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Health condition · Clinically reviewed

Hammertoe and mallet toe, two joints, one biomechanical story.

Buckled middle joints, dropped tips, drifting neighbours - the lesser toes rarely fail alone. For the classical pattern in isolation, see our companion hammer toe guide.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered podiatric surgeon before publication.

  • 02

    Sourced from guidance

    Checked against NICE, the Royal College of Podiatry and peer-reviewed orthopaedic sources listed at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including minimally invasive correction, arthroplasty, arthrodesis and orthotic management.

Key facts

Lesser-toe deformity at a glance.

The essentials, in plain English - what hammertoe and mallet toe are, how they relate to claw and curly toe, and how they are treated in the UK today.

  • What it is

    A group of lesser-toe deformities where the toe buckles at one or more joints and rests in a flexed, prominent position.

  • Hammertoe

    Fixed or flexible flexion of the proximal interphalangeal joint (PIPJ) - the middle joint of the toe curls downward.

  • Mallet toe

    Flexion of the distal interphalangeal joint (DIPJ) - the tip of the toe drops so the nail catches the ground.

  • Claw and curly toe

    Related lesser-toe deformities involving the metatarsophalangeal joint or a rotational element - covered here too.

  • Biomechanics

    Flexor-extensor imbalance, long second ray, hallux valgus, cavus arch and neuropathy all drive the same final pattern.

  • Management

    Footwear, padding and custom orthotics for flexible deformity - surgical correction (arthroplasty or arthrodesis) for fixed, symptomatic disease.

Why this guide matters

Fix the mechanics, not just the corn.

Hammertoe, mallet toe, claw toe and curly toe are all variations on the same theme. Treat the driver behind the deformity and the outcomes get much better.

  • Flexibility decides the plan

    A toe that still straightens on push-up responds to footwear and orthotics. A fixed toe needs a surgical answer.

  • The neighbours matter

    Hallux valgus, hallux rigidus and a long second ray drive many lesser-toe deformities - correcting them together prevents recurrence.

  • Modern surgery is small-scar

    Percutaneous osteotomy and arthrodesis restore alignment through tiny incisions - a very different experience from older correction.

How the diagnosis is made

From painful corn to a clear plan.

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

  1. 01

    Assessing

    Foot exam - standing and seated

    A weight-bearing look at arch profile, hallux position, lesser-toe alignment and MTPJ stability - then a seated assessment of joint flexibility.

  2. 02

    Assessing

    Flexible or fixed?

    Push-up test at the metatarsal head - if the PIPJ straightens, the deformity is flexible and orthotic care may work. If not, it is fixed.

  3. 03

    Assessing

    Look for the driver

    Hallux valgus, second-ray overload, cavus arch, plantar plate tear, rheumatoid disease or diabetic neuropathy - the toe rarely acts alone.

  4. 04

    Confirming

    Weight-bearing X-ray

    Confirms joint position, metatarsal parabola and any subluxation or dislocation at the MTPJ - essential before surgical planning.

  5. 05

    Confirming

    MRI or ultrasound if needed

    Reserved for suspected plantar plate tears, tendon rupture or a lesion under the joint - not routine for isolated hammertoe.

  6. 06

    Preparing

    Vascular and neurological check

    Palpable pulses, capillary refill and light-touch sensation - especially important before considering surgery in older or diabetic feet.

  7. 07

    Preparing

    Shared decision on treatment

    Conservative first for flexible or mild disease. Surgical referral for fixed, painful, ulcerating or rapidly progressing deformity.

Typical timeline: from first consultation to a written plan in one or two visits.

Symptoms

What hammertoe and mallet toe look like.

The classical patterns - and the features that mean it is time to escalate from a corn plaster to a proper assessment.

  • Buckled middle joint (PIPJ)

    The hallmark of hammertoe - the middle joint flexes and sits proud, often catching on the toe box.

  • Dropped tip (DIPJ)

    Mallet-toe pattern - the end joint bends, the nail scuffs the floor and a callus forms at the tip.

  • Dorsal corn or callus

    A hard, painful corn over the prominent knuckle - caused by friction against the shoe upper.

  • Plantar keratosis

    Callus under the metatarsal head from off-loaded pressure - a sign the mechanics are wrong further back.

  • Cross-over or drifting toe

    The second toe pushing over or under the hallux - suggests a plantar plate tear or advanced MTPJ instability.

  • Claw toe pattern

    Extension at the MTPJ with flexion at both interphalangeal joints - often bilateral and linked to neurology or cavus arch.

  • Curly toe

    A congenital rotational deformity - the toe underlaps its neighbour. Common in children, often improves with growth.

  • Red flag - ulcer or discoloration

    Any open wound, bluish tip or non-blanching redness in a diabetic or vasculopathic foot needs same-day assessment.

Treatment

How hammertoe and mallet toe are treated.

Footwear, padding and orthotics for flexible or mild deformity - correction surgery for fixed, painful or ulcerating disease. See the linked services below for each option.

  • Footwear review

    A deep, wide toe box with a soft upper - the single most useful change for most people with lesser-toe deformity.

  • Toe padding and sleeves

    Silicone crest pads, gel sleeves and interdigital wedges reduce corn friction and gently redistribute pressure.

  • Custom orthotics

    A prescription insole with a metatarsal dome off-loads the ball of the foot and reduces flexor overpull.

  • Podiatry callus care

    Regular debridement of corns and calluses - relieves pain and lets the underlying skin recover.

