the pull of longer tendons running down from the leg. This gradual muscle-tendon imbalance allows the toe joints to buckle into fixed, bent positions over years. But aging alone rarely tells the whole story: footwear habits, underlying diseases like diabetes and rheumatoid arthritis, and changes to the foot’s fat pads and arch all play roles. The good news is that most curled-toe problems respond to conservative measures when caught early, and even advanced cases have reliable surgical fixes.

What Is Actually Happening Inside the Foot

Your foot contains two sets of muscles that work together to keep your toes straight. The intrinsic muscles are small ones that live entirely inside the foot, and the extrinsic muscles are larger ones that originate in the lower leg and send long tendons down into the toes. In a healthy foot, the intrinsic muscles stabilize the toe joints from below while the extrinsic tendons flex and extend them from above. When the intrinsic muscles weaken or shrink, the extrinsic tendons pull unopposed, and the toes begin to buckle.

Research on people with hammer toes bears this out. In one study, the ratio of extensor-to-flexor muscle strength at the toe joints was two to three times higher in people with hammer toes than in those without, and that imbalance accounted for roughly half to two-thirds of the abnormal joint angle measured at the base of the toe.¹ In plain terms, the muscles that pull the toes upward had become far stronger relative to the muscles that pull them down, forcing the joints into a bent position.

The intrinsic foot muscles also play a role in how you push off the ground when walking. When researchers temporarily blocked these muscles in healthy volunteers, the subjects could no longer stiffen the small joints at the tips of their toes during push-off, which forced compensatory changes higher up the leg.² That finding hints at why weakened intrinsic muscles set off a cascade: once those muscles can no longer do their job, the toes lose their stable platform and begin to drift into abnormal positions.

Hammer Toes, Claw Toes, and Mallet Toes

Not all curled toes are the same. The three main types are defined by which joints are affected, and the distinction matters because treatment differs for each. In hammer toe, the middle joint of the toe bends downward while the tip may stay flat. In claw toe, both the middle and the end joint curl under while the joint at the base of the toe hyperextends upward, giving a claw-like appearance. In mallet toe, only the joint nearest the tip bends down. A scoping review of clinical definitions found at least 16 different published descriptions for hammer toe and 11 for claw toe, which gives you a sense of how much even specialists debate the boundaries.³

For you, the practical takeaway is simpler. If your toe still straightens when you press on it or relax it in the bath, the deformity is “flexible,” meaning the tendons and soft tissue haven’t permanently tightened yet. If the toe is locked in place and won’t budge, it’s “rigid.” Flexible deformities are far easier to treat conservatively. Once a toe becomes rigid, the options narrow considerably.

Why Aging Makes It Worse

Several things happen to your feet as you get older that all push in the same direction. The intrinsic foot muscles gradually lose mass, a process that accelerates after your 50s and 60s. The ligaments and joint capsules at the base of the toes stretch out over decades of walking, which lets the toes drift upward at the base joint. And the fat pads on the bottom of the foot, which normally cushion the ball of the foot, thin out and shift forward. In people with toe deformities, MRI studies have shown that these fat pads migrate toward the tips of the toes, leaving the metatarsal heads less protected and increasing pressure in the wrong places.⁴

The cumulative effect of these changes is that every year your toes become a little less stable, a little less cushioned, and a little more likely to buckle. Most people don’t notice anything until the process has been underway for years, because the changes are slow and the foot compensates remarkably well for a long time. By the time a toe visibly curls or starts rubbing against the top of a shoe, the imbalance has usually been building for a decade or more.

Diabetes, Neuropathy, and the Biggest Risk Factor People Overlook

If aging alone were sufficient, everyone over 70 would have curled toes. Many don’t. The single condition most strongly associated with toe deformities is diabetic neuropathy, because it attacks the problem from multiple angles at once. Nerve damage from diabetes weakens the intrinsic foot muscles, dulls sensation so you can’t feel early warning signs of pressure or friction, and changes the way you walk.

MRI studies of people with diabetic neuropathy have shown dramatic muscle loss in the foot. In one study, muscle tissue made up only about 8% of the total cross-sectional area of the foot in neuropathic subjects, compared with roughly 31% in people without diabetes.⁵ That level of wasting is severe enough to destabilize the toes even in someone who is otherwise active.

What’s interesting, though, is that the relationship between muscle loss and toe curling isn’t as neat as textbooks once suggested. A separate MRI study found that muscle atrophy and muscle imbalance didn’t reliably distinguish between neuropathic patients who had claw toes and those who didn’t.⁶ That means other factors, possibly changes to the connective tissue or the joint capsules themselves, also contribute to why some neuropathic feet develop claw toes and others don’t. The science here is still evolving.

