In Short

• A bent toe is rarely the whole problem. A hammer toe is usually caused by something else — a bunion pushing against it, a long foot bone, a tight calf, or a torn ligament under the joint. Treating only the toe is the most common reason a correction fails.
• A second toe that crosses over is its own diagnosis. If your second toe drifts sideways and lifts up, the thick ligament under the joint (the plantar plate) has usually torn. That needs different treatment from a simply stiff toe.
• Bendy toes and stiff toes are treated differently. If the toe still straightens when you press up under the ball of your foot, surgery on the soft tissues may be enough. If it does not straighten, the joint itself needs treating.
• The expensive implants are not clearly better. A UK review of 3,878 operations found that bones healed about as well with simple wires as with newer implants placed inside the toe — and the implants cost 640 to 894 times more than a wire.
• Keyhole surgery is not clearly better either. A study comparing it with open surgery found no real difference in healing time, return to activity, the problem coming back, or metalwork needing removal.
• Treatments without surgery really do help while the toe still bends: roomy shoes, a pad behind the ball of the foot, toe sleeves and silicone props.

Keywords: hammer toe · claw toe · crossover toe · bent toe treatment · hammer toe surgery · plantar plate tear · lesser toe deformity · toe surgery London

Hammer, Claw or Mallet: What the Names Mean

The names sound fussy, but they tell your surgeon which joint needs treating.

A crossover toe is different again: the second toe drifts sideways towards the big toe and lifts up. It is not simply a bent toe — it usually means the ligament supporting the joint underneath has given way.

Why Toes Bend

The muscles that curl your toes are much stronger than the ones that straighten them. Anything that upsets that balance, or takes away the support under the toe, lets the curling win.

Common contributors:

• A bunion. The big toe leans across, squashes the second toe and pushes it up. Bunions and hammer toes go together so often that treating one without the other usually does not work.
• Foot shape. A long second foot bone, or a high-arched foot, puts extra pressure under the smaller toes.
• A tight calf. If your ankle cannot bend far enough, every step pushes more weight onto the front of your foot.
• A torn plantar plate — the ligament under the joint that stops the toe lifting up.
• Shoes. Narrow, pointed or too-short shoes worn over many years.
• Inflammatory arthritis, which damages the joints and the tissues that support them.
• Nerve and muscle conditions, which can cause clawing in both feet — worth checking for when toes bend with no obvious cause.

The Plantar Plate: The Part That Is Often Missed

Under each toe joint there is a thick, tough pad called the plantar plate. It works like a seatbelt for the toe: it stops the toe lifting up and keeps it pointing straight.

When it tears — usually slowly, from being overloaded again and again rather than from one injury — the toe becomes wobbly. It lifts, drifts sideways, and in time the joint slips partly or fully out of place. This is what causes most crossover second toes, and it is a known cause of pain under the ball of the foot.

The symptoms start before the toe changes shape. People often describe pain and swelling under the base of the second toe, a feeling of walking on a pebble or a rucked-up sock, and a sense that the toe is unstable — often for months or years before it visibly moves.

This matters because treating a torn plantar plate while the toe is still straight is a much smaller job than treating it after the joint has slipped out of place. It is a good reason to get a toe that “feels wrong” checked before it starts to look wrong.

The Test That Decides the Treatment

Press upwards on the ball of your foot, just behind the bent toe.

• If the toe straightens, it is still bendy. Surgery on the soft tissues — releasing tight structures, moving a tendon, or repairing the plantar plate — may be enough.
• If it does not straighten, the toe is stiff. The joint itself has to be treated, usually by fusing it in a straight position.

Bent toes start off bendy and become stiff over time. That is the best reason not to put off getting it looked at: the operation for a bendy toe is smaller than the operation for a stiff one.

What to Try Before Surgery

If your toe still bends, or you would rather not have surgery, these really do help:

• Shoes with a deep, wide toe area — the single most helpful change. The shoe needs to be deep enough that the bent toe does not rub on the top.
• A dome-shaped pad placed just behind the ball of the foot, to take pressure off the joints. Where you put it matters; too far forward and it makes things worse.
• Silicone toe props, crests or sleeves to cushion the knuckle and stop it rubbing.
• Regular care of hard skin, as the hard skin is often what actually hurts.
• Calf stretches, if a tight calf is part of the problem.
• Toe exercises — scrunching a towel with your toes and spreading them apart — which can help keep the toe moving early on.

None of these will straighten a toe for good. They ease the symptoms, and for many people that is enough for years.

Surgery: What Is Actually Done

Surgery is for pain, rubbing and skin breaking down — not for how the toe looks. Several procedures are often done together in one operation, which is why recovery takes longer than people expect for something that sounds small.

