Quick answer: Toes that curl up are usually caused by muscle imbalance from hammertoe, claw toe, or mallet toe — often linked to tight shoes, bunions, nerve problems, or arthritis. While the toe still bends it responds to roomier shoes, toe spacers, and stretching; rigid, painful curling may need a podiatrist and occasionally surgery.
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
Curled toes have a critical variable most guides skip: whether the deformity is still flexible or has become rigid. A flexible hammertoe can often be resolved conservatively — splinting, shoe modification, physical therapy — in a matter of months. A rigid hammertoe cannot be manually straightened at all; surgery is the only correction, and the longer rigidity goes untreated, the more complex the required procedure becomes. Most patients don't know which type they have — and that single distinction determines the entire treatment path. Call (810) 206-1402 — Dr. Tom evaluates both types weekly.
Table of Contents
- What Does It Mean When Toes Curl Up?
- Cause 1: Hammertoe
- Cause 2: Claw Toe
- Cause 3: Mallet Toe
- Cause 4: Diabetic Neuropathy
- Cause 5: Neurological Conditions
- Cause 6: Ill-Fitting Shoes
- Cause 7: Bunion-Driven Second Toe
- Flexible vs. Rigid: Why This Distinction Matters
- How We Diagnose Curling Toes
- Treatment Options
- Warning Signs
- Frequently Asked Questions
You notice your second toe buckling over itself in your shoe, or your smaller toes have started curling under at the tip. Maybe you have a corn on top of a bent toe joint that keeps coming back no matter how many times you pad it. If you have been searching for what causes toes to curl up, you are in the right place. This is one of the most common structural problems we treat in our clinic — and one of the most misunderstood, because several different deformities look similar from the outside but have completely different causes and treatments.
What Does It Mean When Toes Curl Up?
Toes curl up when the balance between the muscles and tendons that move your toes is disrupted. Your toes have two competing force systems: extrinsic tendons (the long flexor and extensor tendons that run from your calf and shin) and intrinsic muscles (small muscles inside the foot itself — the lumbricals and interossei). When the intrinsics weaken or the extrinsic tendons tighten, the toe gets pulled into a bent or curled position.
The medical terms — hammertoe, claw toe, mallet toe — describe which joint is bent and in what direction. Understanding the distinction helps determine whether splints, wider shoes, and orthotics will work, or whether you are already at the point where surgery is the only lasting fix. In our clinic, we assess flexibility at the first visit because it is the single most important prognostic factor.
Key takeaway: Curling toes result from muscle-tendon imbalance. The key question is always: flexible or rigid? Flexible deformities respond to conservative treatment. Rigid ones usually require correction.
Cause 1: Hammertoe
Hammertoe is the most common reason toes curl up, accounting for the majority of cases we see. It involves abnormal bending at the proximal interphalangeal (PIP) joint — the middle knuckle of the toe — while the metatarsophalangeal (MTP) joint at the base is relatively normal. The toe takes on a shape like an upside-down V or a hammer head. The second toe is most frequently affected, followed by the third.
The underlying mechanism is an imbalance between the flexor digitorum longus tendon (which pulls the toe down and inward) and the intrinsic muscles (which straighten and stabilize the toe). Cramped toe boxes and high heels force the toe into sustained flexion, eventually shortening the flexor tendon and joint capsule. People with a second toe longer than the big toe (called a Greek foot) are especially vulnerable because the second toe buckles against the front of the shoe. In our clinic, we almost always see hammertoe in the second digit when a bunion is present, because the bunion pushes the big toe into the second toe’s space.
Early hammertoes are flexible — you can straighten the toe with your finger. Once the joint capsule and ligaments fibrose, the deformity becomes rigid and resists manual correction. That transition, in our experience, typically takes two to five years depending on footwear choices and activity level.
Key takeaway: Hammertoe = PIP joint buckled. Flexible (early) responds to splints and wider shoes. Rigid (late) almost always requires surgical correction to permanently straighten.
Cause 2: Claw Toe
Claw toe involves a more aggressive deformity than hammertoe and is a red flag for underlying neurological or systemic disease. In claw toe, the MTP joint is extended (toe cocked upward at the base) while both the PIP and DIP joints are flexed (curled under). The result looks like a claw gripping the ground. All four lesser toes are often affected simultaneously, which distinguishes it from isolated hammertoe.
