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Health condition · Clinically reviewed

Hammer, claw and mallet toe, explained - and treated properly.

A bent toe isn’t just cosmetic - it’s a tendon imbalance that can be managed conservatively or corrected surgically, depending on whether it’s still flexible.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK podiatric and foot-and-ankle specialist before publication.

  • 02

    Sourced from guidance

    Cross-checked against BOFAS, NICE and peer-reviewed foot and ankle literature you can see at the end.

  • 03

    Current for 2026

    Reflects modern practice on flexible versus fixed deformity, flexor tenotomy, PIP joint fusion and diabetic foot surveillance.

Key facts

Lesser toe deformities at a glance.

The essentials, in plain English - what each type is, why it happens, and how it’s treated in the UK today.

  • What it is

    A group of toe deformities - hammer, claw and mallet toe - caused by an imbalance between the tendons that flex and extend the toe.

  • The three patterns

    Hammer toe bends at the middle joint, claw toe bends at both joints with the base joint cocked up, mallet toe bends only at the tip joint.

  • Common causes

    Tight or narrow footwear, bunions, muscle imbalance, nerve conditions and inflammatory arthritis.

  • Claw toe association

    Often bilateral and linked to a neurological cause - Charcot-Marie-Tooth disease, diabetic neuropathy or rheumatoid arthritis.

  • Flexible vs fixed

    A flexible toe can still be straightened by hand - a fixed one cannot. This distinction drives the whole treatment plan.

  • When surgery helps

    Fixed deformities that fail conservative care usually respond well to joint-level surgery under a foot and ankle specialist.

Why this guide matters

One deformity, three names - and one key question.

Hammer, claw and mallet toe are often used loosely, but the treatment that works depends on one thing above all others - is the toe still flexible.

  • Flexibility decides the plan

    A flexible toe usually responds to footwear, splints and stretching. A fixed toe generally needs surgery to correct properly.

  • Bilateral claw toe deserves a look

    Symmetrical claw toes in both feet are a recognised sign of an underlying nerve condition, diabetes or inflammatory arthritis.

  • Skin matters as much as bone

    Corns over a bent joint can break down, especially with diabetes - regular podiatry care protects the skin as well as straightens the toe.

How the diagnosis is made

From a bent toe to a clear plan.

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

  1. 01

    Assessing

    History and footwear review

    Onset, which toes are affected, footwear habits and any family or personal history of diabetes, nerve disease or arthritis.

  2. 02

    Assessing

    Neurological screen

    A quick check for reduced sensation, weakness or an abnormal gait, since bilateral claw toes often point to an underlying nerve condition.

  3. 03

    Assessing

    Red flag check

    Skin breakdown, ulceration or reduced foot sensation - especially in diabetes - changes the urgency of referral.

  4. 04

    Confirming

    Flexibility examination

    A specialist podiatrist tests whether each joint can be passively straightened - flexible or fixed - which shapes every option that follows.

  5. 05

    Confirming

    Neurovascular and gait assessment

    Pulses, sensation and walking pattern are checked alongside the deformity itself, particularly where skin breakdown risk is raised.

  6. 06

    Confirming

    Weight-bearing X-ray

    Standing foot X-rays show joint alignment, any coexisting hallux valgus and help plan surgery if it becomes necessary.

  7. 07

    Referring

    Neurology referral if indicated

    Suspected Charcot-Marie-Tooth disease, motor weakness or an unexplained neuropathy warrants specialist neurology input.

  8. 08

    Referring

    MDT foot and ankle referral

    Specialist podiatry and orthopaedic foot and ankle teams work together on persistent, painful or progressive deformity.

Typical timeline: a first podiatry visit to a settled conservative or surgical plan in weeks.

Symptoms

What each deformity actually looks like.

The classic patterns of hammer, claw and mallet toe, the skin problems they cause - and the features that mean it’s time to escalate.

  • Hammer toe

    Flexion (bending down) at the middle joint with extension at the joints either side - the most common lesser toe deformity.

  • Claw toe

    Flexion at both the middle and end joints with the base joint pulled upward - often bilateral and linked to a neurological cause.

  • Mallet toe

    Flexion at the end joint only, with the rest of the toe straight - commonly affects the second toe.

  • Corns and calluses

    Thickened skin over the top of the bent joint and at the tip of the toe, where footwear rubs against the deformity.

  • Pain and footwear difficulty

    Rubbing, pressure and discomfort in ordinary shoes - often the first reason people seek help.

  • Skin breakdown risk

    In diabetes or reduced sensation, corns over a bent joint can progress to ulceration if left unmanaged.

  • Bilateral presentation

    Symmetrical claw toes in both feet raise suspicion of an underlying nerve or muscle condition rather than a purely mechanical one.

  • Red flag - ulceration or numbness

    Any broken skin, infection or loss of sensation over a deformed toe needs prompt specialist podiatry review.

Treatment

How lesser toe deformities are treated in the UK.

Footwear and podiatry care first, then targeted conservative measures - and joint-level surgery where the deformity is fixed.

  • Wide, deep toe box footwear

    The single most effective conservative measure - room for the toes to sit without pressure on the deformity.

  • Toe splints and silicone sleeves

    Cushion the bent joint and can help realign a flexible deformity, guided by a specialist podiatrist.

