The most important clinical decision with Hammertoes Causes Treatment Surgery isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Dr. Tom’s Top Pain Relief Picks — Dr. Hoy’s (2026)
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. I personally use Dr. Hoy’s in my practice for patients who need topical relief.
| Product | Best For | Dr. Tom’s Take | Get It |
|---|---|---|---|
| Dr. Hoy’s Natural Pain Relief Gel 3.5oz menthol + arnica |
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| Dr. Hoy’s Roll-On Pain Relief Roller applicator |
Mess-free application · Travel · Office use · No-touch hygiene | My patients love this for travel. Glides on without hand contact — cleanest application available. | Buy Now |
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Frequent users · Multiple family members · Best value per ounce | If anyone in your home uses pain cream regularly, this is the most economical size. Same formula. | Buy Now |
Why I recommend Dr. Hoy’s over Biofreeze and Bengay: Cleaner ingredient list (no parabens, no synthetic dyes), longer-lasting effect, and the cooling-then-warming dual sensation actually addresses both inflammation and circulation. After 10 years of recommending different topicals, this is the one I keep coming back to.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Related Conditions
Quick Answer
Hammertoes — Causes, Flexible vs. Rigid Deformity, and 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 Hills: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Hammertoe is an abnormal bend at the middle joint of the toe that can become fixed over time. Flexible hammertoes respond to toe pads, splints, and roomier shoes. Rigid hammertoes that are causing corns or pain often require surgical straightening.
Watch: Dr. Tom Biernacki, DPM
✅ Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026
Hammertoes — Causes, Flexible vs. Rigid Deformity, and Treatment
Hammertoes — Causes, Progression, and Treatment Options
Hammertoe is a deformity of one or more of the lesser toes (second through fifth) in which the toe bends abnormally at the proximal interphalangeal (PIP) joint, creating an upward arch that resembles a hammer. The deformity is progressive — it typically begins as a flexible deformity that can be manually straightened, and advances over years to a rigid, fixed deformity that no longer corrects with external pressure. Early intervention during the flexible stage offers the most treatment options and the least invasive solutions.
What Causes Hammertoe Deformity
Hammertoes develop from a muscle-tendon imbalance in the toe. The intrinsic muscles of the foot that should stabilize the toe’s position are relatively weak, allowing the long flexor and extensor tendons to dominate — pulling the toe into the characteristic bent position. Contributing factors include: shoes too short or too narrow (forcing the toe into a bent position for prolonged periods), flat feet (which alter toe mechanics), underlying neuromuscular conditions, and in the second toe specifically, a first MTP joint problem like bunion or hallux rigidus that causes the second toe to be pushed from its normal position by the first toe.
Flexible vs. Rigid Hammertoe
The distinction between flexible and rigid hammertoe is clinically critical because it determines treatment options. A flexible hammertoe can be manually straightened — the joint cartilage and capsular structures have not permanently contracted. Conservative treatment including toe exercises, appropriate footwear, and toe separators or splints can slow or halt progression in flexible hammertoes. A rigid hammertoe cannot be straightened manually — the joint structures have permanently contracted into the deformed position. Rigid hammertoes cannot be corrected conservatively and require surgical correction if the deformity is symptomatic and limiting.
Conservative Management
For flexible hammertoes, conservative management focuses on reducing symptoms and slowing progression. Wide toe-box footwear with a deep toe box prevents dorsal rubbing of the PIP joint against the shoe upper — the most common source of hammertoe pain. Silicone hammertoe pads or caps cushion the prominent joint. Toe splints worn at rest hold the toe in a straighter position and may slow structural progression. Exercises that strengthen the intrinsic muscles — towel scrunches, marble pickups, toe spreads — address the underlying muscle imbalance that drives deformity progression. These measures provide symptomatic relief but do not reverse established deformity.
Surgical Options
When conservative management fails to control symptoms, surgical correction is considered. For flexible hammertoes, a flexor tendon transfer procedure — releasing the tight flexor tendon and transferring it dorsally — can straighten the toe without removing bone. For rigid hammertoes, the standard procedure is PIP joint arthroplasty (removing a small wedge of bone from the joint head, allowing the toe to straighten) or arthrodesis (fusing the joint in a straightened position). K-wires or small screws maintain the corrected position during healing. Surgery is typically performed as day surgery under ankle block anesthesia, with recovery involving protected weight-bearing for 4 to 6 weeks.
Preventing Progression in Early Hammertoe
Early hammertoe detected while still flexible offers the best opportunity for conservative management to be meaningful. Switching to wide, deep toe-box footwear immediately reduces the driving force of shoe compression. Addressing co-existing bunion deformity that may be pushing the second toe out of position is equally important. Beginning toe strengthening exercises early, before significant muscle atrophy has occurred, builds the intrinsic muscle capacity needed to resist further deformity. Regular podiatric follow-up tracks whether progression is occurring despite conservative measures, allowing timely surgical referral before rigid deformity makes the procedure more complex.
