For millions of people, a quick glance down at their feet reveals toes that no longer look quite the way they once did.
Around one in three Americans is expected to experience a change in the shape or appearance of their toes at some point in life.
Although these changes are often dismissed as a cosmetic concern, toe shape can sometimes offer important clues about a person’s wider health.
Deformities including hallux abducto valgus, commonly called bunions, and claw toes may develop after years of wearing unsuitable footwear. In some cases, they cause significant pain when walking or switching between different types of shoes.
Shoes that are tight, narrow or too shallow can repeatedly rub against the toes and aggravate discomfort. Over time, ongoing pressure on the toe joints may cause them to gradually adapt to the restricted space around them.
Footwear and past injuries are not the only possible explanations. Changes in toe shape may also be associated with inflammatory disorders, including psoriatic arthritis, as well as peripheral neuropathy.
Even mild curling, swelling or the development of calluses can sometimes point to vascular problems or chronic conditions such as diabetes.
Because toe problems are easy to ignore, delayed treatment can allow complications to develop. These may include blisters, ulcers that fail to heal and, in the most serious cases, amputation.
Millions of Americans notice changes in their toe shape, yet many do not realize these signs can sometimes be linked to serious health conditions
Anyone who notices an unusual or persistent change should consider seeing a podiatrist, particularly when the problem does not improve with rest or more suitable footwear.
A single swollen toe with a sausage-like appearance can be especially difficult to interpret, particularly when the change develops suddenly and is accompanied by pain or inflammation.
Medical assessment is important because this type of swelling may be linked to dactylitis, also known as a “sausage digit,” gout or a bacterial infection. Dactylitis can affect one toe or finger and cause pronounced swelling.
Podiatrist Jonathan Brocklehurst (pictured) has treated hundreds of patients experiencing changes in the shape of their toes
Recent research published in Diabetes Care suggests that people with nerve damage or muscle-wasting conditions may be more likely to develop toe deformities. These changes can redistribute pressure across the foot, raising the risk of wounds and ulcers.
Enlarged or clubbed toes may also signal reduced oxygen supply to the area, a problem that can be associated with heart disease.
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Spotting toe changes early, together with choosing properly fitted shoes, may help reduce the risk of falls, wounds and infections while allowing treatment—including surgery when necessary—to be considered sooner.
Five symptoms worth watching for include reduced sensation, tingling or numbness, unusually prominent toe joints, possible infection marked by heat, redness and swelling, and sudden or severe pain.
A person’s likelihood of developing toe deformities can be influenced by several factors, including genetics, lifestyle and the shoes they wear.
One patient I remember was a man in his 80s who had played golf for two decades after retiring. He sought help after noticing that his little toe was beginning to overlap the fourth toe, creating friction and a painful corn along its inner side.
I fashioned a silicone toe prop to keep the two toes apart and relieve pressure in the space between them. The device reduced the rubbing around the prominent joints, eased his pain and allowed him to play golf more comfortably.
Treatment for toe deformities can include removable props and sleeves, as well as surgical interventions
Crucially, he felt less pain for a longer period of time. The most significant impact was actually made by the patient himself when purchasing a pair of wider fit shoes for golf, which reduced the rubbing on the outside of his little toes and reduced pressure onto the fourth toe.
Treatment for toe deformities such as hammer or clawed toe can include conservative management using silicone toe props and foam sleeves to protect the toe and relieve pressure.
In severe cases where pain experienced may affect the ability of an individual to conduct day to day activities, a doctor may consider surgical treatment to ‘correct’ the affected joint in the toe.
In cases of severe toe deformity, bespoke footwear and walking aids may benefit the patient in the long-term to maintain balance and reduce pressure on affected toes.
Sadly, in some cases, this realization comes too late, resulting in blisters turning into wounds which ulcerate, become infected and require amputation due to lack of blood flow to the feet due to the effects of diabetes.
Therefore, seeking advice from a podiatrist is crucial even if there are initial ‘gut feelings’ or general concerns about a possible change in shape of the toes.
Don’t ignore it. The earlier you raise concerns, the more likely a better outcome for treating changes in the toes to improve quality of life.
Jonathan Brocklehurst, MSc, MIRL, MRCPod, is a podiatrist based in the UK.
