Hammertoes: Causes, Prevention and Treatment Options

A hammertoe is a toe that bends downward at the middle joint, so it looks curled or shaped like a hammer. It most often affects the second, third or fourth toe and can make the top of the toe rub against shoes, causing corns, blisters and pain. Hammertoes usually develop gradually, and the earlier they are addressed, the more treatment options there are. This guide explains why hammertoes form, how they progress, and which treatments can relieve pain or correct the deformity.

Hammertoe, claw toe and mallet toe: what's the difference?

These terms describe different patterns of toe bending:

• Hammertoe: the toe bends down at the middle joint.
• Claw toe: the toe bends up at the joint where it meets the foot and down at the middle and end joints, so it curls like a claw. Claw toes often affect several toes at once and can be associated with nerve or muscle conditions.
• Mallet toe: the toe bends down at the joint closest to the tip.

All three are caused by an imbalance in the muscles, tendons and ligaments that normally hold the toe straight.

What causes hammertoes?

• Muscle and tendon imbalance: when the muscles that bend and straighten the toe pull unevenly, the toe can gradually stay in a bent position.
• Footwear: shoes with a narrow, shallow toe box or high heels push the toes into a bent position for long periods.
• Bunions: as the big toe drifts toward the smaller toes, it can crowd the second toe and push it into a hammertoe. Read more about bunion treatment options.
• Long second toe: a toe that is longer than the big toe is more likely to be cramped in shoes.
• Inherited foot type: flat feet and high arches both change the forces on the toes.
• Arthritis, injury and nerve conditions: joint damage, trauma and conditions such as diabetic neuropathy can contribute.

Flexible vs. rigid hammertoes

Hammertoes are often described by how much the joint can still move.

• Flexible hammertoe: the toe can still be straightened by hand. This is an earlier stage, and conservative treatment is often effective.
• Rigid hammertoe: the tendons have tightened and the joint is stiff and cannot be straightened. Rigid hammertoes are more likely to cause persistent pain and may require surgery for lasting relief.

Symptoms

• A visibly bent or curled toe
• Pain or irritation on top of the bent joint when wearing shoes
• Corns on top of the toe, or calluses on the tip or under the ball of the foot
• Redness, swelling or a burning sensation
• Difficulty moving the toe or finding comfortable shoes

For people with diabetes or reduced sensation, a corn on a hammertoe can break down into an open sore without much pain. Regular foot checks are important; see our daily diabetic foot care checklist.

Diagnosis

A podiatrist examines the toe, tests how flexible the joints are, looks for corns and calluses and evaluates the rest of the foot, including any bunion. X-rays show the position of the joints and whether arthritis is present. Your podiatrist will also look at your shoes, since footwear often plays a role in both causing and treating symptoms.

Non-surgical hammertoe treatment

When a hammertoe is still flexible, or when pain is mild, conservative care can bring significant relief:

• Change your shoes. Choose shoes with a deep, wide toe box, soft uppers and low heels. Avoid shoes that press on the top of the toe.
• Use pads and cushions. Non-medicated gel sleeves, crest pads and toe cushions reduce friction and pressure on corns.
• Try toe exercises. Picking up marbles or a towel with your toes and gently stretching the toes can help keep flexible hammertoes mobile.
• Splints and taping. Straps and splints can hold a flexible toe in a straighter position.
• Custom orthotics. Prescription orthotics can improve foot mechanics and reduce the muscle imbalance that drives the deformity. See custom orthotics vs. store-bought insoles.
• Professional corn care. A podiatrist can safely trim painful corns and calluses. Avoid medicated corn removers, which can burn healthy skin.

These measures relieve symptoms but do not permanently straighten a rigid toe.

When is hammertoe surgery recommended?

Surgery may be considered when a hammertoe is rigid and painful, when conservative care has not helped, or when recurring corns or sores are a concern. The goal is to straighten the toe, relieve pressure and restore comfortable shoe wear.

Types of hammertoe correction

• Tendon procedures: for flexible hammertoes, lengthening or transferring tendons can rebalance the toe.
• Joint resection: removing a small piece of bone at the bent joint allows the toe to straighten.
• Joint fusion: the bones of the bent joint are joined so the toe stays straight. Fusion is common for rigid hammertoes.

Older techniques often used a temporary pin that stuck out of the end of the toe for several weeks. Today, many surgeons use internal implants that stay inside the toe. At our practice, hammertoe repair is done using dynamic implants and retrofusion screws, and plantar plate injuries that cause unstable, painful toes can be repaired with specialized devices.

Recovery after hammertoe surgery

Recovery depends on the procedure and how many toes are corrected. Most patients walk in a surgical shoe or boot for several weeks, and some swelling of the toe can persist for a few months. Your surgeon will give you instructions on keeping the foot elevated, caring for the incision and gradually returning to regular shoes.

Preventing hammertoes

• Wear shoes with enough length, width and depth for your toes.
• Limit high heels and narrow, pointed shoes.
• Have your feet measured periodically, since foot size can change with age.
• Keep toes flexible with simple exercises.
• Have bunions and early toe deformities evaluated before they progress.

Get help before the toe becomes rigid

A hammertoe that is still flexible is much easier to manage. If you notice a toe starting to curl, or if a corn on top of a toe keeps coming back, schedule a visit with one of our podiatric physicians. We will help you find the right combination of footwear, padding, orthotics or surgical options.

This article is for general educational purposes and does not replace a diagnosis or treatment plan from a qualified healthcare provider. If you have a medical emergency, call 911.