Expert Guide: How to Fix Curled Toes After Stroke (With Home Exercises)

NeuroRehab Team
Tuesday, September 16th, 2025

curled toesspasticity

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Stroke survivors often develop claw toe, which affects about 46% of patients shortly after their stroke . Their toes curl into a claw-like shape, which affects their mobility and quality of life by a lot . The pain makes it hard to stand on the affected leg, so daily activities become quite difficult .

Curled toes need proper care and management as a common problem after stroke . Patients who lose control of foot or toe movement face a much higher risk of permanent walking disabilities . The outlook remains positive though – about 70% of stroke survivors see their curled toes improve with treatments like Botox . The brain can also rewire itself through specific toe exercises that help fix this condition .

This piece covers what stroke survivors should know about curled toes. They’ll learn about the mechanisms and practical home exercises that help restore function and support recovery.

Understanding Curled Toes After Stroke

After a stroke, survivors often face many physical challenges. Toe deformities can greatly affect their mobility and quality of life. Understanding these conditions helps create effective treatment and recovery plans.

What are curled toes?

Curled toes happen when toes bend or curl under the foot unnaturally. Like fingers, each toe has three joints (except the big toe which has two). These joints help toes straighten and bend as needed for balance and walking ^[1]. However, people with curled toes can’t fully extend their toes. This causes discomfort, pain, and serious balance and walking problems ^[1].

Curled toes fall into two main types: flexible and rigid. Flexible curled toes show up in early stages where the toes can still move at the joints ^[2]. Rigid curled toes show up in advanced stages where toes get stuck in their unnatural position, which limits treatment options ^[2].

The condition usually affects the stroke-side foot and develops early—many cases appear before the end of the third month post-stroke ^[3]. Each patient experiences it differently. Some feel a lot of pain while others might not, though they could develop calluses from friction against shoes ^[4].

Types: Claw toe, hammer toe, mallet toe

Curled toes after stroke usually come in three distinct types, each affecting different joints:

1. Claw toe: The four smaller toes bend upward where the toes and foot meet (metatarsophalangeal joint), then bend downward at the middle joints and at the joints nearest the tip ^[5]. This creates a claw-like shape, with toes curling down toward the floor, sometimes so much that the toe curls under itself ^[4].
2. Hammer toe: The toe bends downward at the middle joint (proximal interphalangeal joint). This forces this joint upward and pushes the end of the toe downward ^[5]. It looks like a hammer and usually affects the second toe most ^[6].
3. Mallet toe: A bend forms at the joint closest to the toenail (distal interphalangeal joint). This makes the toe’s tip curl downward ^[5]. The second toe gets affected most often ^[1].

How stroke leads to toe curling

Brain damage from stroke causes toe curling. The brain can’t send proper signals to muscles, which disrupts normal communication through the spinal cord to the Peripheral Nervous System ^[4].

This disruption creates muscle imbalances in feet and toes. Foot muscles might over-contract because of the nerve damage ^[2]. Toe muscles aren’t very strong, so the contracting muscle overpowers opposing muscles. This tightens tendons and makes joints buckle or curl unnaturally ^[2].

The involuntary muscle tightening is a type of spasticity—patients lose control of voluntary toe movements ^[4]. Without treatment, spasticity gets worse as toe joints curl and tighten more. Eventually, they become very rigid and form contractures ^[1].

Research shows that curled toes after stroke often connect to other lower limb problems. Studies found a strong link between claw toes and equinus and/or varus foot deformities ^[3]. This shows why stroke survivors need a complete foot assessment and treatment plan.

Common Causes of Toe Curling After Stroke

Stroke survivors often have toe curling because of brain changes that affect how their muscles work and move. Learning why it happens helps create treatments that work and stops long-term problems.

Spasticity and muscle imbalance

The biggest reason for curled toes after stroke is spasticity—muscles contract without control and become stiff and rigid. Studies show 25% to 43% of survivors develop spasticity in the first year after their stroke ^[7]. This happens when normal muscle control breaks down, and some muscles stay constantly tight.

The feet develop a serious muscle imbalance. Research shows that “muscles in the foot over-contract due to a neurological abnormality” ^[8]. Toe muscles aren’t naturally strong, so the tight muscles easily overpower the opposing ones and force toes into strange positions.

