What is a hammertoe?

A hammertoe is a deformity affecting one or more of the smaller toes.

The toe bends at one or more joints rather than remaining relatively straight.

The deformity can vary considerably.

Some hammertoes remain flexible and can still be manually straightened.

Others gradually become more rigid.

Which toes develop hammertoes?

Hammertoes most commonly affect the:

• Second toe
• Third toe
• Fourth toe
• Fifth toe

More than one toe may be involved.

The second toe is particularly commonly affected.

Are all bent toes hammertoes?

No.

Several different patterns of toe deformity can occur.

Terms include:

• Hammertoe
• Mallet toe
• Claw toe

These terms describe different patterns of bending through the toe joints.

From a patient perspective, the most important issues are:

• Where the toe is bending
• Whether it remains flexible
• Whether it is painful
• Whether pressure lesions are developing
• Whether footwear is becoming difficult

What causes hammertoes?

Hammertoes can develop because of a combination of factors.

These may include:

• Foot structure
• Muscle and tendon imbalance
• Genetics
• Tight footwear
• Toe length
• Bunions
• Changes in foot mechanics
• Arthritis
• Previous injury
• Neurological conditions
• Age-related structural changes

The deformity often develops gradually.

Do tight shoes cause hammertoes?

Footwear can contribute to symptoms and may contribute to progression in susceptible feet.

Shoes that are:

• Too short
• Too narrow
• Too shallow
• Highly tapered through the toes

can hold the smaller toes in a bent position and increase pressure.

However, footwear is rarely the only factor.

Underlying foot structure and muscle-tendon balance may also contribute.

What is a flexible hammertoe?

A flexible hammertoe can still be manually straightened to some degree.

These deformities may respond particularly well to conservative pressure-relief strategies.

Depending on the individual case, early management may help improve comfort and reduce irritation.

What is a rigid hammertoe?

A rigid hammertoe has become structurally fixed and cannot easily be straightened manually.

The toe joints may have become stiff or arthritic.

Rigid hammertoes are more likely to create persistent pressure against footwear.

Conservative treatment can still reduce symptoms, but it cannot necessarily straighten an established rigid deformity.

What symptoms can hammertoes cause?

Symptoms may include:

• Pain on top of the toe
• Corns over prominent joints
• Pain between the toes
• Callus at the end of the toe
• Nail pressure
• Redness
• Shoe irritation
• Difficulty finding comfortable footwear
• Pain during walking
• Pain under the ball of the foot

Some hammertoes remain completely painless.

Treatment is generally based on symptoms and function rather than appearance alone.

Why do corns develop on hammertoes?

When a toe bends upward, the prominent joint can rub against the inside of the shoe.

Repeated pressure stimulates the skin to become thicker.

A concentrated area of thickened skin can then form a corn.

Removing the corn can reduce pain, but if the toe continues to rub against the shoe, the corn may return.

This is why pressure management is an important part of treatment.

Internal link:

Corns & Calluses

Can hammertoes cause pain under the ball of the foot?

Yes.

Changes in toe position can alter pressure beneath the forefoot.

Some patients develop pain or callus under the metatarsal heads.

However, there are many causes of forefoot pain, so assessment is important before attributing symptoms solely to a hammertoe.

How our podiatrists assess hammertoes

Assessment may include:

• Which toes are affected
• Whether the deformity is flexible or rigid
• Location of pain
• Corns or calluses
• Toe-joint movement
• Foot structure
• Big toe alignment
• Forefoot pressure
• Footwear
• Walking mechanics
• Activity
• Relevant medical history

This helps determine whether conservative treatment is likely to control symptoms or whether more advanced assessment may eventually be useful.

Do I need an X-ray?

Not usually for a straightforward flexible hammertoe.

X-rays may be considered when:

• The deformity is rigid
• There is significant pain
• Arthritis is suspected
• Previous injury is relevant
• Multiple joints are involved
• Surgery is being considered

Weight-bearing X-rays can provide useful information about toe alignment and joint structure.

How are hammertoes treated?

Treatment depends on:

• Symptoms
• Flexibility
• Footwear
• Presence of corns or calluses
• Underlying foot structure
• Activity
• Patient goals

Most patients begin with conservative treatment.

Options may include:

• Footwear modification
• Corn and callus reduction
• Padding
• Silicone toe devices
• Toe sleeves
• Pressure redistribution
• Orthotics where appropriate
• Monitoring

Surgery may be considered for selected persistent symptomatic deformities.

Footwear for hammertoes

Footwear is often one of the most important considerations.

Helpful features may include:

• Adequate shoe length
• Wider toe box
• Increased toe-box depth
• Soft upper materials
• Reduced pressure over prominent toe joints
• Secure fit without crowding

The objective is to give the toes sufficient room rather than forcing them against the upper of the shoe.

Padding and toe protection

Padding can reduce pressure over painful areas.

Depending on the deformity, options may include:

• Silicone toe sleeves
• Gel caps
• Toe separators
• Toe props
• Protective padding
• Offloading devices

These do not permanently straighten a rigid hammertoe, but they can improve comfort.

Our podiatrists can advise which device is most appropriate.

Professional treatment of corns and calluses

Corns associated with hammertoes can be carefully reduced by our podiatrists.

Professional debridement can reduce:

• Hard skin
• Focal pressure
• Pain
• Shoe irritation

However, the corn may return if the underlying toe pressure remains.

