Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Hammertoe, Mallet Toe, and Claw Toe: Differences and Surgica relates to toe deformity — typically caused by imbalanced muscles + footwear. Most patients improve in depends on severity with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Lesser toe deformities — hammertoe, mallet toe, and claw toe — are frequently grouped under the generic term “hammertoe” in clinical practice, but they represent distinct deformity patterns involving different joints of the lesser digits. Accurate anatomic classification determines the correct surgical procedure and predicts outcomes. Each deformity pattern also reflects different underlying causes: intrinsic muscle imbalance, extrinsic tendon contracture, neuromuscular disease, or deformity-driving hallux valgus and flatfoot.
Anatomic Definitions
A hammertoe involves flexion contracture at the proximal interphalangeal (PIP) joint with relative extension of the distal interphalangeal (DIP) joint and varying MTP joint position — producing a characteristic triangular dorsal prominence at the PIP joint that conflicts with shoe dorsum. A mallet toe involves isolated flexion contracture at the DIP joint, with normal PIP and MTP joint alignment — the tip of the toe curls plantarward and the nail contacts the ground or shoe toebox. A claw toe involves hyperextension of the MTP joint combined with flexion contracture of both the PIP and DIP joints — producing the most severe deformity, often associated with intrinsic muscle dysfunction from neurological disease (CMT, Charcot neuroarthropathy) or severe flatfoot.
Flexible vs. Rigid Deformity
The critical clinical distinction is whether the deformity is flexible (passively correctable to neutral by examiner) or rigid (fixed contracture that cannot be passively reduced). Flexible deformities retain the ability to straighten with gentle pressure and are managed with softer tissue procedures. Rigid deformities have fibrosed capsular and ligamentous contracture that requires bony procedures to achieve correction. Deformity progression from flexible to rigid typically occurs over years, reinforcing the benefit of early surgical correction.
Conservative Management
Conservative management delays progression and symptom management without structural correction. Footwear modification (extra-depth toe box, soft upper materials, toebox height at least as great as toe height in comfortable position) reduces dorsal corn friction. Toe sleeves, gel spacers, and metatarsal pads offload pressure points. Flexible deformities may benefit from toe-straightening strapping to retard progression. Conservative management is appropriate for asymptomatic or minimally symptomatic flexible deformities and for patients who are not surgical candidates.
Surgical Procedures by Deformity Type
Flexible hammertoe: flexor digitorum longus tenotomy (percutaneous release of the FDL tendon through a 2mm stab incision at the plantar DIP joint crease) immediately releases the PIP flexion contracture with minimal recovery. Rigid hammertoe: PIP joint arthroplasty (resection of the proximal phalangeal head through a dorsal incision, removing approximately 3–4mm of bone and allowing the joint to fibrose straight) or PIP arthrodesis (fusing the joint in neutral position using a K-wire, an absorbable pin, or an intramedullary implant such as the Smart Toe or ProStep). Claw toe correction requires MTP joint release (extensor tendon lengthening, MTP capsulotomy) combined with PIP and/or DIP joint procedures. Mallet toe: distal DIP flexor tenotomy or DIP arthroplasty.
Concurrent Procedure Planning
Lesser toe surgery is rarely performed in isolation. Hallux valgus (bunion) correction is performed concomitantly when deformity forces from medial column instability drive the lesser toe pathology. Weil metatarsal osteotomy (shortening the metatarsal to decompress the MTP joint) accompanies hammertoe repair when MTP joint subluxation or plantar plate pathology is present. First ray stabilization (Cotton osteotomy, or first TMT arthrodesis for Lapidus-type correction) addresses the driving biomechanical cause when first ray hypermobility is identified.
Lesser Toe Surgery at Balance Foot & Ankle
Dr. Biernacki at Balance Foot & Ankle performs percutaneous flexor tenotomy for flexible hammertoes and PIP arthroplasty or arthrodesis for rigid deformities — with surgical planning individualized to each patient’s deformity pattern and activity level. Many procedures are performed under local anesthesia with immediate walking in a surgical shoe. Call (810) 206-1402 for a same-week hammertoe evaluation.
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3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills, MI 48302
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Book Your AppointmentMore Podiatrist-Recommended Hammertoe Essentials
Extra-Depth Orthopedic Shoe
Orthofeet Sprint — tall toe box prevents hammertoe rubbing and friction.
Wide-Toe-Box Walking Shoe
New Balance 990v6 — accommodates curled toes without pressure.
Supportive Insole
PowerStep Pinnacle — reduces forefoot pressure that drives hammertoe.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Rigid hammertoes don’t reduce with splinting alone — the tendon and capsule have contracted. If the toe no longer straightens passively, surgical correction restores alignment in one short outpatient visit. Call Balance Foot & Ankle to see whether your deformity is still flexible (and responsive to the conservative tools above) or if it’s time for a 20-minute in-office correction.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
In Our Clinic
Hammertoes come to our clinic in two flavors: flexible (the toe still passively straightens) and rigid (it doesn’t). For flexible hammertoes we use gel toe crests, roomier toe boxes, custom orthotics to address the underlying instability, and sometimes night splints. Rigid hammertoes with a corn on top of the PIP joint, or a callus under the metatarsal head, usually need a minor outpatient procedure (PIP arthroplasty or fusion) to straighten the toe. The patients who wait too long develop fixed deformities and skin breakdown — we would much rather address a flexible hammertoe early.
In-Office Treatment at Balance Foot & Ankle
When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Hammertoe Treatment Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)