  • Physiotherapy and toe exercises

    Intrinsic foot muscle work, towel scrunches and toe-yoga help flexible deformity, especially early on.

  • Cortisone injection

    A targeted steroid injection can settle inflammation from a plantar plate tear or MTPJ synovitis - see the linked service.

  • Hammertoe correction surgery

    Arthroplasty or arthrodesis of the PIPJ (with tendon transfer if needed) - the definitive answer for fixed, symptomatic disease.

  • Minimally invasive correction

    Percutaneous osteotomy and soft-tissue release through tiny incisions - a modern option for suitable cases.

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 podiatrist or foot-and-ankle surgeon knows your foot, gait and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Foot problems in adults - assessment and management.

  • Royal College of Podiatry. Standards of practice - lesser-toe deformities.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Patient information on hammertoe and claw toe.

  • International Working Group on the Diabetic Foot (IWGDF). Guidelines on foot deformity and ulcer prevention.

Red flags

When toe deformity needs urgent attention.

Most lesser-toe deformity is safely managed in primary care and podiatry. These situations are the exceptions - and where a specialist opinion is needed.

  • Open ulcer over the toe

    Any breakdown of skin over a bony prominence needs prompt review - especially in diabetes, vasculopathy or on steroids.

  • Rapidly progressive deformity

    Sudden new drift of the second toe or dislocation at the MTPJ suggests a plantar plate tear or inflammatory arthritis.

  • Cold, blue or dusky toe

    A vascular red flag - needs same-day assessment to exclude ischaemia, especially in smokers and people with diabetes.

  • New numbness or burning

    A new sensory change may point to a Morton neuroma, tarsal tunnel syndrome or peripheral neuropathy - not just a toe problem.

  • Rheumatoid features

    Symmetrical MTPJ pain, morning stiffness and joint swelling - consider an inflammatory arthritis and refer for bloods.

  • Post-surgical infection

    Increasing redness, pus, fever or wound breakdown after correction - urgent review at the operating unit.

  • Fall or trauma

    A recent fall with new deformity may hide a fracture or dislocation - see the linked foot-fracture guide.

  • Fixed and painful hallux

    A stiff, painful big toe (hallux rigidus) shifts load onto the lesser toes and drives new deformity - address both together.

  • Bilateral cavus arch in a child

    A high-arched, clawed foot in a child or teenager may be the first sign of a neurological condition - deserves a paediatric review.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - shoes with room, small daily kit, gentle joint work and knowing when to step up.

A quiet reminder

Small changes save toes.

A wider shoe, a silicone pad and daily stretches - unglamorous, and often the difference between comfort and surgery.

  1. 01 Footwear

    Give your toes room to breathe

    A deep, wide, soft-toed shoe with a firm heel counter beats any pad or brace. Measure late in the day when feet are largest.

  2. 02 Padding

    Small kit, big relief

    A silicone crest pad or gel sleeve worn daily can dramatically reduce corn pain - a good bridge while you plan longer-term care.

  3. 03 Movement

    Keep the joints supple

    Daily toe stretches, marble pickups and towel scrunches maintain flexibility - especially valuable for early, flexible deformity.

  4. 04 Escalate

    Don’t wait for a wound

    If pain limits walking or a corn keeps returning, surgical correction restores alignment - and modern techniques leave small scars.

Frequently asked

Everything we get asked about hammertoe and mallet toe.

Quick answers on the difference between deformities, non-surgical care, when to operate and diabetes-specific risks.

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

    Hammertoe is flexion at the middle joint of the toe (PIPJ). Mallet toe is flexion at the end joint (DIPJ) - the tip drops. Claw toe combines extension at the MTPJ with flexion at both interphalangeal joints and often affects several toes. Curly toe is a rotational congenital variant. All four are lesser-toe deformities and share overlapping causes and treatments. For a deeper look at the classical hammertoe pattern alone, see our companion guide on hammer toe.

  • Why do lesser toes buckle in the first place?

    The final common pathway is a flexor-extensor imbalance - the tendons that curl the toe overpower those that straighten it. Drivers include a long second ray, hallux valgus, high-arched (cavus) foot, plantar plate tears at the MTPJ, tight footwear worn for years, inflammatory arthritis and diabetic neuropathy. Addressing the driver matters as much as treating the toe itself.

  • Can I fix a hammertoe without surgery?

    A flexible hammertoe often responds well to footwear changes, silicone toe pads, custom orthotics with a metatarsal dome and targeted physiotherapy. Fixed deformity - where the joint no longer straightens - will not resolve without surgical correction, but conservative care still relieves pain and slows progression.

  • When should I consider surgery?

    Consider surgical correction when the deformity is fixed, painful, recurrent, ulcerating or causing a persistent corn despite proper footwear and podiatry. Modern options range from PIPJ arthroplasty and arthrodesis to minimally invasive percutaneous osteotomy. Your surgeon will pick the technique based on flexibility, adjacent-toe involvement and any underlying hallux problem.

  • Are hammertoe and bunion related?

    Very often, yes. Hallux valgus (bunion) pushes the big toe across the second toe, forcing the second toe upward and into a hammer position. Correcting only the hammertoe without addressing a symptomatic bunion frequently leads to recurrence. Both deformities are usually planned together.

  • Is hammertoe a serious problem in diabetes?

    It can be. A rigid, prominent toe against a shoe upper is a classic ulcer site in neuropathic feet. If you have diabetes, peripheral neuropathy or vascular disease, get any corn, callus, wound or discoloration reviewed promptly - the same deformity carries much higher risk in an insensate foot.

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