Hammertoe vs. Mallet Toe vs. Claw Toe: Understanding the Difference
The terms hammertoe, mallet toe, and claw toe are frequently used interchangeably by patients but describe distinct deformity patterns that differ in which toe joints are affected. A true hammertoe involves flexion contracture at the proximal interphalangeal (PIP) joint — the middle knuckle — with the distal interphalangeal (DIP) joint and metatarsophalangeal (MTP) joint in relatively normal position. The toe buckles at the middle joint, creating a raised prominence that rubs against shoe material.
Mallet toe affects only the distal interphalangeal joint — the joint closest to the toenail. The tip of the toe curls downward, creating a callus on the tip of the toe rather than the top of the middle joint. Claw toe involves flexion at both the PIP and DIP joints simultaneously, with hyperextension at the MTP joint — the most complex of the three deformities, and the one most commonly associated with systemic neuromuscular conditions (Charcot-Marie-Tooth, diabetes-related neuropathy) as well as severe chronic cavus deformity. The distinction matters clinically because each deformity pattern is corrected by a different surgical approach targeting the specific contracted joint. Accurate pre-operative diagnosis ensures the correct procedure is performed. At Balance Foot & Ankle in Howell and Bloomfield Hills, our podiatric surgeons assess each lesser toe deformity individually to determine the precise deformity pattern and the targeted correction it requires.
Related Treatment Guides
- Plantar Fasciitis & Heel Pain Treatment
- Custom 3D Orthotics
- Sports Foot & Ankle Injury Treatment
- Bunion Treatment
Michigan patients experiencing foot or ankle problems can schedule an appointment at Balance Foot & Ankle — with locations in Howell (4330 E Grand River) and Bloomfield Hills (43494 Woodward Ave #208). Call (810) 206-1402 for same-week availability.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Hills Office
43494 Woodward Ave, #208
Bloomfield Hills, MI 48302
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Your Board-Certified Podiatrists
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Same-week appointments available at both locations.
In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your hammertoe, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
Differential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Hammertoe and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Mallet toe. Bend at the distal joint only (DIP), not the middle joint.
- Claw toe. Both joints (PIP + DIP) bent — usually multiple toes, often diabetic.
- Crossover toe (2nd MTP). Drift across the big toe — often plantar plate tear underneath.
If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
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.
Most Common Mistake We See
The most common mistake we see is: Cutting corns at home with scissors or razors. Fix: professional podiatric enucleation with sterile instruments prevents infection and recurrence.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Open wound under the bent toe
- Inability to straighten the toe even passively
- Diabetic skin breakdown at the toe joint
- Cold or blue discolouration of the toe
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
More Podiatrist-Recommended Hammertoe Essentials
Extra-Depth Orthopedic Shoe
Orthofeet Sprint — tall toe box prevents hammertoe rubbing and friction.
Wide-Toe-Box Walking Shoe
New Balance 990v6 — accommodates curled toes without pressure.
Supportive Insole
PowerStep Pinnacle — reduces forefoot pressure that drives hammertoe.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
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
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
In This Article
- Quick Answer
- Hammertoe vs. Mallet Toe vs. Claw Toe: Understanding the Difference
- In-Office Treatment at Balance Foot & Ankle
- Differential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Hammertoe and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:Mallet toe. Bend at the distal joint only (DIP), not the middle joint.
Claw toe. Both joints (PIP + DIP) bent — usually multiple toes, often diabetic.
Crossover toe (2nd MTP). Drift across the big toe — often plantar plate tear underneath.If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
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.Most Common Mistake We See
- Warning Signs That Need Same-Day Care
- Frequently Asked Questions
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Hills. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
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 Hills, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
4.5
(28,341+ reviews)
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
This single insole eliminates plantar fasciitis pain in 60% of patients within 2 weeks. The lateral wedge is the active ingredient — it stops the overpronation that causes the fascia to overstretch with every step. Pair with a max-cushion shoe for compound effect.
CURREX RunProDr. Tom’s #1 Brand
4.4
(4,000+ reviews)
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Choose your arch height from a wet-foot test (low/med/high). Wrong arch = re-injury. For runners, athletes, or anyone who failed standard insoles — this is the closest you can get to custom orthotics without paying $500. The carbon heel is what professional athletes use.
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
4.6
(5,500+ reviews)
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
Apply to plantar fascia + calves before bed. Combined with stretching, eliminates morning fascia pain. The clean formula means you can use it daily long-term — Voltaren has 30-day limits, Dr. Hoy’s doesn’t.
Doctor Hoy’s Natural Pain Relief Gel
Natural topical pain relief I use in our clinic. Arnica + camphor formula — apply directly to the area 3–4x daily. ($20–25)
Frequently Asked Questions
Will my bunion get worse over time?
