You may consider surgery if you have hammer, claw, or mallet toes. But athletes, children, and people with health problems such as diabetes, rheumatoid arthritis, neuromuscular disorders, or circulatory problems generally have special considerations. This information may not apply to them.

Consider the following when making your decision:

• You should first try making changes in footwear and other nonsurgical treatments (such as using pads to cushion the painful area).
• You might consider surgery if you have:
  • Severe pain in the toe that interferes with your daily activities, and nonsurgical treatments have failed.
  • A severely deformed foot that interferes with your daily activities.
  • A fixed toe joint deformity. This condition generally requires surgery to relieve the pain and correct the deformity.
• The outcome of your surgery cannot be predicted. The success of surgery for hammer, claw, or mallet toes has not been widely studied. The specific outcomes and risks vary depending on things like the type of surgery, your surgeon's experience, and the severity of the deformity.
• Your expectations play a large role in how you feel about the results of surgery. If you want surgery to improve the way your foot looks, not necessarily to relieve pain, you may be less satisfied with the outcome.

What are hammer, claw, and mallet toes?

Hammer, claw, and mallet toes are toe joint deformities.

• A hammer toe occurs when a toe (usually the second toe) bends down toward the floor at the middle toe joint. This causes the middle joint to rise up.
• Claw toe often affects all toes (except the big toe) at the same time, causing them to bend downward at the middle joints and at the joints nearest the tip, so that the toes curl down toward the floor. The toes bend up at the joints where the toes and the foot meet.
• A mallet toe often affects the second toe, but it may affect the other toes as well. The toe bends down at the joint closest to the tip.

See pictures of hammer, claw, and mallet toes.

What are the risks of hammer, claw, and mallet toes?

Hammer, claw, and mallet toes can cause discomfort and pain and may make it difficult to walk. Shoes may rub on your toes, causing pain, blisters, calluses or corns, or sores. Sores can become infected and lead to cellulitis or osteomyelitis, especially if you have diabetes or peripheral arterial disease. If you have one of these conditions and sores develop, contact your doctor.

Affected toes also have an odd shape, which is embarrassing for some people

When is surgery an option?

If your hammer, claw, or mallet toe gets worse, or if nonsurgical treatment does not help your pain or discomfort, you may think about surgery. Generally, surgery is used only if your symptoms do not improve with nonsurgical treatment. Surgery may not completely return your toes to their normal positions, and toe joint problems may come back after the surgery.

Surgery may not be an option if your toe deformity is caused by a problem with your nervous system or if you have a condition that affects your blood vessels.

What types of surgery are available?

The type of surgery you choose depends on how severe your condition is and whether the toe joint is fixed or flexible. Typical surgical options include:

• Phalangeal head resection (arthroplasty), in which the surgeon removes part of the toe bone.
• Joint fusion (arthrodesis), in which the surgeon removes part of the joint, letting the toe bones grow together (fuse).
• Cutting supporting tissue or moving tendons in the toe joint.

If you need more information, see the topic Hammer, Claw, and Mallet Toes.

Your choices are:

• Try nonsurgical treatments, such as wearing roomy footwear, using pads to cushion the painful area, limiting or modifying activities that cause pain, and taking pain medicine.
• Have surgery.

The decision about whether to have surgery takes into account your personal feelings and the medical facts.

Deciding about surgery

Reasons to have surgery for hammer, claw, or mallet toes

Reasons to not have surgery for hammer, claw, or mallet toes

You have tried nonsurgical treatments, and they have not been effective. You have severe pain or a severely deformed foot that interferes with your daily activities. Surgery may relieve pain and may allow you to walk and wear properly fitted shoes more easily and comfortably. Are there other reasons you might want to have surgery?

The effectiveness of surgery for hammer, claw, and mallet toes has not been widely studied. It will depend on the type of surgery, your surgeon's experience, and the severity of your deformity. Although surgery can reduce pain, it may not improve how your foot looks. Hammer, claw, and mallet toes may come back after surgery, especially if you continue to wear the types of shoes that caused the problem. Complications may include chronic swelling, numbness, or a limited range of motion in the affected toe. Are there other reasons you might not want to have surgery?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for hammer, claw, or mallet toes. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I understand that my toe problem may return after surgery.	Yes	No	Unsure
I know there are risks involved in having surgery.	Yes	No	Unsure
I understand that surgery may not improve the appearance of my foot.	Yes	No	Unsure
I have tried wearing roomy footwear, using pads to cushion the painful area, limiting or modifying activities that cause pain, and taking pain medicine, yet my toe is still very painful.	Yes	No	Unsure
The pain is affecting my work, school, or social life.	Yes	No	Unsure
I understand that no one can predict the success of surgery. It depends on the type of surgery, the severity of my toe deformity, and my surgeon's skill.	Yes	No	Unsure
I understand that my expectations of the surgery may influence my satisfaction with the outcome. I have discussed this with my doctor and surgeon.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use surgery for hammer, claw, or mallet toes.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

Leaning toward NOT having surgery

Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Associate Editor	Pat Truman
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
Last Updated	July 11, 2007