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Quick Answer

A hammertoe is a toe deformity where the middle joint bends abnormally, causing the toe to curl downward. Early-stage (flexible) hammertoes respond well to conservative treatment including custom orthotics, splinting, and proper footwear. When the toe becomes rigid and painful, minimally invasive surgical correction provides lasting straightening with a short recovery time. At Balance Foot & Ankle, we treat hammertoes at every stage with personalized care plans.

What Is a Hammertoe?

A hammertoe develops when the muscles, tendons, and ligaments that hold a toe straight become imbalanced. This imbalance causes the proximal interphalangeal (PIP) joint—the middle joint of the toe—to buckle and bend downward, creating a claw-like or hammer-shaped appearance. Hammertoes most commonly affect the second, third, and fourth toes.

Without treatment, a flexible hammertoe progressively stiffens into a rigid deformity. The bent joint presses against the inside of your shoe, creating painful corns and calluses on top of the toe or at the tip. In severe cases, open sores can develop, which poses a serious risk for patients with diabetes or poor circulation.

Related deformities include mallet toe (where the distal interphalangeal joint at the tip of the toe bends down) and claw toe (where both the PIP and DIP joints buckle). All three conditions share similar causes and treatment approaches, though the specific surgical technique may differ depending on which joints are involved.

Types of Hammertoe

Flexible Hammertoe

In the flexible stage, the toe can still be manually straightened at the affected joint. The tendons and soft tissues have begun to tighten, but the joint has not yet developed permanent structural changes. This is the ideal time to begin treatment, as conservative measures are most effective at this stage. Custom orthotics, toe splints, and footwear modifications can slow or halt progression.

Semi-Rigid Hammertoe

As the condition progresses, the joint becomes increasingly stiff. You can still partially straighten the toe, but it springs back into the bent position. The tendons have shortened significantly and early arthritic changes may be developing in the joint. Conservative treatment can still help manage symptoms, but surgical correction may be recommended if pain is affecting your daily activities.

Rigid Hammertoe

A rigid hammertoe is permanently fixed in the bent position. The joint surfaces have remodeled, and the tendons and ligaments are contracted beyond the point where they can be stretched back. Corns, calluses, and bursitis over the prominent joint are common. Surgical correction is typically necessary to straighten the toe and relieve pain. Modern minimally invasive techniques allow for smaller incisions and faster recovery than traditional open surgery.

What Causes Hammertoes?

Hammertoes develop from an imbalance between the muscles and tendons that control toe position. Several factors contribute to this imbalance:

Footwear: Shoes that are too tight, too narrow, or have high heels push the toes into a bent position for extended periods. Over time, the muscles and tendons adapt to this shortened position and lose the ability to straighten fully. This is the single most common contributing factor.

Foot structure: Inherited foot types—particularly flat feet, high arches, and bunions—alter the mechanical balance of the forefoot. A bunion pushes the big toe toward the second toe, crowding it into a bent position. Flat feet create excessive pronation that destabilizes the lesser toes.

Nerve and muscle conditions: Peripheral neuropathy, stroke, Charcot-Marie-Tooth disease, and other neurological conditions can weaken the intrinsic foot muscles that stabilize the toes, leading to progressive deformity.

Toe length: Having a second toe that is longer than the big toe (known as Morton’s toe) increases the risk because the longer toe is more likely to be compressed by shoes.

Trauma: A broken, jammed, or dislocated toe can damage the joint structures and trigger hammertoe development during healing. Arthritis in the toe joints also disrupts normal alignment and can lead to contracture.

Hammertoe Symptoms

Hammertoe symptoms typically develop gradually and worsen over time if left untreated. The most common signs include a visibly bent or curled toe, pain or irritation at the top of the bent joint when wearing shoes, corns or calluses that develop where the toe rubs against the shoe or against an adjacent toe, redness and swelling at the affected joint, and restricted motion in the toe.

In more advanced cases, the toe may cross over or under an adjacent toe, the ball of the foot beneath the affected toe may become painful (metatarsalgia), and open sores can develop over the prominent joint. Patients with diabetes should seek prompt evaluation for any hammertoe, as the pressure points created by the deformity increase the risk of wounds that heal poorly.

How We Diagnose Hammertoes

Diagnosing a hammertoe starts with a thorough clinical examination. Your podiatrist will assess the toe’s flexibility, check for corns and calluses, evaluate the range of motion at the affected joint, and test the stability of the surrounding tendons. We also examine the overall alignment of your foot, because factors like bunions and metatarsal length patterns often contribute to hammertoe development.

Weight-bearing X-rays are taken to evaluate the degree of joint contracture, check for any arthritic changes within the joint, and assess the bone alignment of the entire forefoot. These images are essential for surgical planning if conservative treatment is insufficient. In some cases, advanced imaging or vascular assessment may be ordered, particularly for patients with diabetes or peripheral vascular disease.

Conservative Hammertoe Treatment

For flexible and semi-rigid hammertoes, conservative treatment focuses on reducing symptoms, slowing progression, and improving comfort. Our podiatrists create individualized treatment plans based on the severity of your deformity, your activity level, and your goals.

Custom Orthotics

Custom-molded orthotic inserts address the underlying biomechanical imbalances that contribute to hammertoe development. By correcting excessive pronation, supporting the metatarsal arch, and redistributing pressure across the forefoot, orthotics reduce the mechanical forces that drive the toe into a bent position. We use 3D digital scanning for precise measurements and craft each device to your exact foot contours.

