From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

The hammer toe, claw toe, and mallet toe deformities are conditions that are most often due to wearing compressive footwear. Sometimes these deformities can be congenital, or due to other problems, but the most common reason is due to footwear.

Each of the lesser toes (all but the big toe) has three bones. The deformities, a hammer toe, claw toe, and mallet toe, are all due to abnormal positions of the bones at the joints between the bones.

• Hammer Toe
  A hammer toe occurs when the middle of the toe points upwards abnormally. This most often occurs in the second toe, and is often the result of a big toe bunion pushing on the second toe. A painful callous often forms on to on the first joint in the toe.

• Claw Toe
  Claw toes appear as the name would describe--like a clenched fist. While most other toe deformities are the result of footwear, claw toes are the result of muscle imbalance. The cause of the imbalance may be rheumatoid arthritis, neuromuscular disorders, a stroke, or other conditions.

• Mallet Toe
  The mallet toe is the deformity where the most distant joint points downward. This is most common in the second toe in patients whose second toe is the longest toe. A painful callous can form at the tip of a mallet toe.

What causes most toe deformities?
The most common reason for these deformities is when tight shoes are worn, the toes are compressed into an abnormal position. When this happens repeatedly, the toes remain in this abnormal position. High heeled shoes are especially notorious for causing these deformities. This is because the toes are not only bunched up, but the weight of the body is pushing them forward even further. The exception, as described above, is the claw toe deformity which is not usually due to footwear.

What is the treatment for these toe problems?
Treatment for a claw toe, hammer toe, or mallet toe is first to wear more comfortable footwear. Special pads and orthotics are made to protect the toes and even to correct the deformity. Usually problems arise from painful calluses and corns forming around the deformities. When someone has an abnormal toe, it tends to rub on footwear and cause problems. Protecting these problem areas with pads will often control the symptoms.

Surgery may be needed to correct a malalignment if the toe deformity causes chronic pain. Surgical treatments are aimed at loosening up the contracted toe joints to allow them to align properly. A fusion between the bones may also be necessary to prevent a recurrence of the problem.

References:

• Mizel, MS, Yodlowski ML; "Disorders of the Lesser Metatarsophalangeal Joints." J. Am. Acad. Ortho. Surg., May 1995; 3: 166 - 173.