For some patients, regular podiatry care forms part of ongoing symptom management.

Internal link:

Routine Foot Care

Can orthotics help hammertoes?

Orthotics do not directly straighten an established rigid hammertoe.

However, they may help selected patients where:

• Forefoot loading contributes to symptoms
• There is associated pain under the ball of the foot
• Foot mechanics are contributing to pressure
• Pressure redistribution is required

Orthotics should therefore be prescribed based on the overall mechanical assessment rather than simply because a hammertoe is present.

Internal link:

Orthotics & Biomechanical Assessment

Can exercises straighten hammertoes?

This depends on the deformity.

For a flexible toe, exercises may help maintain movement, strength and function.

Examples may involve:

• Toe mobility
• Foot strengthening
• Intrinsic muscle exercises
• Balance work

However, exercise cannot be expected to permanently straighten a rigid structural hammertoe.

Patients should be cautious about claims that simple exercises can reverse an established deformity.

Do toe straighteners work?

Toe splints, silicone devices and similar products may improve comfort and positioning while they are being worn.

They can be useful for selected flexible deformities.

However, they should not be promoted as permanently correcting an established structural hammertoe.

What if my hammertoe keeps getting worse?

A progressive deformity should be reassessed.

Our podiatrists may review:

• Toe flexibility
• Footwear
• Corn formation
• Forefoot pressure
• Joint movement
• Associated bunion deformity
• Whether imaging is appropriate
• Whether further treatment should be considered

Not every progressive hammertoe requires surgery, but increasing pain or difficulty wearing shoes may justify discussion of additional options.

When may hammertoe surgery be considered?

Most patients do not begin with surgery.

Surgical assessment may be appropriate when:

• The hammertoe remains persistently painful
• Corns repeatedly return despite appropriate pressure management
• Footwear remains difficult
• The toe is rigid
• The toe causes significant functional problems
• Conservative treatment has not provided adequate relief
• The patient wishes to discuss correction of the underlying structural deformity

The procedure depends on the type and severity of the deformity.

What operations are used for hammertoes?

There is no single operation for every hammertoe.

Different procedures address different structural problems.

Options may include:

• Tenotomy
• Minimally invasive or keyhole exostectomy
• Arthroplasty
• Arthrodesis

The appropriate procedure depends on whether the deformity is flexible or rigid, which joint is involved and what is causing the symptoms.

What is a tenotomy?

A tenotomy involves releasing a tendon that is contributing to the toe remaining in a flexed position.

For selected flexible toe deformities, this may allow the toe to sit in a more favourable position and reduce pressure.

It is generally a relatively small procedure but is not suitable for every hammertoe.

Assessment of the deformity is important before considering it.

What is a minimally invasive or keyhole exostectomy?

An exostectomy involves removing a prominent area of bone that is creating focal pressure.

In selected cases, this can be performed using a minimally invasive or keyhole approach through a small incision.

This may be considered where a localised bony prominence contributes to:

• Recurrent corn formation
• Shoe pressure
• Pain

The procedure is selected according to the individual anatomy and should not be presented as suitable for every hammertoe.

What is hammertoe arthroplasty?

An arthroplasty involves removing or reshaping part of a toe joint to correct a rigid deformity and reduce painful prominence.

It may be considered for selected fixed hammertoes.

The objective is to improve alignment and reduce pressure while maintaining an appropriate functional toe position.

What is hammertoe arthrodesis?

An arthrodesis involves surgically fusing a toe joint in a corrected position.

It is generally considered for selected rigid or more significant deformities.

Fusion can provide structural stability but permanently removes movement from the fused joint.

The choice between arthroplasty and arthrodesis depends on the deformity and individual circumstances.

Will I need a wire sticking out of my toe?

Different surgical techniques use different methods of maintaining toe position while healing.

Where clinically appropriate, internal fixation techniques may be considered rather than relying on a percutaneous wire protruding from the toe.

The fixation method depends on the procedure, anatomy and individual clinical circumstances.

This should be discussed as part of surgical planning rather than presented as a universal technique.

Who assesses patients if surgery may be appropriate?

The initial pathway remains through HealthiClinic Podiatry.

Our podiatrists can assess the toe, provide conservative treatment and determine whether further assessment is appropriate.

For selected patients requiring assessment of podiatric surgical options, Dr Damien Lafferty, Surgical Podiatrist, may be involved in the advanced-care pathway.

The page should retain HealthiClinic Podiatry as the primary service rather than becoming a personal surgical page.

Does every hammertoe need surgery?

No.

Many hammertoes can be managed successfully without surgery, particularly when symptoms are mild.

The decision to consider surgery should be based primarily on:

• Pain
• Function
• Footwear difficulty
• Recurrent pressure lesions
• Rigidity
• Response to conservative treatment

Appearance alone is generally not sufficient reason to recommend surgery.

When should I see a podiatrist?

Consider podiatry assessment if:

• A toe is becoming increasingly bent
• You have a painful corn on a toe
• Shoes repeatedly rub the toes
• There is pain at the end of a toe
• You have recurrent corns between toes
• The toe is becoming rigid
• Walking is uncomfortable
• You are unsure whether the problem is a hammertoe, corn or another condition
• Conservative treatments have not helped
• You want to understand whether surgery is necessary or avoidable