Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Hammertoe: Flexible vs. Rigid — Understanding When Sur relates to toe deformity — typically caused by imbalanced muscles + footwear. Most patients improve in depends on severity with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Hammertoe is a deformity of the proximal interphalangeal (PIP) joint of the lesser toes — the middle knuckle flexes downward, creating the characteristic “hammer” shape. It is among the most common forefoot deformities seen in podiatric practice, progressively worsening over years and eventually requiring surgical correction if conservative management fails to arrest progression. The stage at which a patient presents — flexible vs. rigid — fundamentally changes the treatment options available.
Anatomy and Why Hammertoes Form
The shape of each lesser toe is maintained by a balance between the intrinsic muscles (lumbricals and interossei, which extend the PIP and DIP joints) and the extrinsic muscles (flexor and extensor digitorum longus and brevis). When this muscular balance is disrupted, the PIP joint flexes and cannot be held in extension. Common causes:
- Hallux valgus (bunion): The migrating hallux crowds the second toe, forcing it into a buckled position. Hammertoe at the second toe is the most common presentation and is often secondary to hallux valgus.
- Excessively long second toe: When the second toe extends beyond the hallux, it buckles in narrow-toed footwear.
- Neurological imbalance: Peripheral neuropathy, Charcot-Marie-Tooth disease, and other conditions disrupting intrinsic muscle function.
- Tight footwear: Shoes that compress toes maintain them in a flexed position, promoting adaptive shortening of the flexor tendons over time.
- Trauma: Dislocation or fracture at the MTP joint can disrupt the extensor mechanism.
Flexible Hammertoe: Still Correctable
In the early stages, a hammertoe remains flexible — it can be manually straightened to a neutral position. This is the ideal time for conservative intervention: the deformity is structural but not yet fixed by contracture.
Conservative management for flexible hammertoe:
- Footwear modification: Wide, deep-toe-box shoes that eliminate external forces driving the deformity are essential. Shoes that are too short, too narrow, or with a pointed toe box perpetuate and accelerate flexible hammertoes.
- Custom orthotics: A custom orthotic with a metatarsal pad redistributes forefoot pressure and partially restores the normal toe extensor mechanism by unloading the MTP joint and reducing digital buckling.
- Toe splints and padding: Silicone toe separators and hammertoe crests partially straighten flexible deformities and reduce corns at the PIP joint dorsum.
- Addressing the cause: If hallux valgus is driving the hammertoe, addressing the bunion (with custom orthotics or surgical correction) reduces the crowding force on the second toe.
Conservative measures cannot reverse an established hammertoe deformity — but they can arrest progression, relieve symptoms, and delay or prevent the need for surgery.
Rigid Hammertoe: When Surgery Is Required
As the deformity progresses, the flexor tendons and plantar plate adaptively shorten, and the joint capsule contracts. The hammertoe becomes rigid — it cannot be straightened manually. At this point, the deformity can only be corrected surgically. Conservative measures still manage symptoms (corn debridement, cushioning, footwear guidance) but cannot structurally correct the rigid deformity.
Surgical options for rigid hammertoe include:
- PIP joint arthroplasty (condylectomy/resection): The articular surfaces of the PIP joint are removed, allowing the joint to straighten. Performed with K-wire or implant fixation. Most common surgical technique for rigid lesser toe hammertoes.
- PIP joint fusion (arthrodesis): The joint is fused in a straight position. Provides durable correction; the fused toe has no PIP motion but is structurally straight and pain-free.
- Flexor tendon transfer: The flexor digitorum longus tendon is transferred to the dorsum of the toe to convert the deforming force into a corrective one. More commonly used for flexible deformities that haven’t responded to conservative care.
Recovery after hammertoe surgery involves protected weight bearing for 4–6 weeks in a surgical shoe, pin removal at 4–6 weeks for K-wire fixation, and progressive return to normal footwear over 6–10 weeks.
Hammertoes Causing Pain or Difficulty with Shoes?
Dr. Biernacki evaluates hammertoe flexibility and provides conservative management or surgical options at both our Bloomfield Hills and Howell locations.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Hammertoe — Flexible vs. Rigid & When Surgery Is Needed
Whether your hammertoe is flexible or rigid determines which treatments will work best. Our podiatrists assess your deformity stage and recommend the most effective approach — from toe exercises and splinting for flexible toes to surgical correction for rigid deformities.
Learn About Hammertoe Treatment | Book Your Appointment | Call (810) 206-1402
Clinical References
- Coughlin MJ. Lesser toe deformities. Instructional Course Lectures. 2003;52:421-444.
- Smith BW, Coughlin MJ. Disorders of the lesser toes. Sports Medicine and Arthroscopy Review. 2009;17(3):167-174.
- Schrier JC, et al. A systematic review of hammertoe treatment options. Foot and Ankle Surgery. 2012;18(1):1-10.
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3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills, MI 48302
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New Balance 990v6 — accommodates curled toes without pressure.
Supportive Insole
PowerStep Pinnacle — reduces forefoot pressure that drives hammertoe.
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When to See a Podiatrist
Rigid hammertoes don’t reduce with splinting alone — the tendon and capsule have contracted. If the toe no longer straightens passively, surgical correction restores alignment in one short outpatient visit. Call Balance Foot & Ankle to see whether your deformity is still flexible (and responsive to the conservative tools above) or if it’s time for a 20-minute in-office correction.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
In Our Clinic
Hammertoes come to our clinic in two flavors: flexible (the toe still passively straightens) and rigid (it doesn’t). For flexible hammertoes we use gel toe crests, roomier toe boxes, custom orthotics to address the underlying instability, and sometimes night splints. Rigid hammertoes with a corn on top of the PIP joint, or a callus under the metatarsal head, usually need a minor outpatient procedure (PIP arthroplasty or fusion) to straighten the toe. The patients who wait too long develop fixed deformities and skin breakdown — we would much rather address a flexible hammertoe early.
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Podiatrist-recommended products
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Flexible hammertoe conservative care.
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View on Amazon →Topical relief for painful corns on hammertoes.
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View on Amazon →Related resources
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When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Hammertoe Treatment Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
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Footnanny Heel Cream Dr. Tom’s Pick
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)