For people with diabetes, curled toes are more than a cosmetic nuisance. When toes buckle, the tips and tops of the toes press against shoes, and the displaced fat pads leave bony prominences exposed on the sole. Combined with neuropathy’s loss of sensation, these pressure points become prime sites for calluses and ulcers. The lifetime risk of developing a foot ulcer for someone with diabetes has been estimated at roughly 19% to 34%.⁷ Toe deformity is one of the major risk factors driving those numbers.

Rheumatoid Arthritis and Other Systemic Causes

Rheumatoid arthritis is another common driver of toe curling, and it works through a different mechanism than diabetes. Chronic inflammation erodes the joint surfaces and weakens the ligaments and joint capsules that hold the toe joints in alignment. Over time, the toes drift sideways, dislocate upward at the base, and curl under. Despite advances in medication, forefoot deformity remains a frequent problem in people with rheumatoid arthritis and often eventually requires surgery.⁸

A comparison of people with rheumatoid arthritis who wore shoes versus those who went mostly barefoot found that both groups developed lesser toe deformities, though the specific patterns differed. Shod populations tended to show toes dislocating upward, while unshod populations more often showed toes deviating to the side.⁹ The takeaway is that rheumatoid arthritis can cause toe deformity regardless of footwear, though shoes shape the direction the deformity takes.

Other conditions that can cause or accelerate toe curling include stroke or other neurological conditions that affect muscle control on one side of the body, Charcot-Marie-Tooth disease, and other peripheral neuropathies unrelated to diabetes. A previous toe fracture or surgery can also set the stage by altering the mechanics of the affected joint.

Do Shoes Cause the Problem

Shoes get blamed for almost every foot ailment, and there’s some truth to the accusation, but the story is more nuanced for curled toes specifically. Narrow, pointed toe boxes can crowd the toes and hold them in a bent position for hours at a time, which over years contributes to the soft tissues tightening in that position. High heels shift weight onto the ball of the foot and increase the load on the toe joints. Both habits can accelerate deformity in someone whose muscles are already weakening.

But shoes are not the whole explanation. A study of Maasai women in East Africa found claw toe deformity at high rates regardless of whether the women regularly wore shoes or went mostly barefoot.¹⁰ That result suggests structural or genetic factors can produce curled toes even without the influence of modern footwear. So while switching to shoes with a roomier toe box is a sensible step, especially if your toes are still flexible, don’t assume it alone will prevent the problem.

The Balance and Falls Connection

Curled toes don’t just cause shoe discomfort and calluses. They can quietly undermine your stability. A study of older adults presenting to a falls and balance clinic found that those with weakness of the big toe and lesser toes had poorer balance and mobility, both of which are linked to a higher risk of falling.¹¹ Your toes grip the ground during the push-off phase of walking and make constant small adjustments to keep you upright when you stand. Once they’re locked in a curled position or too weak to press down properly, that fine motor control degrades.

Changes to the foot’s arch compound the issue. As the arch flattens with age, it shifts the angles at the ankle and alters how force travels through the lower leg. Research on over a thousand university students found that decreasing arch height was strongly correlated with increasing heel valgus angle, and the effect scaled up with the severity of the flatfoot.¹² Although that study looked at a younger population, the same biomechanical principles apply in older feet where arch collapse and toe deformity often develop together.

Exercises That Help

The most effective conservative intervention for curled toes in their early, flexible stage is strengthening the intrinsic foot muscles. These are the small muscles you’re engaging when you try to scrunch a towel under your toes or pick up a marble with your foot. A pilot randomized trial in older adults found that a six-week program of intrinsic foot muscle exercises performed twice a week significantly increased toe flexor strength.¹³ The study also found that adding biofeedback, where participants could see their muscle activity on a screen, boosted gains on the weaker foot, which makes sense given that most people have trouble isolating and activating muscles they’ve barely used in years.

Practical exercises you can do at home include:

Towel scrunches: Place a towel flat on the floor and use your toes to pull it toward you, keeping your heel planted.
Toe spreads: Try to fan your toes apart as wide as possible and hold for a few seconds. This targets the muscles between the metatarsals.
Marble pickups: Pick up small objects with your toes and place them in a bowl. This builds the flexor strength that counteracts the curling tendons.
Short foot exercise: While sitting or standing, try to shorten your foot by drawing the ball of the foot toward the heel without curling the toes. This activates the deep intrinsic muscles that support the arch.

A separate case report found that combining intrinsic foot muscle exercises with interphalangeal flexion exercises over just two weeks reduced pressure under the ball of the foot and increased the pain threshold in a patient with forefoot pain.¹⁴ That’s a single case, not strong evidence on its own, but it aligns with the broader principle that strengthening these muscles rebalances the forces across the toe joints.

