What Causes Hammertoe?

Hammertoe occurs when there is a muscle imbalance around the toe joint. This causes the toe to get stiff and bent in a hammer-like position. This condition can affect any toe, but it usually affects the one or more of the middle three toes. It can cause pain and swelling of the affected toe.

Hammertoe is a treatable condition, and in some cases, it can be prevented. This article will cover the types of hammertoe, signs and symptoms, causes, treatment, and more.  

Hammer Toe

PAUL CAMPBELL / Getty Images

Types of Hammertoe 

There are two types of hammertoe: flexible and rigid. Flexible hammertoe is less severe than the rigid type. It can affect two different joints of the toes, either the proximal interphalangeal joint (PIP), which is the middle toe joint, or the distal interphalangeal joint (DIP), near the tip of the toe.

Flexible Hammertoe 

A flexible hammertoe condition is one in which you can still straighten out the affected toe by reducing it (forcing it into a straight position). But usually, any sudden movement of your foot, walking, or standing will cause the deformity to return.

A flexible hammertoe can become rigid over time. It is therefore important that you seek care for a hammertoe to make sure it doesn’t get worse.

Rigid Hammertoe 

Once the tendons of the toe contract and tighten up, they can force the joint out of alignment. If the joint is partially fused through arthritis (joint inflammation), the arthritic joint may be painful when it does move. Once the joint is severely affected, you cannot move the toe and it is permanently bent.

The raised part of the toe will rub up against the shoe, which can lead to painful corns and calluses. These are hard, thick areas of skin. Corns are small, round, and found on the tops or sides of the toes. Calluses are larger and more spread out. They are often seen on the bony parts of the bottom of the foot—the heel, ball of the foot, and side of the foot.

When hammertoe gets this bad, it is called rigid hammertoe.

Claw Toe and Mallet Toe

Claw toe and mallet toe are two toe joint deformities similar to hammertoe. In mallet toe, the toe bends downward at the DIP joint near the tip of the toe.

In claw toe, the toe bends upward at the joint where the foot and toe bones meet, down at the middle PIP joint, and down again (flexed) at the DIP joint. In contrast to claw toe, the DIP joint is extended in hammertoe (bent up).

Most people would call these hammertoe, but podiatrists (medical doctors specializing in conditions of the feet and lower legs) and other healthcare professionals would make the distinction.

Hammertoe Signs and Symptoms

Hammertoe usually does not cause people pain. A hammertoe can cause discomfort with movement. Pain often occurs with walking and stretching the affected toe. Additional symptoms of hammertoe can be mild or severe.  

Mild Symptoms

The main symptom of hammertoe is a toe that is bent at the middle joint.   

Additional mild symptoms include:  

  • Corns or calluses
  • Difficulty and pain with walking
  • Inability to flex the foot or wiggle the toe
  • Claw-like toe appearance in the affected toe
  • Blisters
  • Pain when wearing certain shoes, usually tight shoes or new shoes
  • Pain with a new activity, certain levels of activity, or after lengths of standing

Severe Symptoms

Left untreated, hammertoe can become severe. Over time, it gets harder to straighten out the affected toe.

Severe symptoms of hammertoe are:  

  • Pain and irritation with wearing shoes
  • Inflammation, redness, and/or burning in the affected toe
  • Contracture of the toe (a bending deformity)
  • Open sores (ulcers) 

What Causes Hammertoe?

The prevalence of hammertoe is estimated to be 8.9%, according to a Turkish study reported in 2018. The most common cause of hammertoe is muscle and tendon imbalance, which is the result of changes that occur over time. But this is not the only cause.

Ill-Fitting Shoes

Shoes that are narrow and do not fit well, such as high heels, offer little or no arch support. High heels also put pressure on the toes and cause them to bend at the joints. High-heeled shoes also are usually too narrow in the toe box, the part of the shoe that surrounds the toes in a closed-toe shoe.

Injuries  

Traumatic toe injuries can lead to hammertoe. This includes any injury in which you stub, jam, or break your toe.  

Age

While anyone can experience hammertoe, the risk for the condition increases with age. This is because over time the tendons that connect muscles become shorter, tighter, and less flexible.  

Sex  

Females are more likely to experience hammertoe. This is due to the design of some footwear for women made with a narrow front end, causing the toes to become cramped

Arthritis 

Arthritis is a risk factor for hammertoe. It can make the joints of the toes stiff and sore. Inflammatory arthritis conditions like rheumatoid arthritis and gout have been linked to hammertoe.

Diabetes  

Diabetes (the body’s inability to regulate blood sugar) can lead to hammertoe because it increases the risk for infection and foot ulcers. According to the University of Michigan Health, about half of the people with diabetes have a foot or toe deformity, such as hammertoe.

A complication of diabetes is that wounds in areas such as the top of the toe, where the skin is thin, can reach the bone. This can result in the toe needing to be amputated (surgically removed).

Polio  

Post-polio syndrome, a condition that strikes years or even decades after a person has recovered from polio, can sometimes cause problems with the feet. Polio is a viral infection that affects the spinal cord

Toes that are bent downward are commonly seen in people with post-polio syndrome, which can lead to toe deformities like hammertoe.

