FITNESS & NUTRITION Bones/Joints/Muscles • Juvenile rheumatoid arthritis • Osteoarthritis • Rheumatoid arthritis • Bursitis • Fibromyalgia • Gout • Lupus • Osteoporosis • Sjogren's syndrome • Tendinitis • Trigger finger • Achilles tendon rupture • Back pain • Hip fracture • Rotator cuff injury • Scoliosis • Muscular dystrophy • Dislocation • Shin splints • Bunions • Muscle cramp • Polymyositis • Dermatomyositis • Sprains and strains • TMJ disorders • Scleroderma • Osgood-Schlatter disease • Frozen shoulder • Polymyalgia rheumatica • Baker's cyst • Flatfeet • Morton's neuroma • Tennis elbow • Psoriatic arthritis • Hammertoe and mallet toe • Ankylosing spondylitis • Paget's disease of bone • Reactive arthritis • Metatarsalgia • Plantar fasciitis • Spinal stenosis • Sciatica • Marfan syndrome • Neck pain • Septic arthritis • Knee pain • Stress fractures • CREST syndrome • Dislocated shoulder • Patellar tendinitis • Costochondritis • Bone spurs • Avascular necrosis • Legg-Calve-Perthes disease • Water on the knee • Mixed connective tissue disease • Kyphosis • De Quervain's tenosynovitis • Cervical spondylosis • Thumb arthritis • Ehlers-Danlos syndrome • Golfer's elbow • Pseudogout • Sacroiliitis • Dupuytren's contracture • Achilles tendinitis • Diffuse idiopathic skeletal hyperostosis (DISH) • Osteochondritis dissecans • Osteomyelitis • Ganglion cysts • Chondromalacia patella • Chronic exertional compartment syndrome • Adult Still's disease • Rickets • Growth plate fractures • Greenstick fractures

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A hammertoe is a toe that's curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. The differences between hammertoe and mallet toe are subtle. Both conditions are commonly caused by shoes that are too short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe.

Both hammertoe and mallet toe can cause your toe to press against the top of the toe box of your shoe, causing pain and pressure. In addition, you may have pain from a hard growth of skin (corn) on the top of your toe that can form where your toe rubs against your shoe. Pain may also result from calluses that develop under the tip of your toe or on the ball of your foot.

Unlike a bunion, which affects only your big toe, hammertoe and mallet toe can affect any toe. Most commonly, hammertoe and mallet toe occur in your second toe. Generally, both joints of the toe are affected, causing your toe to bend upward in the middle, giving it a hammer-like or claw-like appearance.

Aside from wearing crowded shoes, hammertoe and mallet toe may result from muscle and nerve damage (neuropathy) caused by conditions such as diabetes, stroke, osteoarthritis and rheumatoid arthritis. Relieving the pain and pressure may involve changing footwear and wearing shoe inserts. More severe cases may require surgery.

Signs and symptoms of hammertoe and mallet toe may include:

• A hammer-like or claw-like appearance of a toe
• In mallet toe, a deformity at the end of the toe, giving the toe a mallet-like appearance
• Pain and difficulty moving the toe
• Corns and calluses resulting from the toe rubbing against the inside of your footwear

Both hammertoe and mallet toe can cause pain with walking and other foot movements.

A common cause of hammertoe and mallet toe is wearing improper footwear — shoes that are too tight in the toe box, or high-heel shoes. Wearing shoes of either type can push your toes forward, crowding one or more of them into a space that's not large enough to allow your toes to lie flat.

The result is a toe that bends upward in the middle and then curls down in a hammer-like or claw-like shape. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses. The bottom of the affected toe can press down, creating the mallet-like appearance of mallet toe.

At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff.

Other causes of hammertoe and mallet toe may include:

• An injury in which you jam or break your toe
• Abnormal foot mechanics because of nerve and muscle damage to your toe resulting from diabetes
• Other diseases that affect nerves and muscles, such as arthritis or stroke

See your doctor if you have foot pain that's persistent and that affects your ability to walk properly and carry out other motions with your foot. Also, see your doctor if one or more of your toes has developed a clenched or claw-like appearance.

Your doctor can diagnose hammertoe or mallet toe by examining your foot.

If your toe is still flexible, your doctor may recommend that you change to roomier and more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Wearing inserts or pads can reposition your toe and relieve pressure and pain.

If your toe has become tight and inflexible, your doctor may recommend surgery. The precise procedure depends on how much flexibility is left in your toe.

• If your toe has some flexibility, your doctor may straighten it by making an incision in the toe and releasing the tendon.
• If your toe is rigid, your doctor may not only cut or realign tendons but also remove some pieces of bone to straighten your toe. This procedure may require that the bones be fixed temporarily with pins while your toe heals.

Usually, you can go home from the hospital on the day of your toe surgery.

You can avoid many foot, heel and ankle problems with shoes that fit properly. Here's what to look for when buying shoes:

• Adequate toe room. Avoid shoes with pointed toes.
• Low heels. Avoiding high heels will help you avoid back problems.
• Adjustability. Laced shoes are roomier and adjustable.
• Comfort. Select comfortable athletic shoes, strapped sandals or soft, roomy pumps with cushioned insoles.
• Breathability. Avoid vinyl and plastic shoes. They don't breathe when your feet perspire.

These additional tips may help you buy the right shoes:

• Buy shoes at midday. Your feet are smaller in the morning and swell throughout the day.
• Measure both feet. Your feet may not be the same size.
• Don't assume your shoe size hasn't changed. As you age, your shoe size may change — especially the width.
• Ask for just the right fit. Have your shoe store stretch shoes in tight spots.

Wearing proper footwear may ease your foot pain. Low-heeled shoes with a deep toe box and flexible material covering the toes may help. Make sure there's a half-inch of space between your longest toe and the inside tip of your shoe. Allowing adequate space for your toes will help relieve pressure and pain.

In addition, your doctor may suggest exercises you can do at home or at work to strengthen your toe muscles. These may include:

• Picking up marbles with your toes
• Stretching your toe muscles

Don't try to remove a corn on your own using such methods as over-the-counter acid treatment, cutting or shaving. Home treatments can cause serious problems, especially if you have diabetes or poor circulation. Breaking the skin could result in an infection — in some cases, an infection serious enough to require amputation.