Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Question:

Several doctors are concerned because my toes curl under. What is this and what causes it?

Answer:

The most likely cause of this is "claw toe" or "hammer toe," common foot conditions that tend to develop among middle age or older adults.

With a claw toe, the joints in the middle and end of the toe flex. With a hammer toe, it's only the middle joint that is flexed. Either way, the toe maintains a flexed (or curled) position. Often the tip of the toe rubs on the bottom of the shoe or the top of the middle joint rubs on the top of the shoe, causing a blister, corn or callus that may become infected. One or more toes may be involved.

These conditions may occur for no apparent reason or may be related to:

• Wearing tight, poorly fitting or high-heeled shoes over many years

• Flat feet

• Bunions, in which the first toe turns toward the other toes and crowds them

• Arthritis of the toes

• An imbalance of muscles leading to tight tendons in the feet

For some, these conditions are a minor annoyance. For others, it may be a painful problem that makes it difficult to find comfortable shoes and impairs walking.

Treatment includes:

• Changing footwear to accommodate the shape of the foot

• Foot exercises to flatten the toes and stretch the tendons

• Cushions or pads to take pressure off corns or calluses

• Splints to help the affected toes maintain a more comfortable position

• Surgery to correct the deformity

If you have no symptoms other than the appearance of your toes, you may need no treatment other than avoiding tight shoes.