This imbalance shows up in three ways:

• Toe flexor muscles tighten and pull toes down
• Toe extensor muscles that straighten toes become weak
• Both problems combine to create severe curling

The muscle imbalance gets worse without treatment. Toe joints stay somewhat flexible at first, but they become stiff and locked in a curled position without help—doctors call this contracture ^[7]. This explains why about 83% of patients who develop claw toes show signs within three months after their stroke ^[9].

Nerve damage and poor brain-muscle communication

The brain can’t send proper movement signals to the toes after a stroke ^[10]. This nerve damage affects the normal pathways between the brain and the Peripheral Nervous System (PNS) that controls foot and toe muscles ^[5].

A healthy brain sends exact signals to keep muscles at the right tension and position. These signals become irregular or stop after a stroke. The brain loses its ability to tell toe muscles when they should relax.

This communication problem affects the stroke-side foot most ^[8]. Digital flexor spasticity (the medical name for toe curling) creates claw-like toes because muscles tighten without relaxing ^[5].

Footwear and posture issues

Neurological factors cause most toe curling after stroke, but outside factors can make it much worse. Bad shoes play a big role in making toe problems worse.

Tight, narrow shoes or high heels squeeze toes and limit blood flow, which can make toe curling worse ^[11]. Stroke survivors who already have muscle problems might see their flexible toe problems become rigid faster with wrong footwear.

Changes in posture and walking after stroke create unusual pressure on the feet. Many survivors develop different ways of walking that strain certain foot muscles too much. Their posture often includes:

• Moving weight away from the affected side
• Walking on their toes
• Rolling their foot inward

These posture changes relate strongly to toe curling. Research proves a strong link between toe-walking and/or inward-rolling feet and claw toes (p<0.0001) ^[9]. This shows how changes in the whole leg contribute to toe curling beyond just the brain problems.

Best Treatment Options for Curled Toes

Stroke survivors need a tailored approach to manage curled toes based on their condition’s mechanisms. The right treatment can make a big difference in their comfort, mobility, and quality of life.

Rehabilitation exercises

Rehabilitation exercises stand out as the best non-invasive treatment for curled toes after stroke. These exercises tap into neuroplasticity—the brain’s natural ability to rewire itself. This helps retrain proper communication between the brain and toe muscles. Patients who practice consistently regain muscle control as their brain relearns how to send signals to feet and toes correctly. Their control and relaxation of toe muscles improve without medication or surgery. Research shows these exercises work best when curled toes come directly from neurological injuries like stroke ^[12].

Botox and medication

Botulinum toxin (Botox) injections are a proven treatment that relieves spasticity by blocking nerves. These injections block acetylcholine—a neurotransmitter that causes muscle contractions. This leads to relaxed muscles and straighter toes. Studies showed that Botox treatments improved claw toe in about 70% of stroke survivors ^[12]. Research also found that targeting both long and short toe flexor muscles with Botox works with doses from 40 to 90 units—much lower than experts thought needed ^[13].

Orthotics and toe separators

Orthotics and toe separators keep toes aligned properly and stretch tight joints and muscles gently. Custom or ready-made devices—especially silicone ones—spread pressure well and stop toes from overlapping or rubbing against shoes. Toe separators mainly work by creating space between squeezed toes. This reduces friction that leads to blisters, calluses, and corns ^[14]. These devices work best with rehabilitation exercises rather than alone since they compensate without fixing the root problem of curled toes ^[15].

Therapeutic taping

Kinesiotape or athletic tape supports proper toe alignment temporarily while reminding patients how their toes should position. This tape offers gentle guidance instead of rigid support, prompting patients to straighten their toes when they feel the tape pull. This method aligns toes and often relieves pain too. Like orthotics, therapeutic taping works best as part of a detailed treatment plan that includes exercises to address neurological issues ^[16].

Surgery as a last resort

Doctors consider surgery only after trying all other treatments. Options include tendon lengthening, bone shortening, steel pin insertion for temporary support, or joint fusion in severe cases ^[5]. Patients end up staying off their affected foot for long periods after these surgeries. Medical professionals recommend surgery only for rigid toe deformities that cause severe pain or seriously affect daily activities ^[6].

Top 5 Home Exercises to Fix Curled Toes

These five targeted exercises help rewire the brain and restore proper muscle function in the feet through home rehabilitation. The exercises create neuroplastic changes that help stroke survivors regain control over curled toes if performed consistently.

