7 Common Hammertoe and Mallet Toe Symptoms You Should Know

Hammertoe and mallet toe are foot deformities that occur due to an imbalance in the muscles, tendons, or ligaments that normally hold the toe straight. In hammertoe, the abnormal bend occurs in the middle joint of the toe, while mallet toe affects the joint nearest to the tip of the toe. These conditions typically affect the second, third, or fourth toes and can develop gradually over time.

Understanding the symptoms of hammertoe and mallet toe is crucial for early detection and management. While these conditions may start as mild and flexible, they can progress to become rigid and more painful if left unaddressed. Recognizing the warning signs can help you seek appropriate medical attention and prevent further complications.

1. Abnormal Toe Bending

The most characteristic symptom of hammer toe is an abnormal bend or curl in one or more toes. In hammertoe, the middle joint of the toe bends downward, creating a hammer-like or claw-like appearance. The affected toe resembles an upside-down “V” when viewed from the side.

In mallet toe, the bend occurs at the joint closest to the tip of the toe, causing the end of the toe to bend downward. Initially, the toe may still be flexible and can be straightened manually. However, as the condition progresses, the tendons tighten and the toe becomes rigid, making it difficult or impossible to straighten without intervention.

This abnormal positioning can cause the toe to rub against the inside of shoes, leading to additional complications such as corns, calluses, and skin irritation. The deformity is usually most noticeable when wearing shoes or when bearing weight on the foot.

2. Pain and Discomfort

Pain is one of the most common and bothersome symptoms associated with hammer toes. The discomfort can range from mild irritation to severe pain that interferes with daily activities and mobility. The pain typically develops gradually and worsens over time as the deformity progresses.

Most people experience pain in two main areas:

• At the bent joint: Pain occurs where the toe bends abnormally, especially when pressure is applied from footwear
• At the tip of the toe: Discomfort develops when the tip of the bent toe presses against the ground or shoe
• At the base of the toe: Pain may radiate to where the toe connects to the foot, particularly when walking or standing

The pain is often worse when wearing shoes, especially those with narrow toe boxes or high heels. Many people find relief when walking barefoot or wearing open-toed shoes. The discomfort may also intensify after prolonged periods of standing or walking, and may improve with rest.

3. Corns and Calluses

Corns and calluses are thick, hardened layers of skin that develop as a protective response to repeated friction and pressure. These are extremely common in people with hammertoe and mallet toe conditions, often appearing in predictable locations.

Corns typically form on the top of the bent joint where the toe rubs against the shoe. They appear as small, round, raised bumps with a hard center surrounded by inflamed skin. These can be quite painful, especially when pressure is applied.

Calluses tend to develop on the ball of the foot beneath the affected toe. When a toe is bent abnormally, it changes the way weight is distributed across the foot, often causing increased pressure on the metatarsal heads. This results in thickened, tough skin patches that may be less sensitive than corns but can still cause discomfort.

Some people also develop corns between the toes where adjacent toes rub against each other, known as soft corns or interdigital corns. These remain softer due to moisture between the toes but can be equally uncomfortable.

4. Inflammation and Redness

Inflammation and redness around the affected toe are common symptoms that indicate irritation and stress on the joints and surrounding tissues. The affected toe may appear swollen, puffy, and noticeably red compared to the other toes.

This inflammatory response occurs for several reasons. The abnormal positioning of the toe creates constant friction against footwear, irritating the skin and underlying tissues. The joints themselves may become inflamed due to the unnatural angle at which they’re being held, leading to joint inflammation similar to arthritis.

The redness is often most pronounced over the bent joint and any areas where corns have developed. The skin may feel warm to the touch and appear shiny or taut when swelling is present. In some cases, the inflammation can extend to the surrounding toes or the ball of the foot.

These symptoms typically worsen throughout the day, especially after wearing shoes or engaging in physical activity. The inflammation may subside somewhat with rest and elevation but tends to return with activity if the underlying condition is not addressed.

5. Limited Toe Mobility

As hammertoe or mallet toe progresses, one of the most concerning symptoms is the gradual loss of toe mobility. In the early stages, the affected toe remains flexible, meaning you can manually straighten it or move it through its normal range of motion, even though it returns to the bent position when released.

However, over time, the tendons and ligaments that control toe movement become progressively tighter and shorter due to being held in the contracted position. This leads to a rigid or fixed deformity where the toe can no longer be straightened, even with manual manipulation.