Fusing the middle joint (PIPJ arthrodesis) — the usual operation for a stiff hammer toe. The cartilage is removed and the toe is held straight until the bones join together. The toe stays permanently straight and stiff.

Tendon transfer — moving the tendon that curls the toe so that it straightens it instead. Used for toes that still bend, and it keeps the movement in the toe.

Plantar plate repair — reattaching the torn ligament under the joint, often through a small cut in the sole of the foot, or from above after shortening the foot bone. Early results for pain and satisfaction are good, though not perfect.

Shortening the foot bone (metatarsal) — making a long foot bone shorter so the toe can sit back down. Often needed alongside a plantar plate repair.

Correcting a bunion at the same time, if one is there and squashing the toe.

How the Toe Is Held Straight — and Why the Cost Matters

Traditionally, a thin metal wire (a Kirschner wire) is passed down the toe and left poking out of the tip for a few weeks. It works well and costs very little, but patients dislike the wire sticking out and there is a small risk of infection where it enters the skin.

There are now many implants that sit completely inside the toe. They are more comfortable and avoid a wire sticking out, and there are over sixty different devices available.

A UK review compared them properly, looking at 3,878 operations. The bones healed about equally well whichever method was used, and although the implants avoided a wire sticking out, one implant failed in up to about 20% of cases. The striking finding was the cost: a wire cost £0.37, while the implants reviewed cost £237 and £331 — 640 to 894 times more. The authors concluded that wires remain reliable and good value compared with the newer devices.

This is not an argument against implants — there can be good reasons to choose one for a particular patient. It is an argument against assuming the more expensive option must be better, and it is a fair question to ask if an implant is suggested to you.

Keyhole Versus Open

A study of 146 toes found no meaningful difference between keyhole and open hammer toe surgery in how long the bone took to heal (about 8.5 weeks for both), how long before returning to full activity (about 10 weeks for both), how often the problem came back, or how often metalwork had to be removed.

As with bunion surgery, the smaller cut is real; the claim that you recover much faster is not well supported by the evidence.

Recovery

Expect the toe to stay swollen and a little numb for several months. If the joint was fused it will stay stiff for good, and it may not touch the ground — this is expected, not a complication.

What Can Go Wrong

• Swelling and stiffness that lasts — very common, and improves over months
• Numbness along the toe, from small nerves near the cut
• The bend coming back, especially if the underlying cause was not treated
• A “floating” toe that does not reach the floor
• The fused joint not joining up, which is often painless and may need nothing done
• Pain moving to a neighbouring toe
• Infection where a wire enters the skin, which usually clears up with antibiotics

Frequently Asked Questions

Speak to a Specialist

Bent toes are easy to dismiss as a minor problem, and easy to under-treat. The question is not just how to straighten the toe, but why it bent in the first place — because a correction that ignores the bunion, the long foot bone, the tight calf or the torn ligament behind it is the one most likely to come back.

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital, Stanmore, and Honorary Associate Clinical Professor at UCL. He treats problems in the front of the foot, including bent smaller toes, plantar plate injuries, bunions and pain under the ball of the foot, with clinics across North and Central London.

Call 07547 395 270 or email secretary@matthewwelck.com. Urgent same-day appointments are offered where possible.

References

1. Hendrick SE, Kannegieter E. SmartToe, ToeGrip and buried k-wire versus percutaneous k-wire fixation for 2nd PIPJ arthrodesis: A comprehensive review of outcomes. Foot (Edinb). 2020;45:101692. doi:10.1016/j.foot.2020.101692
2. Mateen S, Raja S, Casciato DJ, Siddiqui NA. Minimally Invasive Versus Open Hammertoe Correction: A Retrospective Comparative Study. J Foot Ankle Surg. 2024;63(2):156–160. doi:10.1053/j.jfas.2023.09.014
3. Jastifer JR. Plantar Plate Repair for Metatarsophalangeal Joint Instability of the Lesser Toes. Orthop Clin North Am. 2022;53(3):349–359. doi:10.1016/j.ocl.2022.02.002
4. Doh CH, Kim S, Choi YR, Lee HS. Radiologic Outcomes of Plantar Plate Repair through a Plantar Approach for the Dislocated Metatarsophalangeal Joint of the Lesser Toe. Clin Orthop Surg. 2024;16(6):1001–1009. doi:10.4055/cios24046
5. Mirmiran R, Younger M. Lesser Digit Implants. Clin Podiatr Med Surg. 2019;36(4):651–661. doi:10.1016/j.cpm.2019.07.001

Study data above retrieved via PubMed.

This article is for general information and patient education only. It is not a replacement for being assessed, diagnosed or treated by a qualified healthcare professional.