Hammertoes are among the most common structural deformities of the foot — and one of the most reliably correctable through podiatric surgery. At Balance Foot & Ankle, our Michigan podiatrists correct hammertoes in-office or in an outpatient setting, with most patients walking the same day and returning to normal shoes within 4–6 weeks.

What Is a Hammertoe?

A hammertoe is a contracture deformity of one or more of the lesser toes (typically the 2nd through 5th) in which the toe bends abnormally at the proximal interphalangeal (PIP) joint, causing the toe to assume a hammer-like shape. Related deformities include mallet toe (contracture at the distal IP joint) and claw toe (contracture at both IP joints with MTP joint extension). All are caused by muscle and tendon imbalance.

Flexible hammertoes can still be passively straightened by hand. Rigid hammertoes are fixed in their contracted position and cannot be straightened — these are more symptomatic and require surgical correction.

Causes

Hammertoes develop from an imbalance between the intrinsic muscles (inside the foot) and extrinsic muscles (in the leg). Contributing factors include:

• Poorly fitting footwear: Shoes that are too narrow or too short force the toes into a contracted position; high heels transfer pressure to the forefoot and accelerate deformity
• Bunion deformity: The displaced big toe crowds the second toe, pushing it into a hammertoe position — the second toe becomes a “secondary hammertoe”
• Flat feet or high arches: Both alter the mechanical balance of the foot tendons
• Nerve damage: Peripheral neuropathy (especially Charcot-Marie-Tooth disease) weakens intrinsic muscles, allowing extrinsic tendons to overpower them
• Second toe longer than first: The “Morton’s toe” anatomical variant is associated with higher hammertoe risk

Symptoms

Hammertoes cause corns on the top of the PIP joint where the toe rubs against the shoe, pain with shoe-wearing (especially closed-toe dress shoes), calluses under the metatarsal head from abnormal weight distribution, nail problems from the toe tip pressing down, and difficulty finding comfortable footwear. Crossover toes — where the second toe overlaps the big toe — can occur in severe cases.

Conservative Treatment

Conservative measures reduce symptoms but cannot correct established deformity — they are most effective for flexible hammertoes in early stages:

• Wide toe-box footwear to reduce dorsal pressure on the contracted joint
• Toe splints and padding to cushion corns and reduce friction
• Corn debridement in-office
• Stretching exercises for flexible hammertoes to maintain passive range of motion
• Metatarsal pads to offload the plantar callus
• Custom orthotics to address underlying flat foot or biomechanical imbalance

Surgical Correction

Surgery provides permanent structural correction and is typically recommended for rigid hammertoes, painful flexible hammertoes failing conservative care, and hammertoes associated with a bunion repair. Common procedures include:

Proximal Interphalangeal (PIP) Joint Arthroplasty

The most common procedure — the articular surface of the PIP joint is removed, creating a fibrous (non-bony) connection as the joint heals in a straightened position. A temporary K-wire pin is often placed through the toe to hold alignment during healing. The pin is removed in-office at 4–6 weeks. Highly effective for flexible and semi-rigid hammertoes.

PIP Joint Fusion (Arthrodesis)

The joint surfaces are prepared and the joint is fused in a straight position using a small intramedullary implant (e.g., Nextra, StayFuse) or temporary K-wire. Fusion is more stable and has a lower recurrence rate than arthroplasty. The toe becomes slightly shorter and has no PIP joint motion, but this is rarely functional noticeable.

Flexor Tendon Transfer (Girdlestone-Taylor)

For flexible hammertoes with a strong extrinsic flexor driving the deformity — the flexor digitorum longus tendon is transferred to the dorsum of the toe, converting it from a deforming force to a corrective one. Excellent outcomes when properly selected.

Associated MTP Joint Correction

When the metatarsophalangeal joint is also contracted or subluxated (crossover toe), additional releases — plantar plate repair, extensor tenotomy, or Weil metatarsal osteotomy (shortening the metatarsal bone) — are performed alongside the PIP correction for complete realignment.

Recovery Timeline

Hammertoe surgery is performed outpatient under local or regional anesthesia. Most patients walk in a surgical shoe immediately after surgery. Swelling and some discomfort are expected for 4–8 weeks. K-wire removal (if used) occurs at 4–6 weeks as an in-office procedure. Return to regular shoes typically occurs at 6–8 weeks; athletic shoes at 8–12 weeks. Final cosmetic result takes 3–6 months as residual swelling resolves.

Frequently Asked Questions

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