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Health condition · Clinically reviewed

Hammer, claw and mallet toe, lesser-toe deformities — insoles, PIP arthroplasty and arthrodesis.

Progressive lesser-toe deformities from muscle imbalance or crowding. Flexible deformities respond to shoe changes and toe crest pads; fixed deformities need surgery — PIP arthroplasty or arthrodesis.

Jump to treatment See red-flag toe pain
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against BOFAS, NICE CKS or peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK guidance on conservative care, PIP arthroplasty and arthrodesis.

Key facts

Lesser-toe deformities at a glance.

The essentials, in plain English — what hammer, claw and mallet toes are, why the flexible-versus-fixed distinction matters, and what the evidence says actually helps.

  • Definition

    A lesser-toe deformity — hammer toe is PIP flexion, claw toe is combined PIP, DIP and MTP deformity, mallet toe is DIP flexion alone.

  • Most common toe

    The second toe is the most commonly affected — often longer than the first and crowded by a coexisting bunion.

  • Rarely isolated

    Frequently coexists with hallux valgus (bunion) and metatarsalgia — the forefoot is best assessed as a whole.

  • Flexible vs fixed

    Whether the deformity can be passively corrected determines everything — conservative care for flexible, surgery for fixed.

  • Coleman block test

    A simple examination test that assesses hindfoot flexibility and helps guide surgical planning for the lesser toes.

  • Modern implants

    PIP arthroplasty using absorbable implants avoids protruding K-wires and gives a stable, cosmetic result.

Why this guide matters

Flexibility first, surgery second.

Whether the toe can still be passively corrected changes everything — this guide sets out that logic clearly so you know which path applies to you.

  • Flexible deformities have real conservative options

    Wider shoes, crest pads and metatarsal domes genuinely help while the toe still corrects passively.

  • Fixed deformities need surgical correction

    Once the joint is stiff, insoles will not straighten it — PIP arthroplasty or arthrodesis is the honest answer.

  • The whole forefoot is assessed together

    Bunion, metatarsalgia and lesser-toe deformity often coexist and are best planned as a single operation.

How the diagnosis is made

From a rubbing corn to a clear plan.

The steps a UK GP or foot and ankle surgeon will normally follow, in order — so you know what to expect and why.

  1. 01

    Recognising

    Symptom and footwear history

    Which toe, how long, what shoes make it worse — narrow toe-boxes and high heels are classic aggravators.

  2. 02

    Recognising

    Toe alignment examination

    Inspection of each lesser toe for PIP, DIP and MTP posture, dorsal corns and plantar callus patterns.

  3. 03

    Recognising

    Flexibility test

    Passive correction of the deformity — a flexible toe reduces to neutral; a fixed one does not, and that changes the plan.

  4. 04

    Confirming

    Coleman block test

    Assesses whether the hindfoot is flexible or rigid — a key check before considering lesser-toe surgery.

  5. 05

    Confirming

    Standing X-ray of the foot

    Weight-bearing views show the true alignment of the forefoot and any coexisting bunion or metatarsal length issues.

  6. 06

    Confirming

    Assess coexisting problems

    Bunion, metatarsalgia and crossover second toe often travel together — the surgical plan needs to address them together.

  7. 07

    Managing

    Foot and ankle surgery consultation

    For fixed deformities or symptoms failing conservative care — discuss PIP arthroplasty, arthrodesis and any combined bunion correction.

Typical timeline: 2–4 weeks from first appointment to a settled plan.

Symptoms

What a lesser-toe deformity actually looks like.

The joint pattern names the deformity — PIP, DIP or MTP — while corns, callus and a coexisting bunion complete the picture.

  • PIP joint contracture

    The classic hammer-toe posture — flexion at the proximal interphalangeal joint of the lesser toe.

  • DIP joint contracture

    Mallet-toe deformity — a flexion contracture at the distal interphalangeal joint, often with a nail-tip callus.

  • MTP hyperextension

    Claw-toe pattern — the metatarsophalangeal joint sits in extension, with PIP and DIP flexed.

  • Corn over the PIP

    A firm corn on the dorsum of the toe from repeated pressure against the shoe upper — a common presenting complaint.

  • Plantar callus

    Thickened skin under the metatarsal head — reflects abnormal load transfer from the deformed toe.

  • Coexistent bunion

    Hallux valgus crowding the lesser toes — a very common companion, especially with second-toe deformity.

  • Crossover toe

    The second toe drifting over the great toe — usually reflects plantar plate insufficiency at the MTP joint.

  • Red flag

    An acute painful red swollen toe with fever — think septic joint or gout rather than a hammer-toe flare.

Treatment

How lesser-toe deformities are treated in the UK.

A staged approach — footwear, pads and insoles for flexible deformities, and PIP arthroplasty or arthrodesis for fixed ones.

  • Wide toe-box shoes

    A wider, deeper toe-box removes the dorsal pressure that drives corn formation — a genuine, evidence-backed first step.

  • Toe crest pads and splints

    Small silicone pads that support the lesser toes into a straighter position — helpful for flexible deformities.