1. Toe taps

The brain’s muscle control improves through toe taps that stretch the foot’s joints. Here’s how to perform this exercise:

1. Sit in a chair with feet flat on the floor
2. Attempt to raise all toes up from the ground, then place them back down
3. Point your big toe toward the floor while lifting your other four toes upward for an added challenge
4. Hold for 1-2 seconds, then tap toes on the floor and repeat
5. Complete 10 repetitions, then reverse (big toe up, other toes down) for 10 more repetitions

The brain begins adaptive changes with even minimal movement attempts.

2. Marble pickup

Your foot’s intrinsic muscles become stronger while receiving sensory feedback through this exercise:

1. Sit with feet flat on the floor
2. Place 20 marbles (or cotton balls for beginners) in front of you
3. Use your toes to pick up one marble at a time
4. Place each marble into a bowl
5. Complete the exercise with each foot

Larger objects like pom-poms might work better for beginners, or someone could assist you.

3. Towel curls

Your foot’s arch muscles get targeted attention through towel curls:

1. Place a small towel on the floor
2. Sit with your feet on the towel’s edge
3. Use your toes to scrunch and pull the towel toward you
4. Complete 10 repetitions
5. Use your toes to push the towel back out afterward

This exercise strengthens the flexor digitorum brevis, quadratus plantae, and other intrinsic foot muscles.

4. Toe extensor stretch

Curled toes gain more flexibility through this stretch:

1. Pull your toes downward (your foot’s knuckles will prominently pop up)
2. Apply gentle pressure to your foot’s arch with your thumb
3. Hold this stretch for 20-30 seconds
4. Your arch muscles strengthen if you feel cramping in the arch
5. Pull up on the toe tips to help straighten them next

5. Floor grips

Toe muscles become stronger through controlled curling and relaxation with floor grips:

1. Start with feet flat on the floor
2. Attempt to grip the floor by curling your toes downward
3. Hold briefly, then consciously relax your toes
4. Let toes naturally begin straightening
5. Repeat 10 times per session

Most stroke survivors notice gradual improvements in toe flexibility and control by practicing these exercises daily with at least 10 repetitions.

How to Track Progress and Stay Consistent

Tracking your progress plays a vital role in addressing toe curling after stroke. Recovery takes time, but patients can optimize their healing experience with proper monitoring techniques.

Setting realistic goals

Quality motor control should take priority over high-repetition endurance training ^[17]. Medical experts suggest specific targets around movement precision rather than strength alone. Functional screening tests are a great way to get an objective view of your starting point. These tests measure range of motion, flexibility, strength, balance, and motor control ^[17]. You can set measurable standards by creating step-by-step milestones. Start with straightening toes for five seconds, then gradually extend the duration.

Using visual feedback and mirrors

Mirrors are powerful tools to correct toe positioning. Of course, doing exercises barefoot while watching yourself in mirrors substantially improves visual feedback ^[17]. This approach builds kinesthetic awareness through visual confirmation and physical sensation. Research shows that trainees who used mirrors for form checks had 31% fewer training-related injuries over two years ^[2]. Mirrors help spot subtle form issues that you might miss and give instant feedback when you perform movements correctly.

The right time to increase intensity

You should review your progress every six weeks ^[17]. Think over advancing exercise difficulty once you maintain proper form throughout your sessions. Since fatigue often affects form, check if you can keep quality movement even when tired ^[2]. Pressure gages or custom insoles give objective feedback, and some protocols suggest starting at 20 mmHg pressure^[4].

Signs of improvement vs. warning signs

Positive indicators include:

• Better ability to climb up and down stairs ^[17]
• Improved balance during single-leg activities ^[4]
• Less severe symptoms after 6 weeks ^[17]
• More even weight distribution across feet

Note that you should watch for warning signs like increasing pain, joint swelling, or compensatory movements where secondary muscles take over incorrectly ^[2]. Flexible curled toes can become rigid without proper care ^[3], so paying attention to warning signs early is significant.

Conclusion

Curled toes create a major challenge for many stroke survivors. The good news is that treatment works well when patients tackle this condition early. Patients need to spot the symptoms and learn why it happens to start their recovery. A stroke damages the neurological system and disrupts how the brain talks to muscles. This creates muscle imbalances that pull toes into awkward positions.

Quick action makes a big difference in how well treatments work. Toes that still have some flexibility respond better to gentle treatments than stiff, rigid toes that develop without care. Most patients do best with a complete plan that mixes rehabilitation exercises, proper orthotics, and sometimes Botox injections to relax the muscles.