The loss of mobility follows a predictable pattern:

• Early stage: The toe can be easily straightened by hand and the joint moves freely
• Intermediate stage: The toe can still be straightened but requires more force and may be slightly uncomfortable
• Advanced stage: The toe is rigid and cannot be straightened without medical intervention

This reduced mobility can affect your ability to walk normally, as the toes play an important role in balance and pushing off during the walking cycle. Many people compensate by altering their gait, which can lead to additional problems in the feet, ankles, knees, or hips.

6. Difficulty Wearing Shoes

Many people with hammer toes experience significant difficulty finding comfortable footwear. The abnormally bent toe creates challenges that go beyond simple discomfort, often making it necessary to significantly alter shoe choices or sizes.

The protruding bent joint creates a high point that doesn’t fit well in standard shoe designs. This causes the top of the shoe to press down on the joint, leading to pain, pressure, and the development of corns. Many people find that shoes that once fit comfortably now feel too tight or restrictive in the toe box.

Common footwear challenges include:

• Inability to wear closed-toe shoes without pain
• Difficulty wearing dress shoes, high heels, or shoes with pointed toes
• Needing to purchase shoes in larger sizes to accommodate the bent toe
• Experiencing pressure points and rubbing even in properly sized shoes
• Limited shoe style options that provide adequate room for the deformity

This symptom often has a significant impact on quality of life, affecting professional dress codes, social situations, and participation in activities. Many people resort to wearing only athletic shoes, sandals, or specially designed footwear with extra depth in the toe box.

7. Changes in Gait and Walking Pattern

The presence of hammertoe or mallet toe often leads to noticeable changes in how a person walks. These gait alterations develop as the body attempts to compensate for the pain, discomfort, and structural changes in the foot.

When toes don’t function properly, they can’t fulfill their normal role in the walking cycle. Healthy toes help with balance, weight distribution, and pushing off during the propulsion phase of walking. When this function is compromised, people unconsciously modify their walking pattern to avoid pain and pressure on the affected toe.

Common gait changes include:

• Shortened stride: Taking smaller steps to reduce pressure on the affected toe
• Weight shifting: Placing more weight on the outer edge of the foot or on unaffected toes
• Reduced push-off: Less forceful toe-off phase when stepping forward
• Limping: Favoring the unaffected foot or walking with an uneven rhythm
• Altered foot strike: Changing how the foot initially contacts the ground

While these compensatory patterns may provide temporary relief, they can lead to secondary problems over time. Abnormal gait mechanics can cause pain and strain in other parts of the foot, ankles, knees, hips, and even the lower back. Some people develop calluses or pain in new locations as pressure points shift.

Main Causes of Hammertoe and Mallet Toe

Understanding what causes these toe deformities can help with prevention and early intervention. Several factors contribute to the development of hammer toes:

Improper Footwear

Wearing shoes that are too tight, too narrow, or have high heels is one of the most common causes. These shoes force the toes into a cramped position, eventually causing the muscles and tendons to remain contracted even when the shoes are removed. Women are more frequently affected due to wearing high heels and pointed-toe shoes.

Toe Injuries

Trauma to the toe, such as stubbing, jamming, or breaking a toe, can increase the risk of developing hammertoe or mallet toe. The injury may damage the structures that keep the toe straight or cause scar tissue that pulls the toe into an abnormal position.

Muscle Imbalance

When the muscles that control toe movement become imbalanced, with some muscles becoming stronger or tighter than others, the toe can be pulled into a bent position. This imbalance may develop due to foot structure, neurological conditions, or prolonged poor positioning.

Foot Structure and Genetics

Some people are born with or inherit a foot structure that makes them more susceptible to developing hammer toes. Having particularly long toes, high arches, or flat feet can increase the risk. If family members have hammer toes, you may be more likely to develop them as well.

Arthritis

Inflammatory joint conditions, particularly rheumatoid arthritis and osteoarthritis, can affect the joints in the toes. The inflammation and joint damage associated with arthritis can lead to toe deformities over time.

Neurological Conditions

Certain neurological or neuromuscular conditions that affect nerve function and muscle control can contribute to hammer toe development. Conditions such as diabetes with peripheral neuropathy, stroke, or Charcot-Marie-Tooth disease may increase risk.

Age

The risk of developing hammertoe increases with age as tendons and ligaments lose elasticity, and the cumulative effects of footwear choices and foot mechanics take their toll over the years.

