Hammertoes

What Is a Hammertoe?

A hammertoe is a deformity in which one or more of the smaller toes bend downward at the middle joint, resembling a hammer. While any toe can be affected, hammertoes most commonly develop in the second and fifth toes. The condition can be flexible (the toe can still be straightened manually) or rigid (the joint is fixed in the bent position).

Hammertoes are progressive — they rarely improve on their own and tend to worsen over time without treatment. Early intervention is key to avoiding surgery.

Causes

• Muscle imbalance — an imbalance between the tendons on the top and bottom of the toe causes it to buckle and stay bent
• Abnormal walking mechanics — certain gait patterns put excessive force on the smaller toes
• Heredity — a family history of hammertoes increases risk
• Injury — trauma to the toe can disrupt normal tendon balance
• Footwear — shoes that are too short, too narrow, or have a high heel force the toes into a bent position for extended periods
• Bunions — a bunion on the big toe can push the second toe out of alignment, leading to hammertoe

Symptoms

• A toe that is visibly bent or curled downward at the middle joint
• Pain or difficulty when moving the affected toe
• Corns on the top of the bent joint (from rubbing against the shoe)
• Callouses on the ball of the foot beneath the affected toe
• Swelling, redness, or a burning sensation at the joint
• Difficulty finding comfortable shoes

Treatment

Non-Surgical Approaches

When caught early while the hammertoe is still flexible, conservative treatment is often highly effective:

• Wider, deeper shoes — footwear with adequate room in the toe box removes the pressure that worsens deformity and eases pain
• Custom orthotics — address the underlying biomechanical imbalance driving the deformity
• Corn and callus trimming — professional debridement provides immediate pain relief
• Toe pads and cushions — protect the joints from friction and pressure inside footwear
• Toe splints or taping — help hold flexible hammertoes in a straighter position
• Stretching and strengthening exercises — improve tendon flexibility and muscle balance in the toe

Surgical Treatment

Rigid hammertoes — those that can no longer be straightened manually — typically require surgery to correct. Procedures may involve tendon lengthening, joint realignment, or removal of a small portion of bone (arthroplasty) to straighten the toe. Recovery is generally straightforward, and most patients return to normal footwear within a few weeks.