Consistency matters more than intensity. Doing a few minutes of foot exercises every day or every other day is more useful than one long session per week, because the intrinsic foot muscles are endurance muscles that respond to regular activation rather than heavy loading.

Pads, Orthotics, and Pressure Management

When toes are already curled enough to cause friction and calluses, reducing pressure on the affected spots becomes urgent, especially for anyone with diabetes or poor circulation. Crest pads, which are soft gel or foam pads that sit under the curled toes to support them from below, have been shown to improve calluses and even help heal small ulcers at the tips of the toes. One study found statistically significant improvement in callus and ulcer healing after crest pad use.¹⁵ Over several days of use, the pad molds to the bottom of the toes and redirects pressure away from the vulnerable tip.

Custom-molded silicone digital orthoses take a similar approach with more precision. In patients with high plantar pressure at the tips of curled toes, combining callus removal with a silicone orthosis produced the largest pressure reductions.¹⁶ Neither pad nor orthosis straightens a curled toe, but both can make it far more comfortable and prevent the skin breakdown that leads to infections.

Shoes with a deep, roomy toe box give curled toes space to exist without rubbing. Stiff-soled shoes can reduce the bending forces at the toe joints during walking. Avoiding heels higher than an inch or two keeps weight distributed more evenly across the foot. These are unsexy interventions, but they often make the difference between tolerable and miserable.

When Surgery Makes Sense

Surgery enters the conversation when the toe is rigidly fixed, when conservative measures haven’t controlled pain or skin breakdown, or when the deformity is progressing despite your best efforts. The specific procedure depends on the type and severity of the deformity. Common options include tendon transfers, where a tendon pulling in the wrong direction is rerouted to work in a more helpful direction; arthroplasty, where a small piece of bone is removed from the bent joint to allow it to straighten; and arthrodesis, where the bent joint is fused straight using a small pin or staple.

Results are generally good for most people. In one series of patients who underwent fusion of the second toe joint for a crossover hammer toe deformity, ten of eleven patients reported good to excellent outcomes, and ten of eleven achieved solid bone fusion.¹⁷ That’s a small case series, but the high satisfaction rate is consistent with the broader literature on hammer toe surgery.

Recovery typically involves wearing a postoperative shoe or boot with weight on the heel for five to six weeks until pins are removed, then a gradual transition back to normal shoes.¹⁸ Comorbidities matter: the same study found that older patients with two or more additional health conditions, such as diabetes, peripheral vascular disease, or obesity, had significantly higher rates of wound infection and recurrence requiring reoperation. The odds of needing a revision surgery jumped dramatically in that group.

Recurrence After Surgery

One frustration with hammer toe surgery is that the deformity can come back, particularly at the second toe. A study tracking over a hundred patients after surgery found that leaving the second metatarsal relatively long, measured by a specific bone-length ratio, and transposing the metatarsal head to the side during surgery were associated with higher recurrence risk.¹⁹ This suggests that in some patients, shortening the metatarsal bone at the same time as correcting the toe may lower the odds of the problem returning, though the evidence is still being refined.

Recurrence is more likely if the underlying cause of the deformity, whether it’s ongoing neuropathy, inflammatory arthritis, or habitual footwear, hasn’t been addressed. Surgery fixes the structural problem at one point in time; it doesn’t change the forces that created the deformity in the first place. This is why surgeons often pair the procedure with recommendations for wider shoes, custom orthotics, and ongoing foot exercises.

How the Foot Evolved and Why It Matters Now

Human feet evolved for walking and running on uneven ground, and the intrinsic foot muscles played a specific role in that design. Research has shown that when these muscles are functioning, they stiffen the small joints of the foot during push-off, helping you transfer force efficiently from your leg to the ground. When they’re blocked experimentally, people compensate by taking shorter, faster steps and generating more power from the hip, though the overall energy cost of walking doesn’t change much.²

The evolutionary angle matters because modern life essentially detrains these muscles. Walking on flat, hard surfaces in supportive shoes gives the intrinsic foot muscles very little to do. Over decades, they atrophy from disuse, and by the time you’re in your 60s or 70s, the imbalance may have reached a tipping point. Spending some time barefoot on varied surfaces, even just around the house, gives these muscles a reason to fire. It won’t reverse severe deformity, but as a long-term maintenance strategy for foot health, it costs nothing and carries minimal risk for anyone with intact sensation in their feet. People with neuropathy or active wounds should consult their doctor before going barefoot, since they can’t rely on pain signals to alert them to injury.