Hammertoe Treatment 2026: Conservative & Surgical Options | DPM Guide

That second toe that curls at the middle joint. It started as a mild nuisance — now the top of the toe rubs against every shoe you own, a corn is forming on the knuckle, and the toe aches by the end of the day. This is the typical hammertoe progression, and the most important thing to understand is that it gets progressively harder to treat the longer it goes unaddressed.

At Balance Foot & Ankle, we see hammertoes at every stage — from early flexible deformities that resolve with simple shoe changes to rigid, arthritic deformities that require surgical correction. This guide explains the treatment options for each stage so you know exactly where you stand and what to do about it.

Table of Contents

• What Is a Hammertoe?
• Flexible vs Rigid: Why the Distinction Matters
• What Causes Hammertoes?
• Conservative (Non-Surgical) Treatment
• Hammertoe Exercises
• When Surgery Is Needed
• Recovery After Hammertoe Surgery
• Frequently Asked Questions

What Is a Hammertoe?

A hammertoe is a deformity of the proximal interphalangeal (PIP) joint — the middle knuckle of a toe — where the joint buckles upward, causing the toe to curl. The second toe is most commonly affected, though any lesser toe can develop a hammertoe. A related deformity, the mallet toe, involves the distal joint (tip of the toe), and a claw toe involves both the MTP joint and the PIP joint simultaneously.

The deformity produces characteristic problems: a corn (callus) on the top of the toe knuckle from shoe friction, potential ulceration in patients with reduced sensation, and sometimes a callus under the ball of the foot as the metatarsal head is pushed down by the deforming toe.

Flexible vs Rigid: Why the Distinction Matters

The most important clinical distinction in hammertoe management is whether the deformity is flexible (the toe can be manually straightened) or rigid (the joint is contracted and cannot be passively corrected). This determines the entire treatment path.

	Flexible Hammertoe	Rigid Hammertoe
Can be straightened by hand?	Yes	No
Joint status	No fixed contracture; joint cartilage intact	Fixed contracture; often arthritic
Conservative treatment success	High — significant improvement possible	Low — symptoms managed, deformity persists
Surgery needed?	Rarely	Often, if symptomatic
Progression	Will become rigid without intervention	Stable but deformity is permanent

Test your own: press on the buckled joint with your finger. If the toe straightens under gentle pressure, it is flexible. If the joint resists straightening and feels fixed in the curled position, it is rigid. This simple assessment guides your entire treatment approach.

What Causes Hammertoes?

Hammertoes develop from a muscle-tendon imbalance around the toe joints. When the flexor tendons (which curl the toe) overpower the extensor tendons (which straighten it), the toe gradually buckles. This imbalance is driven by several factors: footwear with a narrow toe box or high heel that chronically forces toes into a curled position; an overly long second toe (longer than the big toe) that has nowhere to go in a standard shoe; flat feet or bunions that alter the pull of tendons across the lesser toes; and neurological or systemic conditions that affect muscle balance (less common).

There is also a hereditary component — certain foot shapes are predisposed to hammertoe development regardless of footwear. However, footwear choice dramatically accelerates or decelerates progression.

Conservative (Non-Surgical) Hammertoe Treatment

Conservative treatment is effective for flexible hammertoes and for pain management in rigid cases. The goal is to reduce friction and pressure on the buckled joint, maintain or improve joint flexibility, and slow progression.

1. Footwear Modification

The first and most impactful step. You need a shoe with a deep, wide toe box — enough vertical and lateral room that the buckled toe is not compressed against the upper. The depth matters as much as the width: the toe box ceiling must be high enough that the knuckle doesn’t rub. Avoid pointed toes and heels above 1 inch. Many patients see dramatic corn reduction and pain relief within weeks of switching footwear alone. Athletic shoes with a mesh upper that conforms to the toe shape are ideal for daily wear.

2. Padding and Toe Splints

Corn pads (donut-shaped gel or foam pads placed over the PIP joint prominence) reduce shoe friction directly against the corn. Change regularly and inspect the underlying skin, especially if you have diabetes. Hammertoe splints or crests — small silicone devices that fit under the toe and straighten it — can maintain a flexible hammertoe in a more neutral position during activity, both reducing pain and slowing the progression toward rigidity.

3. Corn and Callus Management

Corns on the top of hammertoes are caused by shoe friction — they are a symptom, not the disease. Regularly trimming or filing the corn reduces pain but does not treat the underlying deformity. We debride corns in-office when they become significantly painful. Do not use over-the-counter corn-removing acids at home if you have diabetes, peripheral neuropathy, or poor circulation — these can cause serious skin breakdown.

4. Custom Orthotics

For patients with a flatfoot deformity or bunion contributing to hammertoe formation, a custom orthotic that corrects the underlying mechanics can significantly slow progression. Orthotics with toe crests or built-in digital props also offload the metatarsal heads that are being pushed down by the deforming toes.

Hammertoe Exercises

Exercises help maintain flexibility in flexible hammertoes and strengthen the intrinsic foot muscles that resist the deforming forces. These are most effective when started early.

Toe Flexion/Extension Stretch

Sitting with your foot flat on the floor, use your fingers to gently straighten the hammertoe and hold for 30 seconds. Then let the toe relax and repeat 10 times. This maintains the range of motion at the PIP joint and gradually stretches the contracted plantar plate and flexor tendons.

