What Is a Hammertoe?

A hammertoe is a deformity of the second, third, fourth, or fifth toe in which the middle joint of the toe (the proximal interphalangeal joint, or PIP joint) bends downward, creating an angular appearance that resembles a hammer. Related deformities include mallet toe (where the end joint of the toe bends down) and claw toe (where both the middle and end joints are bent, along with the toe being raised at the base). These terms are sometimes used interchangeably in common usage, though they have distinct anatomical meanings.

Hammertoes develop when the balance of tendons, muscles, and ligaments controlling toe position is disrupted. The toes are held in their normal, straight position by a balance between tendons that pull them up (extensors) and tendons that pull them down (flexors). When this balance is lost — through muscle imbalance, ligament laxity, nerve damage, or structural changes — the flexor tendons gain dominance over the weaker extensors, and the toe begins to curl downward.

Hammertoes are among the most common foot deformities, affecting over 60 million Americans and becoming increasingly prevalent with age. Women develop hammertoes more frequently than men, largely due to the role of narrow, pointed-toe footwear in accelerating the deformity.

What Causes Hammertoes?

Multiple factors contribute to hammertoe formation, and most cases involve a combination of influences rather than a single cause.

Footwear is the most modifiable contributing factor. Shoes with narrow, pointed toe boxes compress the toes laterally and force them into flexed positions. High heels shift body weight forward onto the forefoot, increasing the flexor tendon forces on the toes. Years of wearing such shoes accelerates the natural tendency toward toe deformity, particularly in people who have genetic predisposition.

Foot structure plays a major role. People with longer second toes (Morton’s toe) frequently develop hammertoe of the second toe because the toe must buckle to fit within a shoe shorter than it is. Bunions cause the big toe to drift toward the lesser toes, crowding them and pushing the second toe into a hammered position. Flat feet create altered tendon mechanics that contribute to hammertoe formation.

Muscle imbalance from various causes — including peripheral neuropathy, neurological conditions, and post-injury changes — disrupts the extensor-flexor balance and can cause or accelerate hammertoe deformity.

Genetics influences toe length, ligament laxity, and overall foot structure, all of which affect hammertoe tendency. Examining your parents’ feet often reveals the trajectory of your own foot deformities.

Trauma — a stubbed or jammed toe, fracture, or dislocation — can initiate hammertoe deformity by disrupting the delicate tendon and ligament balance. Post-traumatic hammertoes may develop months after an injury that initially seemed minor.

Flexible vs. Rigid Hammertoes: Why the Distinction Matters

The most clinically important characteristic of a hammertoe is whether it is flexible or rigid, because this determines what treatment options are available.

A flexible hammertoe can be straightened manually — when you push the bent toe back into a straight position, it moves relatively easily. The tendon contracture hasn’t yet become permanent, and the joint cartilage is intact. Flexible hammertoes can be addressed with conservative measures, and if surgery is needed, less invasive techniques are available.

A rigid hammertoe cannot be manually straightened — the joint has become fixed in the bent position due to joint capsule contracture, joint space narrowing, or cartilage damage. Rigid hammertoes require surgical correction, and the procedure is more involved than for flexible deformities.

The transition from flexible to rigid happens gradually over years. This progression is one of the most compelling arguments for early treatment — addressing a flexible hammertoe before it becomes rigid opens more treatment options and allows less invasive surgical approaches if eventually needed.

Symptoms: When Does a Hammertoe Become a Problem?

Many hammertoes are initially asymptomatic — you can see the deformity but it doesn’t cause significant pain. Over time, however, several problems commonly develop that prompt patients to seek treatment.

The raised portion of the bent toe — the prominent PIP joint — develops painful corns (calluses) from friction against shoe uppers. These hard, thickened skin lesions can become very painful and may develop infected bursae (fluid-filled sacs) beneath them. If the corn is not addressed, the skin beneath it can break down into an open sore.

The tip of the hammered toe presses against the shoe or floor, developing a painful callus or corn at the end of the toe. In some patients, the nail at the tip of the toe becomes deformed or ingrown from this abnormal pressure.

Metatarsalgia — pain in the ball of the foot beneath the metatarsal heads — commonly accompanies hammertoes because the deformity disrupts normal weight distribution across the forefoot. The toe no longer bears weight normally, and excess force is transferred to the metatarsal head below it.

Difficulty finding comfortable footwear is a major quality-of-life impact. As hammertoes progress, fewer shoes can accommodate them comfortably. This affects patients’ ability to work, exercise, and participate in social activities.

Conservative Treatment Options

Conservative treatment aims to relieve pain and slow progression, though it cannot reverse a hammertoe deformity that has already formed. The goals are managing symptoms and preventing the flexible deformity from becoming rigid.

Footwear modification is the most important conservative intervention. Switching to shoes with wide, deep toe boxes that don’t compress or rub against the prominent toe joint eliminates the friction that causes painful corns. Extra-depth shoes with removable insoles accommodate more severe deformities. Sandals and open-toed shoes can relieve pain by eliminating shoe contact with the deformity entirely.

Padding and corn treatment relieves pain from prominent corn formation. Silicone or foam toe pads cushion the PIP joint against shoe pressure. Corn removal through padding, topical keratolytic agents, or professional debridement (trimming) by a podiatrist reduces painful callus buildup. Important caveat: trimming corns at home with razors or scissors risks injury and infection — professional debridement is much safer, particularly for diabetic or immunocompromised patients.

Silicone toe splints or sleeves for flexible hammertoes can provide gentle passive straightening force during shoe wear. While they don’t correct the underlying tendon imbalance, they can reduce symptoms and may slow progression in mild cases.

Custom orthotics address the underlying mechanical causes of hammertoe formation — redistributing metatarsal head pressure, supporting the arch, and controlling pronation or other biomechanical factors that accelerate deformity progression.

Surgical Correction: Procedures and Recovery

When conservative treatment no longer provides adequate pain relief, or when the deformity progresses to the point that it significantly limits daily life, surgical correction is highly effective. Hammertoe surgery has very high patient satisfaction rates — most patients report significant pain relief and improved ability to wear normal footwear.

For flexible hammertoes, a flexor tendon lengthening or release procedure relaxes the over-tight tendon causing the deformity. This can often be performed percutaneously (through a tiny incision) with very quick recovery. A tendon transfer procedure — repositioning a flexor tendon to act as an extensor — provides more powerful correction for moderate flexible deformities.

For rigid hammertoes, arthroplasty (reshaping the joint) or arthrodesis (fusing the joint) are the main options. Arthroplasty removes a portion of the involved bone to allow the toe to straighten, while arthrodesis holds the toe in a straight position with a pin, wire, or implant until the joint fuses solidly. Arthrodesis provides more durable correction but eliminates motion at the joint — for toes that have little useful motion due to rigidity, this is generally acceptable.

Recovery from hammertoe surgery typically involves wearing a surgical shoe for 3-6 weeks while swelling resolves and healing occurs. Significant swelling in the operated toes can persist for months, and fitting into dress shoes may require 3-6 months. The overall results are very favorable — most patients are extremely satisfied with the outcome when their expectations are appropriately set.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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