NHS Lanarkshire logo

Lesser Toe Deformities

University Department of Podiatry

On this page

Additional Information

Related pages

What are Lesser Toe Deformities?

Lesser toe deformities are changes in the shape of any of the four smaller toes of your foot. These changes can often cause pain in the toe itself or can be uncomfortable when wearing shoes due to friction and pressure of the toes against the shoe. These changes are commonly seen in the second toe but can affect any of the lesser toes, leading to clawing, curling or overlapping.

Treatment protocols for lesser toe deformities almost always start with basic principles and we would encourage you to consider trying some self-help treatment.

Back to top of page

What kind of Lesser Toe Deformities are there?

The most common lesser toe deformities are hammer, claw, mallet and overlapping toes. They can occur due to an imbalance between the muscles and tendons within your foot that hold your toes straight. These changes are usually flexible but can become fixed in their new position over time.

Hammer Toe

A hammer toe is when the proximal interphalangeal joint (shown) bends down. Due to the change in shape this can result in a corn/callous developing on the top and/or tip of your toe. This is most commonly seen in the second toe but can occur in any of the smaller toes. If left untreated can become fixed over a period of time.

Illustration of a hammer toe

Claw Toe

A claw toe is when the proximal and distal interphalangeal joints bend down (shown). Due to this change in shape, you may experience pain and calluses or corns over the top and/ or tip of your toe. If left untreated, the severity of the deformity can increase over time.

Illustration of a claw toe

Mallet Toe

A mallet toe is when the distal interphalangeal joint bends down, (shown). Due to this change in shape you may experience pain and calluses or corns over the top and/ or tip of your toe. If left untreated it can become fixed over a period of time.

Illustration of a mallet toe

Overlapping toe

An overlapping toe is often seen alongside a bunion but does not always involve the big toe and can be common in the fifth toe as well. This deformity can lead to discomfort and callous build up over the top of the joints as well as increased pressure between and around the toes.

illustration of an overlapping 2nd toe
Illustration of an overlapping toe from a view from above.

Back to top of page

What are the signs and symptoms of Lesser Toe Deformities?

You may experience any or all of the following:

  • Pain and callous and/or corns over the top of the joints of the toes
  • Deformity in the shape of toe
  • Shoes becoming uncomfortable over the toes
  • Pain and callous underneath the tip of the toe
  • Redness and swelling around the joint
  • Stiffness in the joints of the toe
  • Difficulty walking

Back to top of page

What causes Lesser Toe Deformities? 

The change in the shape of your toes occurs as a result of an imbalance between the muscles and tendons which hold your toes straight and those that bend the toes. There can be several reasons for these changes:

  • Ill-fitting footwear
  • Inflammatory conditions (e.g. rheumatoid arthritis)
  • Trauma
  • Hallux Valgus (Bunions)
  • Neuromuscular conditions
  • Peripheral neuropathy leading to a muscle imbalance

Back to top of page

What Can Help With Lesser Toe Deformities?

To improve comfort, you need to relieve the pressure on the toes and there are several ways you can do this yourself.

Making changes to your lifestyle as well as reducing aggravating activities is key to helping your recovery. Only you can do this.

There are a number of things you can try including:

  • Rest and raise your foot on a stool when you can
  • Put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours
  • Wear shoes with cushioned heels and good arch support
  • Use insoles in your footwear
  • Try regular stretching and foot exercises
  • Try exercises which put no pressure on your feet, such as swimming
  • Try to lose weight if you’re overweight or obese

These a number of things to try to avoid including:

  • Avoid walking or standing for long periods
  • Avoid wearing high heels and tight pointy shoes
  • Avoid wearing flip-flops or backless slippers
  • Avoid walking barefoot on hard surfaces

Back to top of page

Shoes

It is important that you choose footwear that is deep enough to accommodate any hammer toe or clawing deformities. It can also be useful to choose a shoe that has a softer material as the upper. Softer materials can mould around the toes more easily than hard patent leathers.

If your shoe is not deep enough, it will rub on the prominent joints causing the surrounding skin to become red, swollen and in some cases the skin can blister or become thickened. Sometimes a fluid filled sac, called a bursa, can develop over the joint. The bursa can also become inflamed and painful.

Illustration of good shoe toebox depth

Footwear advice video

Illustration of poor shoe toebox depth

Back to top of page

Strapping

Strapping/taping can be used to help support your toe to help guide improved position and stability. This can be a useful short term treatment that can help reduce your symptoms. The aim of this low dye taping is to help stabilize and heal the plantar plate ligament after a sprain or injury.

The tape used for this is a rigid strapping called zinc oxide tape. It’s available in most pharmacies and can also be bought online.

Taping is only a short term treatment and we recommend it’s used until your pain levels decrease.

We advise that each application of the tape is kept in place for a maximum or 3 to 4 days. You may find that the tape needs to be replaced more frequently in order for it to remain effective.