The mechanism is failure of the intrinsic muscles — specifically the lumbricals, which normally keep the MTP joint from cocking up. When the intrinsics are lost, the extrinsic tendons dominate unopposed: the extensor digitorum longus hyperextends the MTP, and the flexor digitorum longus hammers both PIP and DIP. Intrinsic wasting is most commonly caused by diabetic peripheral neuropathy, Charcot-Marie-Tooth disease, rheumatoid arthritis, and alcoholic neuropathy. A patient who comes in with four clawed lesser toes and no clear trauma history gets a neurological workup in our clinic until proven otherwise.
Key takeaway: Claw toe affects all four lesser toes at once and involves MTP extension + PIP/DIP flexion. It is a neurological pattern — diabetes, CMT, and rheumatoid arthritis are the leading causes.
Cause 3: Mallet Toe
Mallet toe is a curling deformity that occurs at the distal interphalangeal (DIP) joint — the very tip of the toe — while the PIP and MTP joints remain straight. The toe looks normal until you get to the tip, which droops or curls under. The most common complaint is a painful corn directly on the tip of the toe or under the toenail, caused by the tip pressing into the ground or the front of the shoe.
Mallet toe is usually caused by shoe pressure combined with a tight flexor digitorum longus tendon. It is less often associated with systemic disease than claw toe. The second toe is most commonly affected. We find that people who wear pointed shoes or have had previous toe trauma (jammed toe in sports) are disproportionately represented in our mallet toe patients.
Cause 4: Diabetic Neuropathy
Diabetic peripheral neuropathy is the single most important systemic cause of curling toes we encounter. In people with diabetes, chronic high blood sugar damages the small nerve fibers that control the intrinsic muscles of the foot. As those muscles weaken and atrophy, the balance between intrinsic and extrinsic tendons is destroyed, producing the classic intrinsic-minus foot: all four lesser toes claw up, the metatarsal heads become more prominent underneath, and fat-pad atrophy leaves the skin beneath the balls of the feet vulnerable to ulceration.
This pattern is dangerous beyond cosmetic concern. The clawed toes and prominent metatarsal heads create high-pressure points on the plantar surface, and with numbness masking pain signals, patients do not feel the warning signs of ulceration forming. According to the American Diabetes Association, foot ulcers precede approximately 85% of diabetes-related lower-extremity amputations. Custom molded orthotics that off-load the metatarsal heads and therapeutic footwear are not optional in these patients — they are limb-saving interventions.
Key takeaway: Diabetic intrinsic-minus foot = all four lesser toes clawed due to motor neuropathy. This creates ulcer-prone pressure points. Custom orthotics and diabetic footwear are medically necessary, not a luxury.
Cause 5: Neurological Conditions (CMT, Stroke, Cerebral Palsy)
Charcot-Marie-Tooth disease (CMT) is the most common hereditary peripheral neuropathy, affecting approximately 1 in 2,500 people. It produces progressive intrinsic muscle wasting that starts in the feet, creating a characteristic high-arched foot (pes cavus) with curled lesser toes and hammer toes. Patients often notice difficulty buying shoes because the high arch and clawed toes require an unusual combination of heel-to-ball length and toe box height. CMT is frequently underdiagnosed because the progression is slow and patients assume their foot shape is just “how their feet are.”
Upper motor neuron lesions — from stroke, cerebral palsy, spinal cord injury, or multiple sclerosis — can produce spastic toe flexion where the toes curl into sustained flexion or strike abnormally during the gait cycle. In these cases the muscle overactivity is neurogenic rather than structural, and treatment may include botulinum toxin injections into the spastic flexors alongside physical therapy and AFO bracing before any surgical correction is considered.
Cause 6: Ill-Fitting Shoes
Shoes that are too short, too narrow in the toe box, or that have a slope forcing the toes into the front (high heels) are a primary driver of hammertoe formation in otherwise healthy feet. The mechanism is simple: sustained toe flexion shortens the flexor tendon over months and years, and the MTP joint ligaments adapt to the abnormal position. Studies have found that women develop hammertoes at a rate four times higher than men, consistent with the greater prevalence of high-heeled and narrow-toed footwear.
In our clinic we always check footwear when a patient presents with curled toes. The correct shoe length should leave a half-inch (about one thumb-width) between the longest toe and the end of the shoe. The toe box should be wide enough that you can wiggle all five toes freely. Many patients are surprised to learn they have been wearing shoes a full size too short for decades.
Key takeaway: Measure your feet while standing, in the afternoon (feet swell during the day), and fit to the longer foot. Most shoe-related hammertoes are directly preventable with correct shoe selection.
