A toe that gradually curls or bends downward is almost always one of a handful of well-understood deformities, with hammer toe being the most common. The bend usually happens at the middle joint of a lesser toe (the second through fifth), and it develops because of an imbalance between the muscles, tendons, and ligaments that normally hold the toe straight. The specific cause ranges from years of wearing tight shoes to nerve damage from diabetes, and the treatments span from simple taping or padding all the way to surgery depending on how far the deformity has progressed.
Hammer Toe, Claw Toe, and Mallet Toe
The name your doctor uses depends on which joint is bent and in which direction. A hammer toe bends downward at the middle joint of the toe. A claw toe does the same thing but also extends upward at the joint closest to the foot, giving the toe a claw-like appearance. A mallet toe bends at the joint nearest the tip. In practice, these terms get used loosely, but the key distinction between hammer toe and claw toe is whether that base joint lifts upward. A literature review in podiatric medicine proposed that the upward extension at the base joint is the defining characteristic of claw toe, while downward bending at the middle joint alone is the single criterion for hammer toe.1PubMed. Definitions of hammer toe and claw toe: an evaluation of the literature
These distinctions matter because the treatments differ. A toe that only bends at one joint is usually easier to manage conservatively than one that is deformed at two joints. Claw toes, with their characteristic upward-and-downward posture, tend to be more associated with neurological conditions and can be harder to correct once they stiffen.
The Most Common Culprit Is Footwear
Shoes that crowd the toes, especially ones with a narrow toe box, force the smaller toes into a bent position for hours at a time. Over months and years, the tendons on the underside of the toe shorten and tighten, eventually holding the toe in that bent shape even when you’re barefoot. High heels compound the problem by shifting body weight onto the ball of the foot, increasing pressure on the toe joints. A biomechanical model of high-heeled shoes found that heel elevation alone significantly increased stress on the first toe joint, and that when combined with a tight toe box, the risk of forefoot deformity rose further.2Hong Kong Polytechnic University Institutional Repository. Development of a computational foot model for biomechanical evaluation of high-heeled shoe designs
This does not mean heels inevitably cause bent toes. Many people wear heels for decades without developing a hammer toe. But the combination of a cramped toe box plus an elevated heel is the single most controllable risk factor. If you’ve noticed a toe starting to curl and you regularly wear pointed or narrow shoes, that is the first thing to change.
Muscle Weakness and the Role of Intrinsic Foot Muscles
Your foot has two sets of muscles controlling the toes. The extrinsic muscles originate in the lower leg and power the big movements, while the intrinsic muscles live entirely within the foot itself and are responsible for fine stabilization. When the intrinsic muscles weaken or waste away, the extrinsic muscles overpower them and pull the toes into bent positions. Measuring intrinsic foot muscle strength is technically challenging; researchers have found that hand-held devices can reliably assess it, but the difficulty of measurement means these muscles are often overlooked in clinical settings.3PubMed Central. Importance and challenges of measuring intrinsic foot muscle strength
This muscle imbalance is the underlying engine behind most bent-toe deformities, regardless of the trigger. Tight shoes, aging, nerve damage, and inflammatory disease can all weaken or tighten different parts of the system, but the result is the same: the balance tips, and the toe buckles.
When Diabetes or Nerve Damage Is the Cause
Diabetic neuropathy is one of the more serious reasons toes bend. When the nerves supplying the foot’s intrinsic muscles are damaged, those muscles shrink. A study comparing diabetic patients with and without claw toes found that people who had both neuropathy and claw toes had markedly smaller intrinsic foot muscles than any other group, including people who had neuropathy alone or claw toes alone.4PubMed Central. Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet The combination of nerve damage plus the resulting muscle wasting appears to be what tips the foot into deformity, rather than either factor on its own.
The consequences go beyond appearance. When toes curl upward at the base and downward at the middle, the fat pads that normally cushion the ball of the foot get pulled forward and displaced. This exposes the bony undersurface of the metatarsal heads, and pressure during walking spikes in those unprotected areas. Research on neuropathic diabetic patients with claw or hammer toe deformity confirmed this pattern: the bent toes shifted load from the tips of the toes back toward the ball of the foot, creating dangerously elevated pressures.5PubMed. Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity Because neuropathy also dulls sensation, people may not feel the damage being done, which is how diabetic foot ulcers begin.
Other neurological conditions that affect the nerves to the feet can produce the same pattern. Charcot-Marie-Tooth disease, spinal cord injuries, and stroke can all lead to progressive claw or hammer toe deformity through the same mechanism of intrinsic muscle wasting.