  • Silicone toe sleeves

    Cushion the corn or callus over the PIP and reduce daily friction from footwear.

  • Metatarsal dome insoles

    Redistribute load away from the painful metatarsal heads — a very useful adjunct where metatarsalgia coexists.

  • Physiotherapy (early flexible)

    Stretching, intrinsic-muscle strengthening and taping — most useful when the deformity is still fully correctable.

  • Percutaneous flexor tenotomy

    A minimally invasive procedure for flexible deformity — release of the long flexor tendon under local anaesthetic.

  • PIP arthroplasty

    Resection of the head of the proximal phalanx to correct fixed PIP deformity — modern absorbable implants avoid protruding wires.

  • PIP arthrodesis

    Fusion of the PIP joint using a K-wire or dedicated implant — a definitive, durable correction for fixed deformity.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, podiatrist or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Patient information and clinical standards.

  • NICE CKS. Hammer toe — assessment and management.

  • Royal College of Podiatry. Guidance on lesser-toe deformities.

  • American Orthopaedic Foot & Ankle Society (AOFAS). Patient education on hammer, claw and mallet toe.

Red flags

When toe pain is not just a hammer toe.

Most lesser-toe deformity is mechanical and manageable. These are the situations where a different diagnosis or urgent pathway needs to be considered.

  • Septic joint

    Acute red, hot, swollen toe with fever or systemic upset — needs urgent assessment to exclude joint infection.

  • Diabetic ulcerated deformity

    Any skin breakdown over a lesser-toe deformity in a person with diabetes — urgent podiatry and diabetic foot team review.

  • Post-op non-union

    Persistent pain, swelling or movement after PIP arthrodesis — imaging and surgical review to check for failed fusion.

  • Nerve injury (digital)

    Numbness or burning in the toe after surgery may reflect injury to the small digital nerves — flag it early.

  • Complex regional pain syndrome

    Disproportionate pain, colour and temperature changes weeks after surgery — needs early recognition and referral.

  • Vascular compromise post-op

    A dusky, cold or blistering toe after surgery — surgical emergency, contact the operating team immediately.

  • Recurrent deformity

    Return of the deformity months or years after surgery — reassessment before any repeat procedure.

  • Rheumatoid forefoot

    Multiple lesser-toe deformities with MTP synovitis and hallux valgus — needs rheumatology input alongside surgery.

  • Charcot foot with lesser-toe collapse

    Lesser-toe deformity with a warm, swollen midfoot in a person with diabetes — urgent Charcot pathway.

Living with it

A slow condition, but a very manageable one.

Four things that make the biggest difference day to day — footwear, pads, skin care and timely review.

A quiet reminder

Get seen while the toe is still flexible.

The earlier a lesser-toe deformity is assessed, the more conservative options are still on the table.

  1. 01 Footwear

    Wider, deeper, softer

    A well-chosen shoe with a generous toe-box does more day-to-day than any pad or splint on its own.

  2. 02 Pads

    Use pads consistently

    Crest pads, toe sleeves and metatarsal domes only work if worn every day — treat them like glasses, not jewellery.

  3. 03 Skin care

    Look after corns and callus

    Regular podiatry keeps skin lesions from becoming ulcers — especially if you have diabetes or reduced sensation.

  4. 04 Reviews

    Reassess before it stiffens

    A flexible deformity has far more options than a fixed one — get seen while things can still be passively corrected.

Frequently asked

Everything we get asked about lesser-toe deformities.

Quick answers on the differences between hammer, claw and mallet toe, when to consider surgery, and what PIP procedures involve.

  • What is the difference between hammer, claw and mallet toe?

    They are all lesser-toe deformities defined by which joint is bent. Hammer toe is flexion at the PIP joint. Mallet toe is flexion at the DIP joint. Claw toe combines PIP and DIP flexion with hyperextension at the MTP joint. The distinction matters because it changes both the examination and the operation.

  • Which toe is most commonly affected?

    The second toe — often because it is longer than the first and gets crowded by a coexisting bunion. Second-toe deformity, hallux valgus and metatarsalgia frequently travel together as a forefoot problem.

  • Do I need surgery, or will insoles fix it?

    It depends on whether the deformity is flexible or fixed. A flexible toe often responds well to wider shoes, crest pads, silicone sleeves and metatarsal domes. A fixed deformity that is painful will usually need surgery — PIP arthroplasty or arthrodesis.

  • What is the Coleman block test?

    A simple examination in which you stand on a small block with the outer part of your foot on the block and the inner heel and first toe off it. It assesses whether the hindfoot is flexible or rigid, and helps guide lesser-toe surgical planning.

  • What does PIP arthroplasty involve?

    A small piece of bone is removed from the head of the proximal phalanx to correct the joint deformity. Modern techniques use absorbable implants that hold the correction from the inside — avoiding the older protruding K-wires that stuck out of the toe for weeks.

  • When is arthrodesis (fusion) chosen instead?

    PIP arthrodesis fuses the joint permanently and is often preferred for rigid deformities, revision cases, or people who need a very durable correction. It is a solid, predictable operation, though the joint will no longer bend.

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