Cause 7: Bunion-Driven Second Toe Curling
A hallux valgus deformity (bunion) is not just a problem for the big toe — it is one of the most reliable predictors of second-digit hammertoe. As the big toe drifts toward the second toe, it crowds the second toe out of its natural position, eventually pushing it upward into a hammertoe or even causing it to cross over the top of the big toe (crossover second toe). In our surgical practice, we routinely correct the second toe hammertoe at the same time as the bunion, because the deformity will not resolve if the underlying driving force (the bunion) is left in place.
Patients who treat their bunion pain with wider shoes but ignore the progressive second toe subluxation are setting themselves up for a harder reconstruction later. The MTP joint of the second toe can sublux (partially dislocate) and eventually dislocate fully if the deformity is not addressed. We have seen patients who waited years and ended up needing a complete MTP joint reconstruction rather than a simple digital arthroplasty.
Flexible vs. Rigid: The Most Important Distinction in Your Diagnosis
Every patient who comes in with curling toes gets this assessment first: I hold the foot in a neutral position and try to straighten each affected toe manually. If the toe straightens completely to neutral, it is flexible. If it resists or can only partially correct, it is semi-rigid. If it does not move at all, it is rigid. This single test determines the entire treatment plan.
Flexible hammertoes can be managed non-surgically with toe spacers, hammertoe splints, metatarsal pads, stretching exercises, and shoe modifications. Rigid hammertoes cannot be permanently corrected without releasing the contracted tendon and reshaping or fusing the joint. The mistake we most commonly see is patients trying conservative measures for years on a rigid deformity and wondering why nothing works — the answer is structural, not mechanical. You cannot stretch a bone back into position.
Key takeaway: Conservative treatment only works on flexible deformities. If your curled toe does not straighten when you push on it, surgery is the only lasting correction.
How We Diagnose Curling Toes in Our Clinic
The diagnostic process for curling toes at Balance Foot and Ankle follows a systematic pattern. We start with a weight-bearing examination — many deformities that look mild on the table look dramatically worse when the patient stands and puts full body weight through the foot. We assess each joint for flexibility, check the skin for corns and calluses (which map the pressure points), and look at the metatarsal head prominences on the plantar surface.
Weight-bearing X-rays are standard for any patient who may need surgical correction. We use them to measure joint alignment, identify any degenerative changes, assess metatarsal length pattern (which affects surgical planning), and rule out stress fractures if pain is a prominent complaint. For patients with suspected neurological causes — bilateral claw toe pattern, family history of foot problems, or a history of diabetes — we coordinate with neurology for nerve conduction studies and EMG to characterize the neuropathy.
Treatment Options: From Conservative to Surgical
Treatment is staged to deformity severity and flexibility status. For flexible deformities, the first line is removing the mechanical force driving the problem: switch to a shoe with a wide, deep toe box and a low heel. Custom or semi-custom orthotics with a metatarsal pad unload the metatarsal heads and reduce the retrograde push that drives the toes upward. Hammertoe splints and toe spacers hold the toe in a corrected position during activity. Physical therapy exercises — specifically towel scrunches, marble pickups, and intrinsic strengthening — help rebuild the muscle balance.
For rigid deformities, surgery is typically the correct answer when the deformity is causing pain, recurrent corns, or difficulty with footwear. The two most common procedures are digital arthroplasty (resecting a small piece of bone at the PIP joint to allow straightening, without fusion) and digital arthrodesis (fusing the PIP joint permanently straight). Arthroplasty preserves some joint motion but carries a small risk of the toe re-curling; arthrodesis eliminates recurrence but creates a permanently stiff joint. For claw toe involving MTP joint subluxation, additional steps such as flexor-to-extensor tendon transfer, plantar plate repair, or metatarsal shortening may be required.
Recovery from digital surgery is typically four to six weeks in a post-operative shoe with weight-bearing permitted from day one in most cases. Temporary fixation with a pin or an implant holds the toe straight during healing. Most patients return to athletic shoes at six weeks and report meaningful improvement in pain and appearance at the three-month follow-up.
⚠️ When to see a podiatrist urgently
- Toe turns white, blue, or cold suddenly (vascular emergency)
- Open sore or ulcer on the toe tip or between toes (especially with diabetes)
- Rapidly worsening deformity over weeks rather than months (may indicate acute nerve or tendon injury)
- Severe pain at rest that is not explained by shoe pressure alone
- Toe locks in position after previously being flexible (sign of acute joint changes)
- Numbness or tingling in multiple toes simultaneously with new curling
Frequently Asked Questions
Can curling toes be straightened without surgery?
