Hammer toe is a condition that affects the second, third, or fourth toe. It affects the middle joint of the toe, which bends down and resembles a hammer.

Black-and-white image of a ballet dancer's feet in ballet shoes. They are holding their foot due to the pain of having hammer toe.Share on Pinterest
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The condition results from an imbalance in the structures surrounding the joint. A common cause is wearing shoes that do not fit correctly. Symptoms include pain, swelling, and difficulty walking.

A hammer toe is flexible when it starts to develop. But if a person with the condition does not receive treatment, it may become rigid.

Keep reading to learn more about the causes, symptoms, and diagnosis of hammer toe, as well as complications, treatment, and prevention.

An imbalance in the muscles and tendons that surround the middle toe joint causes hammer toe. Several factors may contribute to this imbalance, including:

Footwear

Shoes that are too tight in the toe box or have a high heel can force toes into a bent or flexed position. When the toes stay in this position a long time, the muscles that allow the toes to straighten out become tight and less able to work. Eventually, they are unable to straighten out, even when wearing more spacious shoes.

This tightening, along with other factors, is what leads to hammer toe in many cases. Corns and calluses from tight shoes can also aggravate the condition.

Toe length and foot posture

A 2021 article notes that hammer toe is more common in toes that are longer. Long toes may increase the likelihood that the toe will become bent or squashed by tight or heeled shoes. Hammer toe is also more common in people with other foot conditions, such as flat feet or bunions.

Flat feet is when a person has no visible arch when they place their feet on a flat surface. Bunions occur when a bone growth develops on the base joint of the big toe, causing it to lean toward the other toes.

Genetics

Some people may be more likely to develop hammer toe due to genetics.

An older 2013 study examined the incidence of toe deformities, including hammer toe, among 2,446 white European participants using data from 2002–2008. The researchers found that these conditions are highly heritable among this population, meaning that if a relative has hammer toe, others in their family may be more likely to get it.

But as the study did not look at families from other parts of the world, or other races and ethnicities, it is unclear if this applies to all people.

Age and gender

Hammer toe is more common in older adults, particularly among women. In the 2013 study, half of women participants ages 70 years or older had a lesser toe deformity. This may be because, in some cultures, women are more likely to wear shoes that constrict or place pressure on the toes, making hammer toe more likely.

A 2021 cross-sectional study from Malaysia found a significantly higher rate of toe problems in young women who wore high heels to work than in those who wore other types of shoes. The toe problems included calluses, bunions, and hammer toe.

Past injury

Hammer toe is not the direct result of an injury. But the American College of Foot and Ankle Surgeons (ACFAS) notes that earlier trauma to the toe may contribute to its development later on.

Other health conditions

Certain health conditions can raise the risk of hammer toe. These include:

  • diabetes
  • neuromuscular conditions, which affect the muscles, nerves that control muscles, or the communication between the nerves and muscles
  • muscle imbalances that are unrelated to footwear
  • inflammatory joint diseases, such as arthritis

A person with hammer toe will have one toe that is consistently in a bent position. They may have difficulty straightening it or may not be able to straighten it at all.

Other symptoms of hammer toe include:

  • pain in the affected toe, especially when moving it or wearing shoes
  • a callus or corn on top of the middle joint of the hammer toe
  • swelling
  • difficulty walking

Diagnosis involves a physical examination to see if the toe can straighten out or is rigid. If doctors suspect hammer toe, they will order an X-ray to confirm it.

If another condition, such as diabetes, might be affecting the nerves and muscles in the feet, a doctor may order tests for these too.

In the early stages of hammer toe, the toe is still flexible. During this time, nonsurgical approaches can stop the toe from becoming stuck in a bent position. A doctor may recommend:

Footwear changes

People with early stage hammer toe should avoid wearing narrow, tight, or high-heeled shoes. Instead, look for:

  • flat or low-heeled shoes, with a heel of fewer than 2 inches (5 centimeters)
  • shoes with a wide and deep toe box to accommodate long or bent toes
  • open-toe shoes or sandals

Exercises

Exercises may also strengthen and stretch the muscles in the feet, which may reduce the imbalance that is causing hammer toe. Specific exercises include:

  • picking up small objects with the toes
  • scrunching a towel on the floor with the toes
  • gently stretching the toe manually

Over-the-counter products

People can purchase foot aids over the counter (OTC) to hold toes in a comfortable position and reduce pressure on them. This may include cushioned straps, tubes, or cushions. Callus or corn pads can also reduce discomfort.

For pain, people may wish to take OTC pain medications to manage the symptoms.

Splint

A splint is a type of orthotic device that may help reduce the symptoms of hammer toe, or help prevent it from getting worse. The ACFAS reports that placing splints in a shoe may help control imbalances in muscles, tendons, or both.

People can get an orthotic device that is custom-made for their feet from a doctor. Surgeons may also recommend using one after a person undergoes surgery.

Surgical treatment

If nonsurgical treatment does not alleviate symptoms or the hammer toe becomes unmovable, surgery is an option. Surgery for hammer toe usually does not require a hospital stay, and only requires local anesthetic.

The types of surgery available are:

  • Tendon lengthening: This is a possible choice for people with a hammer toe that is still flexible rather than fixed. It lengthens the tendons that are causing the imbalance.
  • Tendon transfer: Another surgery for individuals with a flexible hammer toe, this involves transferring tendons from the bottom to the top of the toe to pull the joint straight.
  • Arthrodesis: This surgery is for rigid hammer toes and involves joint fusion. During the procedure, a surgeon removes a small part of a bone in the joint, allowing it to straighten fully. Sometimes doctors may combine this with tendon lengthening.

After one of these procedures, a person must limit how much they use their feet while the toe heals. People can have pain or swelling for up to 4–6 weeks. A person may have to begin the recovery process with partial weight-bearing exercise in special shoes for 2–6 weeks, before moving onto a rigid athletic shoe after that.

Recovery may take longer in people with certain conditions, such as diabetes.

Hammer toe is a progressive condition, which means it worsens over time. This may result in:

  • pain
  • walking imbalance
  • skin changes, such as corns, calluses, and blisters
  • open sores
  • reduced quality of life

There are also some potential complications of having surgery for hammer toe, such as pain, stiffness, infection, and numbness. It is also possible for the hammer toe to come back.

According to a 2021 article, this happens in 10% of cases. Recurrence is more common in people having surgery on their second toe rather than the third or fourth.

Early treatment can help prevent or lower these risks by making nonsurgical treatment possible.

Since wearing restrictive shoes is a common cause of hammer toe, wearing certain kinds of shoes can reduce the risk of developing the condition. People should look for flat or low-heeled shoes with enough room in the toes and avoid shoes that:

  • have high heels
  • have pointed or narrow toes
  • are too tight

Other causes of hammer toe are not within a person’s control, so focusing on wearing well-fitting shoes is the best way to help prevent it.

People with other foot conditions, such as bunions, flat feet, or neuropathy, may also want to seek treatment for these conditions to help reduce their risk of further problems.

A person with early signs of hammer toe should speak with their doctor. They can assess the toes and begin conservative treatment right away to help prevent the toe from getting more bent.

People who have a more advanced hammer toe should also speak with their doctor. Even if the toe has been in a bent position for a long time, there are treatment options that can help.

Contact a doctor as soon as possible if an open sore develops on the foot that does not heal.

The overall outlook for hammer toe is good. Early treatment has the best chance of preventing the progression of hammer toe, but in people who need surgery, outcomes are also positive. Around 90% of people will not have a recurrence. People can speak with their doctor to receive an evaluation for this common condition.