  • Padding and metatarsal pads

    Redistribute pressure away from prominent joints and the ball of the foot to ease pain in daily wear.

  • Custom foot orthotics

    Correct underlying biomechanics contributing to the deformity - fitted and reviewed by a specialist podiatrist.

  • Stretching and physiotherapy

    Targeted exercises for flexible deformities, aiming to rebalance the flexor and extensor tendons.

  • Regular corn and callus care

    Scheduled debridement by a specialist podiatrist reduces pain and lowers the risk of skin breakdown.

  • Flexor tenotomy or tendon transfer

    Minimally invasive options for a flexible deformity that has not settled with conservative care.

  • PIP joint arthroplasty or fusion

    For a fixed deformity - the joint is reshaped or fused, usually with temporary K-wire fixation, under a specialist orthopaedic foot and ankle surgeon.

Where hallux valgus (a bunion) is present alongside a lesser toe deformity, correcting both together in one operation usually gives a better and more stable result than treating the lesser toe alone. In diabetes, ongoing foot care and surveillance sit alongside any of the above, led by a specialist podiatry team working with orthopaedic foot and ankle colleagues and in line with BOFAS and NICE guidance.

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 specialist knows your feet and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Patient information on lesser toe deformities and hammer toe surgery.

  • NICE. Diabetic foot problems: prevention and management (NG19).

  • Royal College of Podiatry. Clinical guidance on corns, calluses and lesser toe deformity.

  • Charcot-Marie-Tooth UK. Information on foot deformity in hereditary neuropathy.

Red flags

When a toe deformity needs urgent attention.

Most hammer, claw and mallet toes are manageable with routine podiatry care. These situations aren’t - and need a specialist opinion sooner.

  • Ulceration over a bent joint

    Broken skin over a corn or callus, especially with diabetes or neuropathy, needs urgent specialist podiatry assessment.

  • Signs of infection

    Redness, warmth, discharge or spreading pain around a toe deformity should be seen the same day, particularly in diabetes.

  • Sudden loss of sensation

    New numbness or tingling in the feet alongside toe deformity warrants prompt neurological and vascular review.

  • Rapidly progressive bilateral claw toes

    A fast-changing symmetrical pattern raises suspicion of an underlying neuromuscular condition needing specialist neurology input.

  • Absent or reduced foot pulses

    Poor circulation changes both surgical risk and wound-healing expectations - a vascular assessment is needed first.

  • Rheumatoid or inflammatory arthritis flare

    New or worsening claw toe deformity in known inflammatory arthritis should be discussed with the rheumatology team.

Living with it

A manageable condition, with a clear ladder.

Four things that make the biggest difference day to day - the right footwear, careful skin checks, regular podiatry review and knowing when to ask about surgery.

A quiet reminder

The right shoe does more than any insert.

Width and depth in the toe box, kept up consistently, protect the skin and slow progression far better than an occasional pair of trainers.

  1. 01 Footwear

    Choose room over style

    A wide, deep toe box does more for comfort than any insert - fit the shoe to the foot, not the other way round.

  2. 02 Skin

    Check your feet regularly

    Especially with diabetes or reduced sensation - look for redness, blisters or breakdown over the bent joints daily.

  3. 03 Routine

    Keep up podiatry appointments

    Regular corn and callus debridement prevents small problems becoming painful or infected ones.

  4. 04 Escalate

    Don’t wait for skin breakdown

    If padding and footwear changes aren’t enough, ask about flexor tenotomy or joint surgery before things progress.

Frequently asked

Everything we get asked about lesser toe deformities.

Quick answers on hammer toe, claw toe, mallet toe, flexibility, diabetes and surgery.

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

    Hammer toe bends downward at the middle joint while the joints either side extend. Claw toe bends at both the middle and end joints with the base joint cocked upward, and is often bilateral. Mallet toe bends only at the very end joint, closest to the toenail. All three sit on a spectrum of the same underlying tendon imbalance.

  • Why does claw toe sometimes point to a nerve problem?

    Symmetrical claw toes in both feet are a recognised feature of peripheral neuropathy, Charcot-Marie-Tooth disease, diabetes and some cases of rheumatoid arthritis. When the pattern is bilateral, a neurological or systemic assessment is often part of the work-up.

  • Can lesser toe deformities be corrected without surgery?

    Flexible deformities - ones that can still be straightened by hand - often respond to wide footwear, toe splints, padding, stretching and specialist podiatry care. Fixed deformities, where the joint no longer moves, generally need surgery to correct properly.

  • What does surgery for a hammer or claw toe involve?

    For a flexible deformity, a flexor tenotomy or tendon transfer can rebalance the toe with a small procedure. For a fixed deformity, the affected joint is reshaped (arthroplasty) or fused (arthrodesis), often held temporarily with a K-wire while it heals. Any coexisting bunion is usually corrected at the same time.

  • Is this more serious if I have diabetes?

    Yes. Corns and calluses over a deformed toe can break down into ulcers when sensation or circulation is reduced. Diabetic foot care and regular surveillance by a specialist podiatry team are an important part of managing lesser toe deformities in diabetes.

  • Who should I see about a toe deformity?

    Start with a specialist podiatrist for assessment, footwear advice, padding and conservative care. If the deformity is fixed, painful or not improving, they will refer you on to an orthopaedic foot and ankle specialist for a surgical opinion.

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