Hammertoes, Claw Toes, Mallet Toes... And Blisters

by Rebecca Rushton 2 Comments

What are hammertoes? What causes them to buckle and bend over like that? Will they ever straighten again?   

Despite the odd toe posture, people make the mistake of accepting problems like corns, callouses and blisters on the tops of toes, thinking there's nothing they can do. So, in this blog post, I am going to give you a deeper understanding of the causes of hammertoes and some remedies that would alleviate the symptoms.

Hammertoes
Hammertoes - notice the prominent joints on the middle toes (Triad Foot And Ankle Center)

 

What is a hammertoe?

A hammertoe is one of several toe deformities which includes claw toes and mallet toes (see image below). They can occur on any of the three middle toes. Hammertoesare most common on the second toe - the one next to your big toe.

Hammertoes, claw toes and mallet toes
Hammertoe, claw toe and mallet toe deformities

 

Hammertoe causes - What causes toes to bend over?

Let’s talk collectively about what causes the three toe deformities in the picture above.

Toes consist of three bones – just like your fingers (except your big toe which has two bones, like your thumb). Normally, all three bones sit straight and in line – just like if you hold your finger out straight out. They sit straight thanks to the support of ligaments and the fine balancing act between the pull of tendons.

  • Now bend your finger – See how the two joints stick out and become obvious. This is exactly what happens when you have a claw toe. The toe bends over and the two joints become prominent.
The middle toe is a clawed toeClawed middle toe (Allen Foot Doctor)
  • Now bend only the first joint of your finger and keep the end joint straight. This is what happens when you have a hammer toe. The toe bends over and the first joint becomes prominent.

Hammertoes (Shutterstock)

  • Now keep the first finger joint straight and just bend the end joint. This is what happens when you have a mallet toe. The toe bends over and the end joint becomes prominent.

Mallet toeMallet toe (London Foot and Ankle Clinic)


With toe joints sticking out like this, it’s easy to imagine them getting pushed, pinched and rubbed by your shoe when you wear shoes and start walking or running.

hammertoes and claw toes rubbing
Bandaged hammer, claw and mallet toes

 

Hammertoes, claw toes and mallet toes start when there is an imbalance to the equilibrium of the toe joints. Stubbing your toe, someone jumping on it, poor shoe choices holding the toes in a bent position for long periods, developing a bunion, injury… any of these scenarios could cause a change in the pulling power of one tendon over the other. This destabilisation leads to a gradual cascade of events culminating in the toe buckling. It usually happens gradually and gets worse as the months and years pass. Long-term, muscles, tendons and ligaments become increasingly tight one one side of the joint and stretched on the other, holding the toe in this hammered, clawed or mallet position. Diseases also play a role in the cause of toe deformity - people dealing with diabetes, arthritis and neuromuscular diseases are at higher risk of misshapen toes. 

 

Bunion causing hammertoe
Hammertoe right foot cause by bunion. As the big toe slides across, the 2nd toe is pushed upwards. (Cleveland Clinic)



Another factor is toe length - and how closely the curve of your toes match the curve of your shoe (see the image below). This will become relevant if you wear shoes that are too small for you; or too big and loose such that your foot slides forward and hits the end of your shoe. Toes shouldn’t come into contact with the end of your shoe - at all! Ideally you'd have the width of your thumb between the end of your longest toe (whichever toe that is) and the end of your shoe. This gives your feet a little room to move without impacting any of your toes at the end of the shoe. But many people neglect this.

Which toe is longest

There is a large variability in which toe is longest. Which of your toes is longest? Does the curve of your toe lengths match the shape of your shoe? If not, this may put you at risk of developing a hammertoe, claw toe or mallet toe.

 

Sometimes one toe can be especially long so as not to fit the rounded parabola of your shoe. Less commonly, the third or fourth toe can be especially longer. These long toes are the ones most likely to be affected to developing a toe deformity - if your shoes don’t fit it properly. Remember the rule of thumb for shoe-fit.

Very long second and third toes
Hammertoes on the 2nd, 3rd and 4th toes. The second toe is much longer than the big toe. And if held out straight, the third toe would be longer than the big toe too. This almost certainly wouldn’t match the shape of the shoe. (MedicineNet)

 

Just to reiterate, if you don’t have enough room at the end of your toebox, your toe will be impacted. Similarly, if your shoes are too loose and you allow your foot to slide forward, your toes may hit up against the end of your shoe and your toes buckle.

 

Hammertoes can be flexible or rigid

Flexible – In the earlier stages of a toe deformity, the toe sits in a bent position, but the joints are still flexible enough to be held straight.

Rigid – Once the toe has been sitting in its bent position for a long time, ligaments and tendons tighten and the bones change shape. These changes maintain the bent position and the joints become stiffer and stiffer, until one day, the toe can't even be straightened at all.