Towel Scrunches

Place a small towel on the floor and use your toes to scrunch it toward you. 2 sets of 20 repetitions daily. Strengthens the intrinsic muscles (lumbricals and interossei) that resist the hammertoe deforming force.

Marble Pickups

Place 10–20 marbles on the floor and pick them up one at a time with your toes, transferring them to a cup. This works both intrinsic and extrinsic toe flexors and improves neuromuscular coordination of the lesser toes.

When Surgery Is Needed

Surgery is appropriate when: the hammertoe is rigid and causing significant pain, shoe fitting is impossible, corns are recurring and causing skin breakdown, or the deformity is causing secondary problems such as a dislocated MTP joint. Surgery is elective and should be considered only after conservative measures have been thoroughly tried.

PIP Joint Arthroplasty (Most Common)

The head of the proximal phalanx is resected, creating space and allowing the toe to straighten. The toe is temporarily held with a pin for 3–6 weeks while scar tissue forms to maintain the correction. Outcomes are excellent — approximately 90% of patients achieve pain-free correction. The toe is slightly shorter after surgery, which most patients find acceptable.

PIP Joint Fusion (Arthrodesis)

The joint surfaces are removed and the bones are fused in a straight position, often with an internal pin or implant. Fusion is more stable than arthroplasty and less likely to recur, but produces a permanently stiff toe. Preferred for severe deformities or when durability is the primary concern (active patients, athletes).

Flexor-to-Extensor Tendon Transfer (for Flexible Cases)

For flexible hammertoes that have failed conservative care, a tendon transfer procedure can rebalance the forces at the joint without fusing it, preserving more natural joint motion. This is technically more demanding but produces an excellent functional outcome in appropriate candidates.

Recovery After Hammertoe Surgery

Most hammertoe procedures are done outpatient under local anesthesia with sedation. Immediate weight-bearing in a surgical shoe is typically allowed. The pin (if used) is removed in the office at 4–6 weeks — this is a simple, brief, minimally uncomfortable procedure. Return to athletic shoes at 6–8 weeks. Final results are assessed at 3–6 months, as residual swelling can persist for several months post-operatively.

Frequently Asked Questions

Can a hammertoe straighten out on its own?

Flexible hammertoes can significantly improve — and potentially straighten — with consistent use of toe splints, appropriate footwear, and exercises. Rigid hammertoes cannot straighten without surgery; conservative care manages the symptoms but not the deformity itself. Early treatment gives you the best chance of avoiding surgery. If your toe can currently be straightened manually, start conservative treatment now before the window closes.

Does taping a hammertoe help?

Taping can help in two ways: it can hold a flexible hammertoe in a straighter position during activity (reducing friction on the knuckle), and it can provide some proprioceptive feedback that improves toe alignment. It is not a structural correction but is a reasonable adjunct to other conservative measures. Silicone splints are generally more practical for daily use than tape.

How do I know if my hammertoe needs surgery?

Surgery is typically indicated when: the toe is rigid (cannot be manually straightened), pain is persistent despite appropriate footwear and padding, the corn is recurring and causing skin breakdown, or the deformity is severe enough that no commercially available shoe fits comfortably. A podiatry evaluation will assess flexibility, X-ray findings, and functional impact to determine whether conservative or surgical management is appropriate for your specific case.

The bottom line: Hammertoe treatment is most effective and least invasive when started early, while the deformity is still flexible. Wide shoes, toe splints, daily exercises, and orthotics can maintain a flexible hammertoe and prevent it from progressing to a rigid, surgical problem. If you are in Michigan and your hammertoe is limiting your footwear options or causing persistent pain, a same-day evaluation at Balance Foot & Ankle will determine exactly where you are in the progression and what your best options are.

Sources

1. Schrier JC, Verheyen CC, Louwerens JW. Definitions of hammer toe and claw toe: an evaluation of the literature. J Am Podiatr Med Assoc. 2009;99(3):194–197.
2. Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot Ankle Int. 2000;21(2):94–104.
3. Shirzad K, Kiesau CD, DeOrio JK, Parekh SG. Lesser toe deformities. J Am Acad Orthop Surg. 2011;19(8):505–514.
4. Highlander P, VonHerbulis E, Gonzalez A, et al. Complications of the Weil osteotomy. Foot Ankle Spec. 2011;4(3):165–170.

Hammertoe — Frequently Asked Questions

When should I see a podiatrist for hammertoe?

If symptoms persist beyond 2 weeks of self-care, interfere with daily activity, or worsen suddenly, schedule a podiatrist evaluation. Early intervention typically shortens recovery and prevents chronic compensation patterns.

Will I need imaging or surgery?

Most hammertoe cases resolve with conservative care—custom orthotics, supportive shoe changes, anti-inflammatory protocols, and targeted physical therapy. Imaging (X-ray, ultrasound, MRI) is reserved for cases that fail conservative treatment or when structural pathology is suspected. Surgery is rarely the first option.

Does insurance cover hammertoe treatment in Michigan?

Most major Michigan insurance plans (BCBS, BCN, Priority Health, HAP, Medicare, Medicaid HMOs, United, Aetna, Cigna) cover medically necessary podiatric care. Custom orthotics may have separate DME coverage rules. Our team verifies your specific benefits before your visit.