Hammertoe and Mallet Toe: The One Question That Decides What Will Help

If one of your toes has started to curl, there is a single question that matters more than anything else in this article: can you still straighten it by hand? If yes, the deformity is flexible, and there is a good deal you can do. If no, it is rigid, and the honest answer changes. Everything below is organised around that split.

What these deformities are

Clinicians group curled lesser toes — the four toes other than the big toe — into three patterns, depending on which joints are bent:¹

• Hammertoe. The middle joint of the toe bends downward. The most common of the three, and usually the second toe.
• Mallet toe. The joint nearest the nail bends downward.
• Claw toe. The joint at the base of the toe bends upward while both further joints bend down, so the toe curls like a claw.

They are common. A US survey of 2,445 adults found hammertoe in 18% and claw toe in 2%.² Lesser toe problems become more frequent with age, are more common in women, and run strongly in families.¹

Why toes curl

The underlying mechanism is a tug-of-war the small muscles lose. Long muscles running from the shin and calf pull the toes; short muscles inside the foot are supposed to balance them. When the short muscles are weak relative to the long ones, the toe is pulled into a bend and, over time, stays there.¹

Several things tip that balance. Shoes with a narrow front or a raised heel push the toes into a bent position for hours at a time. A bunion crowds the second toe sideways and is strongly associated with it curling. A second toe that is longer than the big toe, flat feet, injury, and conditions such as rheumatoid arthritis or diabetic nerve damage all raise the risk.¹

One practical consequence: if you have a bunion, look at your second toe. The two travel together, and the toe is often the easier of the two to catch early.

Why it matters beyond the toe

A curled toe presses against the shoe at the knuckle and against the ground at the tip. Corns and calluses form at those points. In people with diabetes or reduced sensation, those pressure points can become ulcers without being felt, which is one reason toe deformities are checked at diabetic foot reviews.

There is also a balance cost. In a study that followed 312 people aged 60 to 90 for a year, those with a lesser-toe deformity were about twice as likely to fall as those without.³ The lesser toes do more for standing balance than most people credit them with, and a toe that cannot press down does not do its share.

If the toe is still flexible

This is where conservative care has something to offer, and the aim is to keep the toe flexible and stop it progressing.

• Shoes with room at the front. A wide, deep toe box removes the mechanical driver. Clinical guidance puts this first, before any device or exercise.¹
• Pads and props. A pad over the knuckle or a prop under the toe reduces pressure at the points that hurt.¹
• Foot muscle work. A 2024 clinical review of physical therapy for lesser toe deformities concluded that the newer emphasis on strengthening the small muscles of the foot "appears to be quite effective in correcting less severe deformities and preventing the deformities from worsening."⁴ That is the mechanism above, worked from the other side. The usual exercises are towel scrunches, picking up marbles with the toes, and gently pulling the bent toe straight and holding it.
• A podiatrist, early. A flexible deformity is the stage at which someone who does this for a living can make the most difference.

Be aware of how thin the trial evidence is for all of this. A 2021 case report on taping for hammertoe noted that no research had been found detailing conservative treatment of flexible deformities.² The recommendations above are standard clinical practice with a plausible mechanism, not the output of large randomised trials.

If the toe is rigid

Once the joint has fixed, exercises and splints will not straighten it. The goal of conservative care shifts to comfort: shoes that accommodate the shape, pads that take pressure off the knuckle and tip. That still helps — in a small study of older adults, a moulded silicone toe prop reduced peak pressure at the tip of the second toe in people with rigid deformities as well as flexible ones.⁵ But it is symptom management, not correction.

Correction of a rigid toe is surgical. That is not a failure of conservative care; it is what conservative care is for — to delay this point, and to keep you comfortable if it arrives.¹

What about toe separators?

You will see them recommended for hammertoe. A 2024 systematic review of toe separators in physiotherapy concluded they can be a valuable tool in the conservative treatment of hallux valgus — bunions — and associated deformities.⁶ Bunions are where the evidence for separators lives. For hammertoe and mallet toe specifically, we have not found trials, and we are not going to imply otherwise.

We make a toe trainer. It is built for the foot-muscle work in the flexible section above, not for straightening a toe. If you want to see what the research does and does not support for it, it is here.

The short version

Try to straighten the toe by hand. If it moves: roomier shoes now, pads where it rubs, foot muscle work, and a podiatrist before it stops moving. If it does not move: shoes and pads for comfort, and a conversation about surgery if it hurts. And if you have diabetes or cannot feel your feet well, do not wait for pain — have the toe looked at.

*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.

References

1. Hammertoe. StatPearls. National Center for Biotechnology Information, updated 2026. PMID: 32644694. Read it
   Peer-reviewed clinical reference. Source for the three-way classification, the muscle-imbalance mechanism, risk factors, and the conservative-first management sequence.
2. The impact of kinesiology taping on a Greek foot with a hammertoe — a case report. 2021. Read it
   Cited for the prevalence figures it collects (US: 18% hammertoe, 2% claw toe) and for its statement that no research was found on conservative treatment of flexible deformities. It is a single case report; the taping result itself is not used here.
3. Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. ISB Clinical Biomechanics Award 2009: toe weakness and deformity increase the risk of falls in older people. Clinical Biomechanics. 2009;24(10):787–791. PMID: 19751956.
4. Treatment of lesser toe deformities based on physical therapy. Foot and Ankle Clinics. 2024. Read it
   Narrative clinical review. Authors and full citation to be added — see notes.
5. Conservative approach in the management of lesser toe deformities in older adults. PMID: 36074350. Read it
   20 older adults, 10 flexible and 10 rigid, pre/post design. Measured pressure, not correction. Authors and journal to be added — see notes.
6. Krześniak H, Truszczyńska-Baszak A. Toe separators as a therapeutic tool in physiotherapy — a systematic review. Journal of Clinical Medicine. 2024;13(24):7771. doi:10.3390/jcm13247771. PMID: 39768694. Read it
   Scope is hallux valgus. Not a hammertoe review.