 

How to treat claw toe and hammer toe symptoms

Hammertoes, claw toes and mallet toes can lead to painful corns, callouses and blisters in two areas:

1. The top of the toe

  • Naturally, the more shallow the toebox of the shoe, the more it will push down on the prominent joint(s). Corns, callouses and blisters may be the result. So choose a shoe with a deep toebox.
  • Gel toe sleeves can cushion the prominent joints and protect them from pressure, rubbing and shear forces.
  • Your podiatrist can make a toeprop to lift the shoe off the prominent joint and save the skin from trauma.
Gel toe sleeves

 

2. The tip of the toe

  • The tip of the toe isn’t designed to bear weight - it doesn’t have the natural fatty padding to tolerate this. Therefore, a gel toe cap can be used to cushion the tip of the toe.
  • You can wear a toeprop to prevent the toe from bending over so much. Toeprops can be custom made by your podiatrist. Toeprops will relieve symptoms if your hammertoe, claw toe or mallet toe is at least partially flexible. If it is fixed, the toeprop may in fact lift your toe up and rub the top of the toe more!
  • If you are dealing with rigid misshapen toes and finding it difficult to get relief using the other methods mentioned, surgery is a viable option consider, to straighten the toes.

 

Gel toe caps

 

pre-made toeprop
Off-the-shelf toeprops take up space under the toes so the toes are less able to bend over. (ResearchGate)
Off-the-shelf toeprop
Off-the-shelf toeprops for hammertoe, claw toe and mallet toes consist of a firm foam pillow with an elastic loop that goes over one toe to hold it in place. Be careful the elastic doesn't get too tight!

 

Custom made toe prop
Custom made toeprop by a podiatrist. This will stop toes 2 and 3 from bending over so much. This will prevent blisters, corns and callouses on the tips of the toes. https://youtu.be/lL4_E_DlCgc

 

While none of these treatments will reverse your hammertoe, claw toe or mallet toe (except surgery of course), when used correctly and frequently enough, toeprops and gel toe protectors will keep your corns, callouses and blisters at bay. If you’re in any doubt, be sure to see a podiatrist to get advice on how to maximise the effect of these interventions to minimise the symptoms.

 

Wrapping up

As the old saying goes, prevention is always the best cure. While easier said than done, it's for this reason podiatrists recommend wearing shoes that accommodate your toes adequately. Hammertoes and other toe deformities develop gradually. It might appear that you get away with small or loose shoes for weeks, months or even years. Once you notice the toes bending, the cascade of event has started. 
Be sure to consult a podiatrist if you suspect you’ve got a hammertoe, claw toe or mallet toe developing as there may be something they can do to slow the progression, alleviate your symptoms and prevent your blisters.





Rebecca Rushton
Rebecca Rushton

Author

Podiatrist, blister prone ex-hockey player, foot blister thought-leaderauthor and educator. Can’t cook. Loves test cricket.


2 Responses

Rebecca Rushton
Rebecca Rushton

July 25, 2019

Hey Genny, the gel toe sleeves are a great choice. With one on the 2nd toe, you’ll be protecting a) the top of the 2nd toe [the hammertoe] b) the 1/2 interdigital space c) the 2/3 interdigital space. Let us know how you go.

Genny Bolton
Genny Bolton

July 25, 2019

Rebecca – Great info, thanks so much. I’ve kicked up my walking routine and, of course, problems with toes are starting. I need to separate as blisters are forming interdigitally. I’ve tried taping #2 and #3 together. This irritated the big toe and #4 which caused blisters on both and blisters also formed at the bottom of taped #2. I’m going to try the gel toe sleeves and caps and going to look into fixomull and lucotape. I have bunions and toes #2 are the really unhappy ones. One of them is getting a little hammery. I’ve had problems with the metatarsal pad hurting, but new orthotics help. Thanks, again. Genny

Leave a comment


Also in Blister Blog

How Easy It Is To Bring A Weightbearing Blister Back From The Brink
How Easy It Is To Bring A Weightbearing Blister Back From The Brink: Lesson #3 From Adelaide 2019

by Rebecca Rushton

Weightbearing blisters can be devastatingly painful. Find out what you'll need to bring them back from the brink of disaster, and how to implement it. It's actually pretty easy.

View full article →

toe-prop made from felt
Toe-props For Toenail Blisters: Lesson #2 From Adelaide 2019

by Rebecca Rushton

If your toes bend over and you get blisters under your toenail, you'll need a toe-prop. Find out how to make your own, or where to get them custom made.

View full article →

pre-race toenail care
Pre-Race Toenail Care: Lesson #1 From Adelaide 2019

by Rebecca Rushton

While unkempt toenails aren’t the only cause toenail blisters, they are the most easily avoided. Find out about the importance of pre-race toenail care, and how to get it done.

View full article →