Each toe is controlled by two muscle systems: the long flexors and extensors that come from the lower leg via tendons, and the short muscles inside the foot (interossei and lumbricals) that keep the toe straight by flexing the base joint and extending the middle joint. When the short muscles weaken or the long tendons tighten too much, the flexors win over the middle joint, and the toe buckles: that is a hammer toe, with a bent middle joint and often a slightly raised base joint, so the "knuckle" stands up. A claw toe is bent at both the middle and end joint with the base joint pulled up, like a claw, often in several toes at once and more often with nerve disease, high arches and rheumatism. A mallet toe is bent only at the end joint, so the toe tip points down into the shoe. All three start as flexible deformities, where the toe can be straightened by hand, and become rigid over the years, when the joint capsule shrinks and the joint fixes; it often takes a few years. The symptoms come from pressure: corns and calluses on the knuckle, under the toe tip and under the forefoot, pain in shoes, tenderness in the base joint, and sometimes sores in those with diabetes or reduced sensation. The causes in order: shoes that are too tight, too short or have a high heel (the toes are pressed together and forward over years), hallux valgus where the big toe pushes in under the second toe, a second toe longer than the big toe (Morton's foot), flat or high arches, muscle imbalance after stroke, polyneuropathy, Charcot-Marie-Tooth and other nerve diseases, rheumatoid arthritis and psoriatic arthritis that damage the joints, injuries, and heredity. Women are affected five times as often as men, almost entirely because of shoes.
Hammer toe, claw toe or mallet toe?
| Hammer toe | Claw toe | Mallet toe | |
|---|---|---|---|
| Bent joint | The middle joint; the base joint often slightly up | The middle and end joint, the base joint strongly up | Only the end joint |
| Looks like | An inverted V with the knuckle up | A claw gripping | The toe tip points down |
| Which toes | Most often the second toe, sometimes the third | Often several toes, both feet | Most often the second or third |
| Common cause | Shoes, hallux valgus, long second toe | Nerve disease, high arch, rheumatism, shoes | Long toe in a short shoe, injury to the extensor tendon |
| Pressure point | The knuckle on top, under the forefoot | The knuckles on top, the toe tips, under the forefoot | The toe tip, the nail |
Test: sit with the foot relaxed and try to straighten the toe with your fingers. If it straightens completely: flexible, and everything below helps. If only partly or not at all: rigid, and treatment is about offloading and protecting, or surgery. Seek care soon for a sore, redness or heat over the toe (especially with diabetes), rapidly increasing bending of several toes (nerve disease should be ruled out), swollen, warm toe joints in the morning (rheumatism), and when shoes and toe protectors aren't enough for you to walk without pain.
Treatment while the toe is flexible
- Shoes with a high and wide toe box: the single most important measure. The toes should be able to lie straight and move upwards without touching the upper; a soft upper (knitted, soft leather), a low heel (under 3 cm), a thumb's width in front of the longest toe, and try shoes on in the afternoon when the foot is at its largest. No pointed shoes, no tight ballet flats, no high heels in daily life. In many the symptoms disappear completely from this alone.
- Toe protectors and insoles: a silicone cap or ring over the knuckle against rubbing, a toe crest pad under the toes that lifts the toe tips and straightens the toe in the shoe, insoles with support behind the ball of the forefoot (metatarsal pad) if you have pressure and calluses under the forefoot; available from a podiatrist or pharmacy.
- Taping: a strip of sports tape or kinesiology tape under the toe, pulled upwards over the knuckle and fixed on top of the foot, so the toe is held straight; or a toe loop that pulls the toe down at the base joint. Used in the daytime in shoes for a few weeks to months; doesn't straighten permanently but offloads and slows progression.
- Toe exercises, five minutes a day: towel scrunch (sit, scrunch up a towel with the toes, 2 minutes); pick up marbles with the toes and put them in a bowl; toe spread (spread the toes 10 times, hold 5 seconds); stretch the toe manually (hold the base joint still and straighten the middle joint with the other hand, 30 seconds × 3, every day; this is the most important for keeping the joint flexible); short foot (draw the ball of the foot towards the heel without bending the toes, 10 × 5 seconds; strengthens the short muscles that keep the toes straight); toe lifts (standing, lift only the big toe, then only the other four, 10 times). Barefoot at home as often as possible.
- Corns and calluses: soften in a footbath, file gently with a foot file (don't cut), urea cream daily, protect with silicone; they come back until the pressure is gone, so shoes first. Corn plasters with salicylic acid shouldn't be used with diabetes or reduced circulation. A podiatrist for deep corns.
- Treat the cause: hallux valgus (see hallux valgus), flat feet with insoles, rheumatism via a rheumatologist, nerve disease via a neurologist.
- Pain: anti-inflammatory gel on the base joint, cold after a day in shoes, a cortisone injection in the base joint for marked inflammation (rarely, and not repeatedly).