Before you start it can sometimes be helpful to have your strips of tape pre-cut. To get the correct length of tape you can use your hand as a reference. Starting at the tip of your longest finger run the tape to the base of your palm. This should give you the correct amount or tape. Next cut the tape lengthwise into 2 equal sized pieces. Take one of the pieces and stick it back on the roll for later

Illustration of how to use tape to strap a toe

Back to top of page

Pain Activity Ladder

By following the pain activity ladder you can identify activities that you would consider severely painful, moderately painful and mildly irritating and act to change your habits.

The pain scale, most often used in healthcare, measures pain from 0-10 (zero being no pain and 10 representing the worst pain you could imagine).

If you can identify the level of pain you are experiencing, you will find out if you are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing your activity.

When you are completing your rehabilitation exercises it is often best to work within the green (and sometimes amber zones depending on what you deem is an acceptable level of pain) both during the exercises and within 48 hours of completing your exercises. If you find yourself in the red zone you are likely pushing yourself too hard and may flare up the pain.

Back to top of page

Ankle, foot and toe exercise

The following exercises will help to improve your pain over a period of time. Remember to follow the advice from the Pain Activity Ladder section above.

Back to top of page

Further information about Lesser Toe Deformities

Download

Back to top of page

image of a wasp, an acronym for weight, activity, shoes and partnership

W.A.S.P. is an acronym employed by our podiatrists to remind you of your current situation regarding your foot pain. It stands for Weight, Activity, Shoes and Partnership.

This is based on some of these areas of your lifestyle that go relatively unnoticed, in your life, until one day this comes sharply in to view then it stings you, resulting in your foot pain and now you pay attention, seeking help.

Weight reduction

People who tend to have increased weight can have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve and pain and the healing process.

Shoes

Shoes that have flexible soles generally offer the foot less support and can increase the stress in soft tissues in your feet. If you have shoelaces make sure they are tied appropriately. Avoid wearing hard, flat or unsupportive shoes.

Activity modification

Pacing is the term used for breaking down an activity or task. This can be done by taking regular breaks and prioritising daily activities can help. This can also help prevent ‘over-stimulating’ the pain system, so it is important to plan rests and set achievable goals.

Partnership

Your partnership with our MSK podiatrists, is based on the aims from NHS Scotland’s Realistic Medicine strategy, for you using healthcare services to feel empowered to discuss your treatment fully with our clinicians, including the possibility a suggested treatment might come with side effects – or even negative outcomes.

Back to top of page

Additional information

Acute Injury Management

POLICE is an acronym (Protection, Optimal Loading, Ice, Compression and Elevation) that is used as a management strategy for many injuries and conditions for the first 24 to 72 hours.

  • Protection and relative rest are advised immediately after injury for the first 24 to 72 hours.
  • Optimal Loading refers to having a balanced rehabilitation program which encourages early and gradual activity to improve recovery. How you progress will vary from person to person depending on the injury. It is about finding the injured areas happy place and increasing slowly and gradually.
  • Ice may be used for reducing pain and swelling. There are safety points to follow when you use ice:
    • Don't ice over a numb area or open wound. If the skin is numb you won't notice if you're developing an ice burn and ice on an open wound can increase the risk of infection.
    • Be wary of ice burns – don't apply ice directly to the skin, wrap an ice pack in a clean, damp tea towel before applying. Avoid prolonged exposure to ice, 10-20 minutes is usually adequate.
    • Apply crushed ice/frozen peas wrapped in a damp towel for 10-20 minutes, 2-3 times per day for the first 5-7 days post injury/ flare up of pain.
    • Stop applying ice if there are any negative effects such as increase in pain or swelling or skin soreness.
  • Compression and Elevation are helpful for reducing inflammation. This can be done by keeping your joint raised on a pillow and compressed by wrapping a bandage around it.
    Do not make the bandage too tight and do not wear tubi-grip or any compression bandage in bed at night.
  • Heat: After 2-3 days, you may find that heat is more relaxing.

You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and is not directly touching your skin.

You should do this for 10 to 15 minutes, 3 to 4 times a day.

What do I do if my symptoms flare up?

Flare ups of pain are common. Some people have recurrent flare ups of pain so it is important to know how best to manage these flare ups. In most cases a pain flare-up will settle within 6 weeks.

Top Tips

  • You will likely find it helpful to rest a bit more but it is still important to keep active. This will help to avoid becoming stiff and your muscles becoming weak.
  • If you aim to get a balance between rest and activity it should help your pain to settle down. You may be sore at first, however, start slowly and gradually increase the amount you do.
  • Reduce movements or tasks that aggravate your symptoms. This can help especially in the early days.
  • Adopting positions or movements that reduce your pain can be useful.

Pain Relief

Analgesia

  • Analgesia also known as pain relief can be an important part in helping you manage your symptoms and allow you to stay active.
  • Taking suitable pain relief regularly allows you to move more normally and continue your usual activities without causing any damage. It is unlikely that medication alone will resolve your pain totally. For this reason we are using the term pain relief (A 30-50% reduction in pain would be deemed to be a good success).