Yes — but only if the deformity is still flexible, meaning the toe straightens when you manually push it. Flexible hammertoes and claw toes can be managed with wider shoes, hammertoe splints, custom orthotics, and stretching exercises. Once the joint capsule and tendons have contracted enough that the deformity is rigid, surgical release and correction is the only way to achieve lasting straightening. This is why early treatment matters: most flexible deformities become rigid within two to five years if the underlying shoe or structural problem is not addressed.
Why do my toes curl up at night or when I take my shoes off?
Toes that curl involuntarily when unloaded — especially at night — are often showing a spastic or neurogenic pattern rather than a structural one. Diabetic neuropathy, Charcot-Marie-Tooth disease, and upper motor neuron lesions (stroke, MS, spinal stenosis) can all produce this. If your toes curl predictably when you remove your shoes or during rest, that pattern warrants a neurological evaluation rather than just a shoe fitting. In our clinic, night-time or rest curling is an automatic trigger for nerve testing.
Is hammertoe the same as claw toe?
No. Hammertoe bends at the middle joint (PIP) while the MTP joint at the base is relatively neutral. Claw toe involves the MTP joint being extended (cocked up) while both the PIP and DIP joints are flexed. Claw toe tends to affect all four lesser toes simultaneously and is more strongly associated with underlying neurological or systemic disease. Mallet toe is a third variant that bends only at the tip joint (DIP). The distinction matters because claw toe should trigger a systemic workup, while isolated hammertoe is typically a local mechanical problem.
Do toe stretches really help curling toes?
Stretching exercises help for flexible deformities, particularly in combination with intrinsic muscle strengthening (toe scrunches, marble pickups) and proper footwear. The goal is to re-establish the muscle balance that has been disrupted. However, stretching does not reverse structural changes in a rigid joint — it cannot lengthen a contracted tendon or a fibrosed joint capsule. Think of exercises as maintenance and prevention for early deformities, not correction for established rigid ones.
The Bottom Line
Curling toes are caused by a breakdown in the muscle-tendon balance that keeps your toes straight. The most common cause is hammertoe driven by footwear and biomechanical factors, but claw toe, mallet toe, diabetic neuropathy, Charcot-Marie-Tooth disease, and bunion-driven second toe deformity all produce similar appearances with very different underlying mechanisms. The single most important thing you can assess at home is flexibility: if your toe straightens when you push on it, conservative treatment has a real chance. If it does not move, you are past the window for non-surgical correction and surgery will be needed to achieve lasting results.
American Academy of Orthopaedic Surgeons. Hammer Toe. OrthoInfo, AAOS.
Sources
- Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot Ankle Int. 2000;21(2):94-104.
- Schrier JC, Verheyen CC, Louwerens JW. Definitions of hammer toe and claw toe: an evaluation of the literature. J Am Podiatr Med Assoc. 2009;99(3):194-7.
- Bus SA, et al. IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):25-36.
- Shy ME. Charcot-Marie-Tooth disease: an update. Curr Opin Neurol. 2004;17(5):579-585.
- American Diabetes Association. Microvascular complications and foot care: standards of medical care in diabetes 2024. Diabetes Care. 2024;47(Suppl 1):S231-S243.
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In-Office Treatment at Balance Foot & Ankle
Flexible hammertoes can be managed with toe splints, wider shoes, and metatarsal pads. Once the deformity becomes rigid, minimally invasive hammertoe correction restores alignment with small incisions and rapid recovery. See hammertoe treatment options →
📋 Dr. Tom Biernacki, DPM, FACFAS answers:
Whether curled toes can be corrected without surgery depends entirely on flexibility. A flexible hammertoe — where you can manually straighten the toe — responds to non-surgical treatment: wide toe-box shoes to remove compression, toe splints or straightening pads, physical therapy exercises (towel scrunches, marble pickups, toe stretches), and addressing the underlying cause like tight calf muscles or flat feet. With consistent treatment, flexible deformities can stabilize and sometimes improve. A rigid hammertoe — where the toe is fixed in the curled position — cannot be straightened by any conservative means; surgery (proximal interphalangeal joint arthroplasty or fusion) is the only correction. If curling came on suddenly in all toes rather than gradually in one, it may indicate a neurological cause that requires urgent evaluation — particularly if accompanied by muscle weakness or balance problems.
Footwear & Orthotics for Curling Toes
A deep, roomy toe box keeps pressure off curling toes (hammertoes), and orthotics can rebalance the forefoot. See our podiatrist-recommended shoes, and see a podiatrist if the toes are becoming rigid.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.