Plantar Plate Tears and Crossover Toe
Sometimes a toe drifts or bends not because of muscle imbalance but because a key stabilizing structure underneath the toe joint has torn. The plantar plate is a thick band of fibrous tissue on the underside of each lesser toe joint, and it acts like a sling holding the toe down against the ground. When it tears or wears through, the toe loses its anchor and begins to drift upward, sideways, or both. The second toe is the most commonly affected. The injury usually happens through chronic wear rather than a single traumatic event, though it can also occur with acute trauma or in people with rheumatoid arthritis.6Orthopaedics and Trauma. Plantar plate rupture: aetiology, diagnosis and treatment
As the joint becomes unstable from a plantar plate tear, the toe can cross over the adjacent toe, a condition called crossover toe. This happens because once the joint subluxates upward, a small muscle on the inner side of the toe gets trapped by a ligament and starts pulling the toe sideways instead of stabilizing it.7PubMed Central. Correction of Crossover Toe Deformity by Arthroscopically Assisted Plantar Plate Tenodesis If you’ve noticed your second toe gradually drifting toward or over your big toe, a plantar plate problem is a likely explanation. Early-stage plantar plate injuries can be treated with taping, stiff-soled shoes, and anti-inflammatory measures, but once the toe has visibly crossed, surgery is usually needed.
Bent Toes in Children
Not every bent toe is acquired. Congenital curly toes are common in infants and toddlers, where one or more toes curl under or overlap. The fourth toe is the most commonly affected, followed by the fifth. A systematic review found that these deformities mostly show up in young children and are often brought to a doctor because of parental concern about appearance rather than pain.8PubMed Central. Congenital Curly Toes in the Pediatric Population: A Management Algorithm and Systematic Review
The good news for parents is that mild cases often improve on their own or with simple taping. A prospective study of newborns with curly or overlapping toes found the condition in roughly 3% of babies, and taping corrected the problem in 94% of affected toes with no complications.9Paediatrics & Child Health. Prospective study of a noninvasive treatment for two common congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes) For more severe cases that don’t respond to conservative measures, a minor surgical procedure to release or transfer the flexor tendon typically resolves the deformity. Because many curly toes never cause symptoms, the decision to treat is often about trajectory: if the toe is worsening or starting to cause pressure problems in shoes, intervention makes sense. If it’s mild and stable, watching and waiting is reasonable.
The Bunion Connection
Bent lesser toes and bunions often travel together. A bunion pushes the big toe sideways into the second toe’s territory, crowding it and sometimes forcing it upward into a hammer toe position. When both problems coexist, treating the hammer toe alone without addressing the bunion tends to produce disappointing results. Research on hammertoe surgery failure found that performing first ray surgery (a procedure on the big toe or its metatarsal, which includes bunion correction) at the same time as hammertoe repair cut the recurrence risk roughly in half.10PubMed. Risk Factors for Failure in Hammertoe Surgery
On the outer edge of the foot, a similar but less common deformity called a tailor’s bunion can develop. This is a bony bump on the outside of the fifth metatarsal head. Despite being fairly common, it rarely causes symptoms for most people.11PubMed. Tailor’s bunion: a review When it does, it’s usually because shoes press against the prominence. Wider footwear and padding resolve most cases without surgery.
Non-Surgical Treatments That Actually Help
If you catch a bent toe while it’s still flexible, meaning you can manually straighten it with your fingers, you have a window to slow or stop progression without surgery. The options are straightforward:
- Roomy shoes: A wide, deep toe box lets the toes spread naturally and removes the compressive force that worsens deformity.
- Toe splints and pads: Gel sleeves, crest pads (which sit under the toe to support it), and buddy-taping can reduce pain and keep the toe in a better position.
- Stretching and strengthening: Exercises like towel scrunches and marble pickups target the intrinsic foot muscles. The evidence for these is modest, but since the underlying problem is muscle imbalance, strengthening the weaker side of the equation makes mechanical sense.
- Custom orthotics: For people whose toe deformity is driven by an abnormal arch or gait pattern, a molded insole can redistribute pressure and slow progression.
Conservative measures work best for flexible deformities. Once the joint has stiffened into a fixed position and you can no longer straighten the toe by hand, padding and splints can still reduce pain but won’t correct the shape. That’s when the conversation shifts to surgery.
Surgical Options and What to Expect
Hammertoe surgery generally involves either fusing the bent joint in a straight position (arthrodesis) or releasing the tight tendons and joint capsule to allow the toe to straighten. For decades, the standard approach has been an open procedure using pins or small implants to hold the fusion. A study of 100 feet treated with joint fusion for hammer toes used a combination of tendon release at the top of the toe and fusion at the middle joint, which remains a widely used approach.12PubMed. Treatment of symptomatic hammertoe with a proximal interphalangeal joint arthrodesis
Minimally invasive (percutaneous) techniques have gained ground in recent years. These use small incisions and burrs to reshape bone without fully opening the joint. A comparative study found that both open and minimally invasive approaches produced similar outcomes: bone healing took about 8 to 9 weeks in both groups, and return to activity averaged roughly 10 weeks regardless of technique.13The Journal of Foot and Ankle Surgery. Minimally Invasive versus Open Hammertoe Correction: A Retrospective Comparative Study The minimally invasive group had a slightly higher rate of recurrence (about 3% versus 0%), but the difference wasn’t statistically significant.
