Hammertoe: Causes, Treatment & When You Need Surgery

What Is a Hammertoe?

A hammertoe is a contracture (abnormal bending) of the proximal interphalangeal (PIP) joint — the middle joint of the toe. This causes the toe to bend downward at the middle joint, creating a hammer-like appearance. The condition most commonly affects the second, third, or fourth toes and can involve one or multiple toes simultaneously.

There are two stages of hammertoe. A flexible hammertoe means the joint can still be manually straightened. At this stage, conservative treatments are most effective. A rigid hammertoe means the joint has become fixed in the bent position and cannot be straightened by hand. This indicates the tendons and joint capsule have permanently contracted, and surgical correction is typically needed for lasting relief.

Related conditions include mallet toe (bending at the distal joint near the tip) and claw toe (bending at both the proximal and distal joints). While the names differ based on which joints are affected, the causes and treatments are similar.

What Causes Hammertoes?

Hammertoes develop when there’s an imbalance between the muscles and tendons that control toe position. Several factors contribute to this imbalance.

Footwear is the most common modifiable factor. Shoes with narrow toe boxes compress the toes into a bent position, and over time the muscles and tendons adapt to this position. High heels compound the problem by forcing the toes into the front of the shoe. Women develop hammertoes roughly five times more often than men, largely due to footwear patterns.

Foot structure plays a significant role. Flat feet, high arches, and bunions alter the mechanical forces acting on the toes. A bunion pushes the big toe toward the second toe, crowding it and eventually forcing it upward into a hammertoe position. Longer second toes (Morton’s toe) are more susceptible because they’re compressed against the shoe more than shorter toes.

Nerve and muscle conditions like peripheral neuropathy and diabetic neuropathy can weaken the intrinsic foot muscles that normally keep toes straight, allowing the stronger extrinsic muscles to pull the toes into a bent position. Arthritis affecting the toe joints can also contribute to deformity development.

Hammertoe Symptoms

The visible bend in the toe is the most obvious symptom, but hammertoes often cause additional problems. Corns develop on the top of the bent joint where the toe rubs against the shoe. Calluses form on the ball of the foot under the affected toe as the bent position shifts weight-bearing pressure. Pain occurs at the bent joint, especially when wearing shoes, and may worsen with walking. Redness and swelling around the joint indicate inflammation. In advanced cases, the toe may cross over or under an adjacent toe, creating further complications.

Conservative Hammertoe Treatment

For flexible hammertoes, conservative treatment focuses on reducing symptoms and preventing progression. The single most impactful change is switching to shoes with a deep, wide toe box that allows the toes to lie flat without compression. Avoid high heels and pointed-toe shoes entirely.

Toe exercises can help maintain flexibility and strengthen the muscles that counteract the deformity. Towel scrunches (placing a towel on the floor and scrunching it with your toes), marble pickups, and manual toe stretching performed daily help keep the joint mobile. Splints and toe spacers worn at home can help maintain proper alignment.

Custom orthotics address the underlying biomechanical factors that contribute to hammertoe development. By supporting the arch and redistributing pressure across the forefoot, orthotics reduce the forces that pull the toes into a bent position. Padding over corns and cushioning under the ball of the foot provides symptom relief while addressing the deformity conservatively.

Hammertoe Surgery

When the toe has become rigid or conservative treatment hasn’t provided adequate relief, surgical correction offers excellent results. Hammertoe surgery is typically performed as an outpatient procedure under local anesthesia. The most common techniques include arthroplasty (removing a small section of bone to allow the toe to straighten) and arthrodesis (fusing the bent joint in a straight position using a small pin or implant).

Recovery from hammertoe surgery is straightforward. Most patients walk in a surgical shoe immediately after the procedure. Swelling gradually resolves over four to eight weeks, and most patients return to regular shoes within six to eight weeks. The surgical pin, if used, is typically removed in the office after three to four weeks. Dr. Biernacki discusses all surgical options during your consultation, including which approach is best suited to your specific deformity and lifestyle goals.

Frequently Asked Questions

Can hammertoes be reversed without surgery?

Flexible hammertoes can often be managed and sometimes improved with consistent use of wider shoes, toe exercises, splinting, and custom orthotics. However, once a hammertoe becomes rigid, the structural changes are permanent and surgery is the only way to restore normal alignment. This is why early treatment — while the toe is still flexible — is so important.

How long is hammertoe surgery recovery?

Most patients walk in a surgical shoe on the day of surgery. Swelling takes four to eight weeks to fully resolve. Surgical pins are typically removed after three to four weeks. Most patients are back in regular shoes by six to eight weeks and can resume full activity, including exercise, by eight to twelve weeks.

Will my hammertoe get worse over time?

Yes — hammertoes are progressive. Without intervention, a flexible hammertoe will eventually become rigid. The deformity increases the risk of painful corns, calluses, and difficulty fitting shoes. Early treatment with proper footwear, exercises, and orthotics can slow or stop this progression significantly.

Sources

• American College of Foot and Ankle Surgeons — Hammertoe
• American Podiatric Medical Association — Hammertoes
• Journal of Foot and Ankle Surgery — Hammertoe Correction Techniques

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