Padding & Splinting

Gel toe pads, cushioned corn covers, and hammertoe crests protect the prominent joint from shoe friction and reduce corn formation. Toe splints and straps gently hold the toe in a straighter position, helping to maintain flexibility and prevent further contracture. While these devices do not reverse a hammertoe, they provide meaningful symptom relief and can significantly slow progression when used consistently.

Footwear Modifications

Switching to shoes with a deep, wide toe box is one of the most important steps in managing hammertoes. Shoes should have at least a half inch of space between the longest toe and the end of the shoe. Avoid heels higher than two inches, and look for shoes with soft, flexible uppers that accommodate the toe deformity without creating pressure points. Your podiatrist can recommend specific shoe brands and styles suited to your foot shape.

Stretching & Strengthening Exercises

Targeted exercises help maintain and improve flexibility in the affected toe joint. Toe curls, marble pickups, and towel scrunches strengthen the intrinsic foot muscles. Manual stretching of the toe joint several times per day helps counteract the tightening tendons. While exercises alone cannot correct a hammertoe, they are an important component of a comprehensive conservative treatment program and can improve overall foot function.

Surgical Hammertoe Correction

When conservative treatment no longer provides adequate relief, or when the hammertoe is rigid and causing persistent pain, surgical correction is recommended. Modern hammertoe surgery has advanced significantly, with minimally invasive options that reduce scarring, swelling, and recovery time.

Arthroplasty (Joint Resection)

In this procedure, a small portion of bone is removed from the affected joint to allow the toe to straighten. The toe retains some flexibility at the joint. Arthroplasty is typically used for less severe rigid hammertoes and offers a quicker recovery. The procedure is performed through a small incision under local anesthesia, and most patients walk in a surgical shoe immediately afterward.

Arthrodesis (Joint Fusion)

For more severe or recurrent hammertoes, arthrodesis permanently fuses the PIP joint in a straight position. The damaged cartilage surfaces are removed and the bone ends are held together with an internal implant (typically a small pin or absorbable fixation device) while they heal into one solid bone. This procedure provides the most reliable long-term correction and has the lowest recurrence rate. The fused joint does not bend, but since the PIP joint contributes little to normal walking function, most patients notice no significant functional limitation.

Minimally Invasive Techniques

Our surgeons use minimally invasive approaches whenever possible, performing the correction through incisions as small as 2–3 millimeters. These techniques use specialized instruments and fluoroscopic (live X-ray) guidance to reshape the bone without large incisions. Benefits include less post-operative pain, reduced swelling, smaller scars, and faster return to regular footwear.

Tendon Lengthening & Transfer

In cases where tendon imbalance is the primary driver, tendon procedures may be performed alongside bone work. Flexor tendon lengthening relaxes the tight tendon pulling the toe down. Flexor-to-extensor tendon transfer reroutes the tendon from the bottom of the toe to the top, creating an active force that holds the toe straight. These soft tissue procedures help address the root cause of the deformity and reduce the chance of recurrence.

Recovery After Hammertoe Surgery

Most patients walk in a surgical shoe or boot immediately after surgery. Sutures are removed at 10–14 days, and swelling gradually decreases over 4–8 weeks. Return to regular shoes typically occurs at 4–6 weeks, with full healing at 8–12 weeks. Your podiatrist provides specific post-operative instructions, including elevation protocols, ice application, and gentle range-of-motion exercises to optimize your recovery.

Preventing Hammertoes

While you cannot change your inherited foot structure, there are practical steps you can take to reduce your risk of developing hammertoes or prevent existing ones from worsening. Wearing shoes with a wide, deep toe box that allows your toes to lie flat is the most important preventive measure. Avoid pointed-toe shoes and heels over two inches for extended wear.

Performing daily toe stretches and strengthening exercises maintains muscle balance and joint flexibility. If you have flat feet, high arches, or bunions, custom orthotics can correct the biomechanical imbalances that predispose you to hammertoes. Regular foot check-ups are especially important if you have diabetes or a family history of toe deformities.

Hammertoes & Diabetes

Hammertoes pose an elevated risk for patients with diabetes. Diabetic peripheral neuropathy reduces sensation in the feet, meaning painful pressure points from a hammertoe deformity may go unnoticed. Combined with impaired circulation that slows wound healing, even a small corn or blister over a hammertoe can progress to a serious ulceration.

At Balance Foot & Ankle, we provide comprehensive diabetic foot care that includes hammertoe monitoring and management. Early correction of toe deformities in diabetic patients is a proactive strategy to prevent wounds, infections, and the serious complications they can cause. If you have diabetes and notice any change in your toe alignment, schedule an evaluation promptly.

Frequently Asked Questions About Hammertoe

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Dr. Tom Biernacki, DPM

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Dr. Carl Jay, DPM

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Dr. Daria Gutkin, DPM, AACFAS

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Sources

1. American College of Foot and Ankle Surgeons. “Hammertoe.” FootHealthFacts.org.

2. American Academy of Orthopaedic Surgeons. “Hammer Toe.” OrthoInfo.aaos.org.

3. Schrier JC, et al. “Hammertoe correction with PIP joint fusion: a systematic review.” Foot Ankle Surg. 2023.

4. Coughlin MJ, et al. “Lesser Toe Deformities.” Mann’s Surgery of the Foot and Ankle, 9th ed. Elsevier, 2014.

5. American Diabetes Association. “Foot Complications.” Diabetes.org.

This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment. Results vary by individual. Balance Foot & Ankle Specialists — serving Howell, Bloomfield Hills, and communities throughout Michigan.