Complications exist with either approach. A review comparing open and percutaneous hammertoe correction found that open surgery had a higher infection rate (about 5% versus 2%), while the percutaneous group had more instances of impaired wound healing. Pin migration occurred in about 5.5% of open cases. Both groups saw significant pain improvement, with the percutaneous group reporting a somewhat larger drop in pain scores.14PubMed. Hammertoe Correction With K-Wire Fixation Compared With Percutaneous Correction
For bunions, surgical options range from minimally invasive bunionectomy to more involved procedures that realign the first metatarsal bone. A comparison of minimally invasive bunionectomy and a traditional modified Lapidus procedure found that both achieved similar correction on X-rays and similar patient-reported outcomes, though the minimally invasive procedure was significantly faster to perform.15PubMed Central. Early Radiographic Outcomes of Minimally Invasive Bunionectomy Compared to the Modified Lapidus Procedure Recurrence was uncommon in both groups.
What Predicts Whether Surgery Will Succeed
Not all hammertoe surgeries hold up equally well over time. A study examining risk factors for surgical failure found that second toes were more than twice as likely to recur as third or fourth toes. Having a larger sideways deviation of the toe before surgery also predicted worse outcomes, as did certain less conventional surgical techniques. The most protective factor was addressing the big toe at the same time: when first ray surgery was performed alongside the hammertoe repair, recurrence dropped by about 50%.10PubMed. Risk Factors for Failure in Hammertoe Surgery If your surgeon recommends fixing a bunion and a hammer toe in the same operation, this is likely why.
Why Bent Toes Shouldn’t Be Ignored in Older Adults
As the foot ages, ligaments and tendons degenerate, and deformities including claw toes, hammer toes, and bunions become increasingly common. These aren’t just cosmetic problems. Bent toes change how the foot contacts the ground and can lead to calluses, corns, and in people with poor circulation or sensation, skin breakdown and ulceration.
The fall risk is the one that tends to surprise people. A study of older adults found that those with lesser toe deformity were about 32% more likely to fall, and those with hallux valgus (bunion) were more than twice as likely to fall compared to people without these deformities. Toe flexor strength was also significantly lower in the fallers.16PubMed. ISB Clinical Biomechanics Award 2009: toe weakness and deformity increase the risk of falls in older people The toes play a bigger role in balance than most people realize. They grip the ground during the push-off phase of walking and help make micro-adjustments to keep you upright. When the toes can’t function properly because they’re bent and rigid, that stabilizing mechanism is compromised.
For older adults, this connection between toe deformity and falls means that even a seemingly minor hammer toe deserves attention. It doesn’t necessarily require surgery, but proper footwear, padding, and exercises to maintain whatever toe strength remains can be genuinely protective against a fall.
An Evolutionary Perspective on Why Feet Are Vulnerable
The human foot is remarkably specialized for upright walking, with its arches and parallel metatarsals representing evolutionary adaptations not found in other primates. A comparative survey of primate feet noted that the modern human foot is so precisely adapted to bipedal movement that even small deviations from its established structural pattern can produce debilitating problems. In other words, the foot works brilliantly when everything is aligned correctly, but it has very little margin for error. The toes, which in our primate relatives are long and flexible for gripping branches, have been shortened and stiffened in humans to aid push-off during walking. That stiffness comes at a cost: when muscles weaken, tendons shorten, or joints degenerate, the toes can’t compensate the way a more flexible appendage might. They buckle instead.
This also helps explain why toe deformities are so common in populations that wear restrictive footwear. The foot evolved for barefoot locomotion on varied terrain. Encasing it in a rigid, narrow shoe for most of waking life introduces forces the foot wasn’t designed to handle, and the toes, as the most distal and most constrained part of the foot, take the brunt of it.
When to See a Doctor
A bent toe that is still flexible, painless, and not worsening can often be managed with the conservative approaches described above. But certain signs warrant a visit to a podiatrist or orthopedic foot specialist sooner rather than later. If the toe is rigid and you can’t straighten it manually, progression to the point where conservative treatment is effective may have already passed. If you have diabetes or any condition that affects sensation in your feet, even a mild deformity needs professional monitoring because of the ulceration risk. If the toe is painful, swollen, or red at the joint, an inflammatory or infectious process could be at play. And if a toe has started crossing over its neighbor, the plantar plate damage driving the deformity won’t heal on its own.
Newer diagnostic tools are also making it easier for specialists to evaluate foot deformities. Weight-bearing CT scans, which image the foot while you’re standing on it, give a three-dimensional view of bone alignment under real-world loading conditions. This technology has become increasingly available over the past decade and can reveal subtle joint misalignments or bone deformities that standard X-rays miss, helping surgeons plan more precise corrections.