Trauma case: toe problems after a serious leg injury

A serious injury to the foot or leg can affect the toes long after the original wounds have healed. If the tendons that move the toes are damaged or scarred, the toes can be pulled out of line. This case shows the kind of problem that can follow, and how it can be treated.

Why can toes change shape after an injury?

Each toe is moved by tendons that pull it up and down. Toe deformities such as claw toe and hammer toe happen when these tendons become too tight or out of balance.¹ A bad leg injury can cause this, for example when scarring shortens the muscles and tendons that bend the toes.² The bent toe can then rub on the other toes and the inside of the shoe, causing pressure and pain.¹

The case

A man in his 60s came to see us after a motorcycle accident that badly injured his right leg and foot. He had three main problems:

• His second toe hung downwards in a claw shape and kept catching on the ground, making him trip.
• His big toe pointed upwards and rubbed on his shoes, and its nail had become misshapen.
• He found it hard to get shoes that fitted.

On examination, the pattern suggested tendon damage from the original injury.

What can help?

The first step for painful bent toes is usually non-surgical: padding and strapping to stop toes rubbing, and soft, roomy shoes, or insoles and special footwear.¹ In this case, the toes were badly out of line and making him trip, so surgery was the better option.

Problems like these don't correct themselves, and rubbing can lead to inflamed or broken skin.¹ Surgery for toe deformities can involve releasing or lengthening tendons, cutting and realigning a bone (an osteotomy), or fusing a toe joint so it stays straight (arthrodesis).¹ For this patient, the big toe was realigned with an osteotomy held with a fine wire, and the second toe joint was fused and supported against the third toe.

The outcome

At his review 8 months later, both toes had healed in a better position. He could wear normal shoes again, and he was back to walking for an hour a day.

Every person and every injury is different, and not everyone will have the same result. Like any operation, toe surgery has risks, including infection, slow bone healing, stiffness and the deformity coming back.¹ Swelling can take up to 6 months to settle completely.¹

When to see a podiatrist

See a podiatrist if a toe has changed shape after an injury, rubs on your shoes, or makes you trip. Get checked sooner if you have diabetes or poor circulation, as rubbing toes can lead to ulcers and infection.¹

If an old injury is causing problems with your toes, book an appointment to talk through your options.

References

1. Healthdirect Australia (2026). Surgery for problems of the small toes. https://www.healthdirect.gov.au/surgery/surgery-for-problems-of-the-small-toes
2. Gonçalves H, Kajetanek C, Graff W, et al. (2015). Flexor digitorum brevis tendon transfer to the flexor digitorum longus tendon according to Valtin in posttraumatic flexible claw toe deformity due to extrinsic toe flexor shortening. Orthopaedics & Traumatology: Surgery & Research, 101(2), 257–260. https://doi.org/10.1016/j.otsr.2014.12.008

Reviewed by Andrew Schox, Podiatrist, BSc(Hons) PGradDipPod MPod. Last reviewed October 2026.