Hammertoes & Claw Toes

Hammertoe and claw toe conditions are fairly common. Generally, these toe deformities occur in those who wear constrictive shoes and in athletes with chronic overuse and hyperextension of the toes.

What Causes Toe Deformities?

Toe deformity can be the result of wearing a shoe that is too short. In many people, the second toe is actually longer than the big toe, and if shoes are sized to fit the big toe, the second, and maybe even the third toe, will have to bend to fit into the shoe. Shoes that are pointed make matters even worse. Combine pointed shoes with high heels, and the foot is constantly being pushed downward, squishing the toes against the shoe box.

Claw toes are common in people with high arches. And they can come from a muscle imbalance in which the deeper (intrinsic) toe muscles are weaker than the surface (extrinsic) muscles of the toes. This type of muscle imbalance can occur from more serious neuromuscular disease. A hammertoe in the second toe is also common in people who have a bunion in the big toe. The big toe angles too far toward the middle of the foot, and the second toe can end up with a hammertoe deformity. See Bunions for more information.

What Part of the Toe is Affected?

The toe bones connect to form the toe joints. The metatarsophalangeal joint (or MTP joint) is the first joint that connects the toe to the foot. The ball of the foot is formed by the MTP joints. The second joint is the proximal interphalangeal joint (or PIP joint), and the last is the distal interphalangeal joint (or DIP joint). Each joint is surrounded by a joint capsule made of ligaments that hold the bones together. Two tendons run along the bottom of each toe that allow us to curl our toes, and one tendon runs along the top that raises the toe. See Foot Anatomy.

In a hammertoe deformity, the first joint (MTP) is cocked upward, and the middle joint (PIP) bends downward. A claw toe deformity has a cocked up MTP joint, and both the middle joint (PIP) and the tiny joint at the end of the toe (the DIP) are curled downward. Claw toes always have extension deformity at the metatarsophalangeal (MTP) joint.