Exercises at home play a crucial role because they trigger neuroplasticity – our brain’s amazing power to rebuild itself after injury. Regular practice helps patients get stronger and rebuild proper brain-muscle connections. Simple exercises like toe taps, picking up marbles, towel curls, toe stretches, and floor grips make a difference. On top of that, it helps to track progress with clear goals and visual feedback to stay motivated throughout recovery.

Curled toes can really affect a person’s ability to move and enjoy life, but there’s hope for getting better. Nearly 70% of stroke survivors respond well to the right treatments. Recovery takes time and dedication, but many patients regain better foot function and feel less pain with proper medical guidance and consistent home exercise. Small wins add up gradually and lead to better mobility and a fuller life.

Key Takeaways

Curled toes affect nearly half of stroke survivors, but with proper understanding and consistent treatment, significant improvement is possible for most patients.

• Early intervention is crucial: Flexible curled toes respond much better to treatment than rigid deformities that develop when left untreated.

• Home exercises activate brain rewiring: Daily practice of toe taps, marble pickup, and towel curls helps restore proper brain-muscle communication through neuroplasticity.

• Multiple treatment options exist: Rehabilitation exercises, Botox injections, orthotics, and therapeutic taping can effectively address toe curling with 70% success rates.

• Consistent tracking ensures progress: Use mirrors for visual feedback, set realistic goals, and monitor improvements every six weeks to optimize recovery outcomes.

• Address underlying causes, not just symptoms: Focus on correcting muscle imbalances and spasticity rather than relying solely on compensatory devices like toe separators.

The key to successful recovery lies in understanding that curled toes result from neurological damage disrupting brain-muscle communication, making rehabilitation exercises the most effective long-term solution for restoring proper toe function and mobility.

References

[1] – https://www.flintrehab.com/how-to-fix-curled-toes/?srsltid=AfmBOoqDfTAqWx2KRk9wlo3VNYezPe4wWd5AfgDa2gQFgkO8SFEkVoj0
[2] – https://mirrorsdelivered.com/blogs/tips-and-tricks/how-mirrors-impact-posture-injury-prevention-in-workouts?srsltid=AfmBOoplavgNg211gssZvSOXSVltD0MOIZ5YxVZV-R4Np8MSFfA4OMxD
[3] – https://www.upstep.com/a/blog/exercises-for-claw-toes?srsltid=AfmBOoowHAaORL5erTjjguTPkXQ9vhmu5HasIkC5WFbE8BTZ5XXJUx9L
[4] – https://pmc.ncbi.nlm.nih.gov/articles/PMC7220527/
[5] – https://www.neurolutions.com/after-stroke/claw-toe-effective-strategies-for-management-and-treatment-of-related-toe-conditions/
[6] – https://www.saebo.com/blogs/clinical-article/exercises-help-fix-curled-toes-stroke?srsltid=AfmBOoo46t7_YzT9Hv2gFict4_VdIJhr3gp0EiJRX_ccvubKA0ALqBNJ
[7] – https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects/spasticity
[8] – https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects/claw-toe
[9] – https://pubmed.ncbi.nlm.nih.gov/20097630/
[10] – https://www.flintrehab.com/how-to-fix-curled-toes/?srsltid=AfmBOor2G7NMp_HgVkqpbQBCH4JDF0Hg7u9Uj6DN-ZR2JZVDkSc0PpLF
[11] – https://footnanklecenters.com/what-causes-involuntary-toe-curling-a-comprehensive-guide/
[12] – https://www.flintrehab.com/how-to-fix-curled-toes/?srsltid=AfmBOoo1fT7KxkroU_8SWHtTO-QMCSE0YvypQe4ztfH3GFAaoMTDOIjL
[13] – https://pubmed.ncbi.nlm.nih.gov/16198612/
[14] – https://health.clevelandclinic.org/benefits-of-toe-separators-and-spacers
[15] – https://www.flintrehab.com/how-to-fix-curled-toes/?srsltid=AfmBOoojE1vYXcSv_KoXQfeVFEkBpLjbyObqrJtP6PI9IUzM2lM4xxtz
[16] – https://www.flintrehab.com/how-to-fix-curled-toes/?srsltid=AfmBOopOD9KA1Sv-uMYrmeWRqhbhcH8TeHAfSs-7Bc4mTIV5MMeZcjBz
[17] – https://www.orthovirginia.com/our-doctors/nordt/exercise-and-cartilage/

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