Small toe deformities are bent lesser toes that rub on footwear and form corns. They start flexible and, untreated, become fixed. While the toe is still flexible, footwear changes and exercises help; a fixed, painful toe is corrected surgically, which is highly effective.
Symptoms
- A toe bent at a joint, rubbing on shoes
- Corns on the knuckle or tip
- Three patterns: hammer (middle joint), claw (middle and end joints), mallet (tip joint)
- An advanced toe can ride over or under its neighbour
Causes & risk factors
- Toe muscle imbalance
- Tight, pointed footwear and high heels
- An associated bunion crowding the second toe
- A high-arched (cavus) foot
- Neurological conditions or rheumatoid arthritis
Conservative treatment comes first
- A deep toe-box shoe
- Gel sleeves and foam pads
- Podiatry to reduce corns
- Toe-strengthening exercises while the toe is still flexible
- The corn is the symptom — unless the toe position is addressed, it recurs
When surgery is considered
A flexible hammer or mallet toe is treated with a tendon transfer that keeps it mobile; a fixed hammer toe is reshaped or fused straight for durability; a claw toe with a dislocating joint needs a joint release, plantar-plate repair and Weil osteotomy. Mostly day-case — normal footwear at 6–8 weeks, swelling settling over 3–6 months.
Questions & answers
A flexible toe can improve with early treatment, but a deformity rarely corrects itself once established.
The corn is caused by the bent toe pressing on the shoe. Until the toe position is corrected, the corn recurs.
Yes, they are often treated in the same operation, as a bunion frequently drives the neighbouring hammer toe.
Sources & further reading
- OrthoInfo (AAOS) — Hammer Toe
- BOFAS patient information