Prevention Tips

While not all cases of hammertoe and mallet toe can be prevented, especially those related to genetics or underlying medical conditions, there are several steps you can take to reduce your risk or prevent these conditions from worsening:

Choose Appropriate Footwear

Select shoes with adequate room in the toe box that allow your toes to lie flat and move freely. Avoid shoes with pointed toes or excessively high heels. Ensure there’s at least a half-inch of space between your longest toe and the end of the shoe. Choose shoes made from soft, flexible materials that don’t squeeze or compress the toes.

Wear Proper Shoe Size

Have your feet measured regularly, as foot size can change over time, especially after pregnancy or with age. Always try shoes on at the end of the day when feet are at their largest. Never assume you’re the same size in every brand or style.

Perform Toe Exercises

Regular toe exercises can help maintain flexibility and strength in the toe muscles and tendons. Try picking up marbles or small objects with your toes, stretching your toes by pulling them gently, or using your toes to crumple a towel placed on the floor. These exercises are especially beneficial if you notice early signs of toe deformities.

Use Protective Pads

If you notice early signs of hammer toe development, protective pads or cushions can help reduce friction and pressure on the affected toe, preventing the formation of painful corns and calluses and slowing progression.

Maintain Healthy Weight

Keeping a healthy body weight reduces the stress and pressure on your feet, which can help prevent or slow the development of foot deformities.

Address Foot Problems Early

If you notice any signs of hammer toe development or experience persistent foot pain, consult a healthcare provider early. Flexible hammer toes are much easier to manage than rigid ones, and early intervention can prevent progression.

Manage Underlying Health Conditions

If you have diabetes, arthritis, or neurological conditions, work with your healthcare provider to manage these conditions effectively, as they can contribute to foot problems including hammer toes.

Frequently Asked Questions

Can hammertoe go away on its own?

Hammertoe will not resolve on its own without intervention. However, in the early flexible stage, exercises, proper footwear, and orthotic devices may prevent progression and reduce symptoms. Once the toe becomes rigid, the deformity is permanent without medical procedures.

How can I tell the difference between hammertoe and mallet toe?

The main difference lies in which joint is affected. Hammertoe involves an abnormal bend in the middle joint of the toe (proximal interphalangeal joint), while mallet toe affects the joint nearest to the tip of the toe (distal interphalangeal joint). Both can cause similar symptoms but occur at different locations.

Are hammer toes painful?

Not all hammer toes are painful, especially in the early stages. However, as the condition progresses, pain typically develops due to pressure from footwear, corn and callus formation, and joint inflammation. The severity of pain varies from person to person.

What type of shoes should I wear if I have hammertoe?

Choose shoes with a wide and deep toe box that doesn’t press on the bent toe, soft flexible materials, low heels (no higher than 2 inches), and adequate cushioning. Athletic shoes, comfort shoes designed for foot problems, and sandals with adjustable straps are often good options. Avoid high heels, pointed-toe shoes, and tight-fitting footwear.

Can exercises fix hammertoe?

Exercises can help in the early flexible stage of hammertoe by strengthening muscles and maintaining joint flexibility, potentially preventing progression. However, once the toe becomes rigid and fixed in position, exercises alone cannot reverse the deformity, though they may still help with symptom management.

When should I see a doctor for hammer toe?

You should consult a healthcare provider if you notice any abnormal bend in your toe, experience persistent pain or discomfort in your toes, develop corns or calluses that don’t improve with home care, have difficulty finding comfortable footwear, or notice the condition is worsening. Early evaluation is especially important if you have diabetes or circulatory problems.

Is hammertoe hereditary?

While hammertoe itself is not directly inherited, certain foot structures and mechanical characteristics that predispose someone to developing hammer toes can run in families. If your parents or siblings have hammer toes, you may have an increased risk of developing them, especially if combined with other risk factors like improper footwear.

Can hammertoe affect my ability to walk?

Yes, hammertoe can affect walking ability, particularly as the condition progresses. The pain, altered foot mechanics, and compensatory gait changes can make walking uncomfortable and less efficient. Severe cases may significantly impact mobility and quality of life, making it difficult to participate in normal daily activities or exercise.

References:

• Mayo Clinic – Hammertoe and Mallet Toe
• American Academy of Orthopaedic Surgeons – Hammertoes
• American Orthopaedic Foot & Ankle Society – Hammer Toe
• NHS – Hammer Toe
• Cleveland Clinic – Hammertoe