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How to Fix Curled Toes: Causes, Treatments, and Tips

how to fix curled toes after stroke

For many years, therapists did not know how to fix curled toes long-term. Instead, they gave patients toe separators and sent them on their way.

These days, we have a better understanding of what causes curled toes, which helps therapists recommend better treatment options.

To help you have an informed conversation with your therapist, here’s everything you should know about fixing curled toes:

Types of Curled Toes

Curled toes are characterized by just that: toes curling under. Your doctor or therapist can look at the toe joints to help diagnose the type of curled toes that you have.

Here are the different types of curled toes:

  • Hammertoe — when the toe bends at the middle joint, which forces the joint upward and the end of the toe downward, resembling a hammer.
  • Mallet toes — when the toes bend down at the joint closest to the tip of the toe.
  • Claw toe — when the 4 smallest toes bend up at the joint closest to the foot, and then each joint thereafter bends down. The toes appear to curl down, and in severe cases, may curl into themselves.

What Causes Toes to Curl Up?

Sometimes curled toes are caused by wearing shoes that are too tight for too long. Other times, curled toes are the result of neurological injury like stroke.

When the neurological impact of stroke impairs the brain’s ability to send motor signals to the toes, the muscles in the foot and toes respond by tightening, resulting in curled toes. This is known as spasticity.

Curled toes can make walking uncomfortable and even painful. Fortunately, there are treatments that can help fix the condition.

Treatment for Curled Toes

Here are some of the best ways to fix curled toes:

1. Rehab Exercises

therapist working with patient to fix curled toes with exercises

Therapeutic exercise for curled toes is the most effective, noninvasive treatment available. It works best when curled toes are the result of neurological injury like stroke.

Curled toe exercises (like the ones we list below) help retrain the brain to properly send signals to the feet and toes. It works by activating neuroplasticity, the brain’s natural ability to rewire itself, through repetitive exercise.

The more you use your toe and foot muscles, the better your brain gets at controlling and relaxing those muscles. When beginning treatment of curled toes, rehab exercises are the best place to start.

Want 25 pages of stroke recovery exercises in PDF form? Click here to download our free Stroke Rehab Exercise ebook now (link opens a pop up for uninterrupted reading)

2. Botox

Botox is an evidence-based treatment for fixing curled toes after stroke. It helps relieve spasticity by acting as a nerve block, resulting in relaxed muscles, which helps the toes relax. All stroke patients respond differently to Botox. Talk to your therapist to see if you’re a good fit.

3. Electrical Stimulation

When you combine electrical stimulation with other treatments, like toe exercises and Botox, you may see more results. Electrical stimulation helps stimulate the brain and encourage reconnection between the brain and the toe muscles. This treatment is most effective when curled toes are the result of neurological injury like stroke.

4. Orthotics and Toe Separators

feet with toe separators to help fix curled toes

If you’re currently working with an occupational therapist, (s)he may have already suggested an orthotic with toe crests to help with your curled toes. These orthotics help realign the feet and may help improve pain.

Orthotics are a compensation technique, though. Although it may help improve the condition in the short-term, further neglect of the foot muscles may worsen the condition.

If you’re going to use orthotics – and if your OT recommended it, you should listen to them – be sure to use them in addition to practicing your toe exercises. That way, you’re addressing the root of the problem as well.

5. Roomy Shoes

If your curled toes are caused by wearing shoes that are too tight for too long, then getting shoes with bigger toe boxes can greatly help. This will give the toes necessary “wiggle room.” Also, be sure to avoid high heels as these greatly increase pressure on the toes and may worsen the condition.

6. Surgery

If you have tried most of these treatments without success, then, your doctor may recommend surgery. Depending on the problem, your doctor might need to relax some of the muscle tendons in order to relax the toes.

Like most invasive surgery, these procedures require lengthy recovery time and will require you to remain off the foot for an extended period of time. Your best option is to try conservative management for your curled toes before considering any type of surgery.

Exercises for Curled Toes

The best way to fix curled toes is to rewire the brain through specific toe exercises.

The following exercises for curled toes below will help — but they may feel weird at first. Some of them require you to curl your toes even more, which you might not want to do.

However, using those muscles is how you will regain control of them.

Here are some simple curled toes exercises to start with:

  • Toe Taps. Attempt to raise all your toes up off the ground and then place them back down. Repeat 10 times. It’s okay if you can’t move your toes very much yet. Attempting the movement will initiate important changes in the brain.
  • Floor Grips. With your feet flat on the floor, attempt to grip the floor by curling your toes, and then release as best you can. Repeat 10 times.
  • Finger Squeezes. Cross your foot over your knee and place a finger in between your big and second toes. Then, squeeze your toes together to pinch your finger as hard as you can. Release, and repeat 10 times.
  • Marble pickup. Place a dozen marbles on the floor and attempt to pick them up using your toes. This can be difficult at first, and it’s okay if you need a caregiver to assist you.
  • Towel curls. Place a towel on the floor and use your toes to pinch the towel and pick it up. Then, place it back down, flatten it out, and repeat. This is a difficult exercise, so it’s okay if you don’t get it at first. You will get better with practice.
  • Toe Extensor Strengthening. Cross your foot over your knee so that you’re sitting cross-legged. Then, place a resistance band around the top of your foot to pull your toes back toward your body, like so:

Then, use your foot to push the resistance band away from your body. Return to center and repeat 10 times.

This will be very difficult in the beginning, so remember: as long as you attempt to make the movement, you’re stimulating changes in the brain.

If you need to do these exercises passively with the help of a caregiver, that’s a great place to start.

Tips for Living with Curled Toes

It takes time to rewire the brain with rehab exercises for curled toes, so be patient. As long as you put in the reps, the brain will work hard to reward your hard work!

In the meantime, here are some tips to help you out:

  • Stretch your toes to keep the tendons as lengthened as you can. Avoid this if it’s too painful, but once those tendons shorten, it’s hard to reverse.
  • Try some toe separators when you’re at home. Yes, the cheap foam beauty salon tools that you use to keep your toes separated while manicuring. Using toe separators can help reduce the pain of curled toes.
  • Use toe cushions in your shoes when you’re out and about. Toe cushions are like little pillows for your toes that comfortably go inside your shoes and reduce the pain.
  • Ask your occupational therapist to show you how to use athletic tape. Some OT’s know how to use athletic tape to help align and support curled toes. Ask your OT to see if they can show you how.
  • Get a pair of magnetic gel insoles. A stroke survivor named James claimed that they helped reduce his curled toes. Since it’s a non-invasive treatment, why not give it a shot? You can also cut the gel insoles up to protect your toes from painfully rubbing around in your shoes.

It’s possible that curled toes can go away on their own in time — a phenomenon known as spontaneous recovery.

However, you can take an active role in your recovery by experimenting with these various treatments for curled toes (with your therapist’s approval, of course).

And there you have it! These are the best ways to fix curled toes.

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