Paracetamol

  • Paracetamol is a good general pain management medication. It is used to help manage lots of different types of pain.
  • Sometimes people believe they need something ‘stronger’ than paracetamol when in fact, taking a regular dose rather than a one-off dose is more effective.
  • Spreading the doses of the paracetamol evenly out over a day will help you control your pain. Visit NHS Inform for more detailed information on paracetamol.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

  • NSAIDs are medications that can reduce swelling around joints and nerve endings to give pain relief. They are particularly useful
    in treating inflammatory type pain. Two commonly prescribed NSAIDs are ibuprofen and naproxen.
  • Although NSAIDs can be very useful they are not suitable for everyone. Visit NHS inform for further information related to NSAIDs.

There are other forms of pain relievers available. If you feel your current pain relievers are not helping your pain or you are
experiencing any side effects from your medication, please seek advice from your GP or pharmacist.

For general information on medication visit NHS Inform.

Staying in work and returning to work

We know that staying in work or returning to work as soon as possible is good for your mental and physical health.

If you have problems with activities at work, it may be helpful to ask for a workstation/workplace assessment or talk with your manager or Occupational Health Department. This can help with alterations or provision of equipment or altering your working day or tasks.

There are organisations which can support you at work or help you return to work. You can visit Knowledge Scotland for further information.

Weight Management

Weight Reduction – People who are overweight tend to have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve the healing process.

A good indicator of whether you need to lose weight is your body mass index (BMI), which you can calculate with the NHS BMI calculator.

If your BMI states you are overweight or obese it is likely that losing weight will reduce your symptoms. Carrying extra fat also increases your risk of heart disease, stroke, type 2 diabetes, and some cancers. Reducing your portion sizes and eating a balanced diet can be helpful in reducing weight. NHS informs provides a free online 12-week weight management programme to get you started right away.

If you need a little more help and feel that you would benefit from working with others in group sessions NHS Lanarkshire’s Weigh to Go programme, groups in North and South Lanarkshire, will help you become more active, eat well and lead a healthier lifestyle.

Smoking

Smoking can affect how your body recovers from musculoskeletal problems. If you smoke then the good news is that by stopping smoking it can improve your health in many different ways. Giving up smoking is not something you have to do on your own. You’re twice as likely to stop smoking successfully if you get the right support from the NHS. There is a free NHS stop smoking service available in Lanarkshire to help you succeed.

Chronic Pain

Some people will have pain which persists beyond the expected time frame for their condition. For further information on this and how best to manage it please visit our Chronic Pain webpage.

Pain Association Scotland is a national charity that delivers professionally led self-management pain education in the community.

Active Health Programme

South Lanarkshire

Active Health is a programme for residents of South Lanarkshire living with long term conditions. Residents are referred via Acute, Physio & specialist nurses to a 10-week programme and then signposted onto a wide variety of mainstream physical activity, sport & outdoor opportunities.

South Lanarkshire Leisure and Culture have many active community opportunities as well as specialised referral programmes. Full details of the 20 leisure centres can be found on the SLL website. Contact details across South Lanarkshire or call 01698 476262 to find out the number of your local leisure centre.

Please contact your health professional to discuss this referral or contact SLLC on 01698 476262.

Contact details

North Lanarkshire

North Lanarkshire Leisure’s Active Health Programme in partnership with NHS Lanarkshire provides a range of supported programmes to help individuals realise the benefits of becoming more physically active whilst also assisting those who are recovering from minor or even more serious illness.

The Active Health Programme has both a General Programme where individuals can access the mainstream health and fitness programmes running within NL Leisure Venues including swimming, jogging, golf and more!

A Specialised Health Class Programme which requires a referral from a health professional, this option is available to individuals who require additional specialised support in taking part in physical activity and classes include Strength and Balance, Cardio I, Cardio II, Back Care and Macmillan Move More classes.

A health and social care professional can make a referral by using the Active Health referral form found at the bottom of the page in the link below.

Contact Details - Health & Wellbeing Information

Mental Wellbeing

It is very important to look after your own mental wellbeing. This can have an influence on your recovery or management of your Musculoskeletal problem. Visit our mental wellbeing page for more information.

Back to top of page

If the advice on our website hasn't helped or improved your foot issue, you can self-refer and book an appointment.

Please complete our e-referral form and email this form to podiatry.hub@lanarkshire.scot.nhs.uk

The Podiatry Hub is open from Monday to Friday from 8am to 6pm.

Call the hub on 01698 753753

Podiatry hub telephone details 01698 753753
Glasgow Caledonian University logo
ï ’

NHS Lanarkshire Psychological Services: Digital Resources

Information for GPs and staff in all mental health services

Your Feedback – comments, concerns and complaints

NHS Lanarkshire is committed to improving the service it provides to patients and their families. We therefore want to hear from you about your experience. If you would like to tell us about this please visit our feedback page.

Near Me Lanarkshire