A hammertoe is a toe that's curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. Otherwise, any differences between hammertoe and mallet toe are subtle. Both hammertoe and mallet toe are commonly caused by shoes that are too short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a hammer-like or claw-like appearance. Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you may need surgery to experience relief.

Causes of Hammer Toes

A common cause of hammertoe and mallet toe is wearing improper footwear — shoes that are too tight in the toe box, or high-heel shoes. Wearing shoes of either type can push your toes forward, crowding one or more of them into a space that's not large enough to allow your toes to lie flat. Hammertoe and mallet toe deformities can also be inherited and may occur despite wearing appropriate footwear. The result is a toe that bends upward in the middle and then curls down in a hammer-like or claw-like shape. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses. The bottom of the affected toe can press down, creating the mallet-like appearance of mallet toe. At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff.

Other causes of hammertoe and mallet toe may include:

• An injury in which you jam or break your toe
• Abnormal foot mechanics because of nerve and muscle damage to your toe resulting from diabetes (diabetic neuropathy)
• Other diseases that affect nerves and muscles, such as arthritis or stroke

Signs & Symptoms of Hammer Toes

Signs and symptoms of hammertoe and mallet toe may include:

• A hammer-like or claw-like appearance of a toe
• In mallet toe, a deformity at the end of the toe, giving the toe a mallet-like appearance
• Pain and difficulty moving the toe
• Corns and calluses resulting from the toe rubbing against the inside of your footwear

Both hammertoe and mallet toe can cause pain with walking and other foot movements. 

Diagnosis of Hammer Toes

Your doctor can diagnose hammertoe or mallet toe by examining your foot.

Treatments of Hammer Toes

If your toe is still flexible, your doctor may recommend that you change to roomier and more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Wearing inserts or pads can reposition your toe and relieve pressure and pain. If your toe has become tight and inflexible, your doctor may recommend surgery. The specific procedure depends on how much flexibility is left in your toe:

• If your toe has some flexibility, your doctor may straighten it by making an incision in the toe and releasing the tendon.
• If your toe is rigid, your doctor may not only cut or realign tendons but also remove some pieces of bone to straighten your toe. This procedure may require that the bones be fixed temporarily with pins while your toe heals.

Usually, you can go home from the hospital on the day of your toe surgery.

Prevention of Hammer Toes

You can avoid many foot, heel and ankle problems with shoes that fit properly. Here's what to look for when buying shoes:

• Adequate toe room. Avoid shoes with pointed toes.
• Low heels. Avoiding high heels will help you avoid back problems.
• Adjustability. Laced shoes are roomier and adjustable.
• Comfort. Select comfortable athletic shoes, strapped sandals or soft, roomy pumps with cushioned insoles.
• Breathability. Avoid vinyl and plastic shoes. They don't breathe when your feet perspire.

These additional tips may help you buy the right shoes:

• Buy shoes at midday. Your feet are smaller in the morning and swell throughout the day.
• Measure both feet. Your feet may not be the same size.
• Don't assume your shoe size hasn't changed. As you age, your shoe size may change — especially the width.
• Ask for just the right fit. Have your shoe store stretch shoes in tight spots.

When to seek Medical Advice

See your doctor if you have foot pain that's persistent and that affects your ability to walk properly and carry out other motions with your foot. Also, see your doctor if one or more of your toes has developed a clenched or claw-like appearance.