When surgery is needed
Surgery is considered when the toe is rigid and causes pain, sores or rubbing despite the right shoes and protection for at least six months, when the base joint has dislocated so the toe lies on top of its neighbour, or when corns keep returning and stop you walking. With a flexible hammer toe a tendon transfer (the flexor tendon is moved to the top) can straighten the toe with preserved mobility; with a rigid one, part of the middle joint is usually removed and the toe fixed with a pin or implant for four to six weeks so it stiffens in a straight position (arthrodesis), sometimes combined with lengthening of the extensor tendon and hallux valgus surgery. It is done under local anaesthetic or as day surgery, you walk on the heel in a special shoe for four to six weeks, the swelling lasts three to six months, and the toe becomes straight but stiff at the middle joint, which most don't notice. Nine in ten are satisfied; risks are recurrence, stiffness, swelling, numbness and a toe that ends up too high or low. Rehab afterwards: the toe exercises above for the other toes, arch training, shoes with a high toe box forever.
Foot cupping for hammer toe
Cupping doesn't straighten a toe, but it does something about the cause behind the flexible hammer toe: the muscles of the long flexor tendons in the calf and under the foot, which are chronically tight and pull the toes crooked, and the sole's tendon sheet (the plantar fascia) that tightens and holds the arch in a poor position. Released flexors and a softer sole make it easier for the short toe muscles to keep the toe straight, reduce the pressure under the forefoot and relieve the ache in the arch and calf that often comes with it. How to, in the evening, after a footbath: oil the sole and lower leg. Glide the dynamic mini cup with light to moderate suction along the sole from the heel towards the toes and back, ten strokes, with extra time along the inside of the arch; small circles under the ball of the forefoot where the calluses sit (not over the corn itself or cracked skin); then the inside and back of the calf from the ankle up towards the back of the knee with the dynamic cup, ten strokes (the long toe flexors lie deep in the calf), and the front of the lower leg from the ankle towards the knee, five strokes (the extensors). Finish with manual toe stretching, toe spreading and short foot. Five to eight minutes, three to four times a week. Don't cup over the toes and toe joints themselves (too small and bony, bruises), not over sores, corns or cracked skin, not with diabetes and reduced sensation or poor circulation in the feet, not over swollen, warm joints (rheumatism in a flare, gout), and not over the surgical area until the surgeon has approved. More on the foot in foot pain, plantar fasciitis and foot massage.
Read more
Toe pain, hallux valgus, Morton's neuroma and forefoot pain, foot pain: where does it hurt, plantar fasciitis, dry feet and calluses, foot massage and cupping – the complete guide.
Frequently asked questions
What causes hammer toe?
An imbalance between the toe's flexors and extensors, so the middle joint buckles and the knuckle stands up. The most common causes are tight, short or high-heeled shoes over years, hallux valgus where the big toe pushes in under the second toe, a second toe longer than the big toe, flat or high arches, nerve diseases and rheumatism, injuries and heredity. Women are affected five times as often, almost entirely because of shoes. The second toe is most often the one affected.
Can hammer toe be straightened without surgery?
Yes, if the toe is still flexible (can be straightened with the fingers): shoes with a high and wide toe box, toe protectors and a crest pad, taping that holds the toe straight in the shoe, daily manual toe stretching, the short foot exercise and toe exercises, plus treatment of hallux valgus or flat feet. It rarely straightens the toe completely but stops the progression, removes the pain and corns and keeps the joint mobile. A rigid hammer toe is only straightened with surgery.
Which shoes should you wear with hammer toe?
A high and wide toe box so the toes can lie straight and move upwards without touching the upper, a soft upper, a low heel (under 3 cm), a thumb's width in front of the longest toe, laces or velcro so the foot doesn't slide forward, and try them on in the afternoon. No pointed shoes, tight ballet flats or high heels in daily life. The right shoes remove the symptoms completely in many and are what decides whether the toe gets worse.
When does hammer toe need surgery?
When the toe has become rigid and causes pain, sores or rubbing despite the right shoes and protection for at least six months, when the base joint has dislocated so the toe lies over its neighbour, or when corns stop you walking. The operation (tendon transfer for a flexible toe, fusion of the middle joint with a pin for a rigid one) is done as day surgery; you walk in a special shoe for four to six weeks, the swelling lasts up to six months, and nine in ten are satisfied.
Does cupping help hammer toe?
Not the bend itself, but the cause behind a flexible hammer toe: the tight long toe flexors in the calf and sole and the taut plantar fascia. The mini cup along the sole and under the forefoot, the dynamic cup along the inside and back of the calf and the front of the lower leg, followed by manual toe stretching and short foot, five to eight minutes three times a week. Don't cup over the toes and toe joints, over corns or sores, with diabetes and reduced sensation or over swollen, warm joints.
Written by Curam. Last updated 17 October 2026. This is general self-care information and does not replace medical care. For sudden, severe or unusual symptoms, contact your doctor. Talk to your doctor before cupping if you are pregnant, take blood thinners or have a condition affecting skin, blood vessels or blood.