In most cases, yes — gradually. Bunions are progressive deformities; without intervention, the metatarsal bone continues to drift outward over years. The rate of progression varies enormously: some bunions are stable for decades; others worsen significantly within 5 years. Wearing narrow, pointed-toe footwear accelerates progression. If your bunion is causing pain or limiting footwear choices and is still mild-to-moderate, earlier surgical correction has better outcomes than waiting for severe deformity.
Can I fix a bunion without surgery?
Conservative treatment manages symptoms but cannot structurally correct the deformity. Wide toe-box shoes, bunion pads, toe separators, and orthotics reduce pain and slow progression. They cannot realign the metatarsal bone because the deviation involves structural changes to the joint capsule and ligaments. If the goal is permanent cosmetic and functional correction, surgery is the only option. If the goal is pain management and living comfortably with the bunion, conservative care can be effective for years.
Can splints or bunion braces straighten a bunion?
No — this is one of the most common misconceptions. Bunion splints maintain toe alignment while being worn and may slow progression, but cannot reverse the bony deviation. The first metatarsal has physically rotated and shifted laterally — no external splint can move bone. Studies show splints worn nightly improve comfort and reduce inflammation but do not change bunion angle on X-ray. They’re a useful adjunct for pain management, not correction.
What causes bunions? Are they genetic?
Bunions have a strong genetic component — about 70% of patients with bunions have a first-degree relative with bunions. The underlying cause is a biomechanical instability of the first metatarsophalangeal joint, likely inherited. Footwear doesn’t cause bunions but accelerates them — tight, narrow shoes in a genetically predisposed person progress much faster than in someone who wears supportive shoes. Women develop bunions more often than men largely due to footwear choices over decades.
What shoes should I wear with a bunion?
Wide toe box is non-negotiable — the box must accommodate the bunion without compressing it. Avoid anything with a tapered or pointed toe, stiletto heels, or thin canvas uppers that press against the bump. Best options: Hoka Bondi, New Balance 574, Brooks Ghost (wide), Altra (all models have anatomical toe box). For dress occasions, Vionic and Orthofeet make supportive wide-toe options. The general rule: your toes should never feel compressed.
How long is recovery from bunion surgery?
Recovery depends on the procedure. Simple bunionectomy (soft tissue only): 4–6 weeks. Osteotomy (bone cut and realignment, the most common modern approach): 6–12 weeks non-weight-bearing in a boot, full recovery 4–6 months. Lapidus procedure (fusion at the base of the first metatarsal): 6–8 weeks non-weight-bearing, 6–9 months full recovery. The Lapidus has the lowest recurrence rate and is preferred for severe bunions or hypermobile first rays. We discuss the specific procedure during your surgical consultation.
Will I be able to walk after bunion surgery?
Yes — most patients walk in a surgical boot immediately or within 1–2 weeks. Full return to regular shoes takes 6–12 weeks depending on the procedure. Return to athletic activity typically takes 4–6 months. The question we hear most often is whether the foot will be comfortable and functional long-term — the answer is yes for the vast majority. Over 90% of patients are satisfied with bunion surgery outcomes at 5-year follow-up.
Can bunions come back after surgery?
Yes — recurrence is possible, especially without lifestyle changes. With modern osteotomy procedures, recurrence runs 5–10% at 10 years. The Lapidus procedure has the lowest recurrence rate (2–5%) because it addresses the hypermobility at the metatarsal base. The single biggest recurrence factor is returning to narrow, pointed-toe shoes within 6 months of surgery. We follow patients for 2 years post-surgery specifically to catch early recurrence signs.
Does insurance cover bunion surgery?
Most PPO and Medicare plans cover bunion surgery when it’s functionally necessary — meaning pain limits daily activity, conservative care has been attempted, and X-rays show a meaningful deformity. Purely cosmetic bunionectomy is not covered. We document conservative treatment failure and functional limitation prior to surgery to build the strongest possible insurance case. Call our office at (810) 206-1402 and we’ll verify your coverage before your consultation.
Can children get bunions?
Yes — juvenile bunions account for about 10% of all bunions and are typically bilateral and genetic. They’re most common in girls aged 10–15. Treatment in growing children is conservative whenever possible — wide-toe-box shoes and monitoring. Surgical correction is generally delayed until skeletal maturity (16–18) because operating on open growth plates increases recurrence risk. If your child has a painful or rapidly progressing bunion, evaluation is warranted to track progression.
When is bunion surgery actually necessary?
Surgery is appropriate when: pain is consistent and limits daily activities despite 3–6 months of conservative care, footwear options are severely restricted, there’s a secondary deformity (hammer toe, crossover toe) being driven by the bunion, or joint arthritis is developing. Mild, painless bunions don’t require surgery even if they look significant on X-ray. The decision is always functional, not cosmetic — we operate on pain, not appearance.
Get Expert Care at Balance Foot & Ankle
Same-week appointments at our Howell and Bloomfield Hills offices. Board-certified podiatric surgeons. Most insurance accepted.
Ready for Expert Care?
Same-day appointments in Howell & Bloomfield Hills, MI.
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 and almost 1 million subscribers on youtube.