Alcohol Use Disorder 

Hammertoe is sometimes the result of nerve damage caused by alcohol use disorder. That type of damage can weaken the muscles of the foot and toes.  

Stroke  

Some survivors of stroke (loss of blood flow to the brain or a bleed in the brain) report the curling of their toes post-stroke. A stroke can also cause nerve and muscle damage in the feet and toes.  

Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth disease is a group of disorders that affect the peripheral nervous system and can result in smaller, weaker muscles. It can also cause foot deformities, such as hammertoe.

High Arches

Having a high arch, called cavus foot, can lead to hammertoe.  

Toe Length  

People whose second toe is longer than their big toe are more likely to have hammertoe in the second toe. People with long toes are more likely to have toe deformities due to footwear compression.

Bunions

A bunion is a painful bump on the outside of the foot at the base of the big toe. It is a risk factor for hammertoe. Pressure from bunions can lead to hammertoe.

Genetics

Hammertoe can run in families. While a curled toe isn’t necessarily hereditary, foot shape can be passed down through generations. Therefore, if your parent or grandparent has a hammertoe, it is more likely you will have the condition.  

Flat Feet  

Flat feet is a condition in which one or both feet have little or no arch. It is a risk factor for hammertoe. In people with flat feet, there is pressure on the toes when the foot tries to compensate for a lack or reduced arch. Additionally, the tendons can become inflamed from attempts to balance the foot.

How Is Hammertoe Diagnosed?

Your healthcare professional can make a diagnosis of hammertoe by examining your affected toe. Your doctor will do a physical exam that includes touching and moving the foot and toes to see how the joints respond. They may request imaging of your toes to look for joint damage.  

If you have diabetes or another condition that causes nerve damage, your doctor may request additional testing to look for tendon damage or another cause of your toe pain.

Hammertoe Treatment

The severity of your symptoms determines treatment options for hammertoe. 

When to See a Healthcare Provider

Hammertoe is a condition that can get worse with time. Get in touch with your doctor right away if you experience symptoms of hammertoe, including a rigid toe joint, pain at the top of a bent toe, corns or calluses at the top of the bent joint, inflammation or swelling of the toe, or painful and restricted movement of the toe.

How to Fix a Hammertoe That’s Mild or Moderate

Mild hammertoe can be managed by making some lifestyle changes and using over-the-counter (OTC) therapies. 

One of the easiest ways to correct a hammertoe is to wear properly fitting shoes. If you have high arches that have affected your toes, you may benefit from using shoe insoles or toe pads. These help by shifting the toe position, which can correct the toe curvature and relieve pain.

Hammertoe straightening devices are available over the counter. These straighten the toe while you wear them. But as soon as you take off the device the toe will curl into a hammer shape again.

You can find OTC therapies to treat bunions, corns, and calluses. These include creams, cushions, and toe pads.

For corns and calluses, wart medicine containing salicylic acid can also be applied to remove the excess skin for a few days. Or, you can go to a podiatrist to have it debrided (skin removed with a blade). These measures need to be repeated as corns and calluses will usually return.

If bunions, corns, and calluses are painful or cause deformity, your doctor may recommend surgery to treat these conditions.

If you experience blisters, OTC creams can treat those, and toe pads can keep the blisters from rubbing against shoes.

Toes mildly affected by hammertoe might be gently stretched to keep them flexible, although this may not affect the progression of the condition. Your doctor can recommend exercises or refer you to physical therapy to manage your symptoms.

You can also apply splints or use kinesiology tape (strips of special tape applied in specific ways) on the affected toe to help realign it. However, the condition is likely to continue to worsen when you stop taping. Frequent or continuous taping can also cause skin problems.

Treatment for Severe Hammertoe

If you experience pain from severe hammertoe, taking an anti-inflammatory pain reliever like Advil (ibuprofen) can help to relieve pain and swelling. If OTC pain relievers don’t work for you, your doctor might prescribe a stronger pain reliever or give you a cortisone shot to alleviate pain.

Your doctor might recommend surgery if you experience severe pain, are unable to bend the affected toe, if your your ability to walk or do your daily activities is affected, or if other nonsurgical options don’t help you.

If you still have motion in the joint, a surgery called arthroplasty may be tried to remove pieces of bone. Arthrodesis/fusion surgery is another surgical option that removes any bony growths on the toe and aligns the joint, before a steel pin is inserted to correct the toe’s positioning.

Surgery to repair the affected toe is performed on an outpatient basis and you can return home on the day of the surgery. 

Preventing Hammertoe

Depending on the cause of your hammertoe, it might be possible to prevent the condition.  

Prevention

Many factors increase your risk for hammertoe. Some of these might be preventable, while others might be out of your control.

Wear Proper-Fitting Shoes 

One of the best and easiest ways you can prevent hammertoe is to avoid wearing shoes that pinch and put pressure on your toes. If your shoes are too snug, have the length and width of your feet measured and find shoes that suit those measurements.  

Doctors typically recommend wearing shoes with roomy toe boxes, with extra depth in the height of the toe box and with at least half an inch of space between the longest toe and the tip of the shoe. Orthotic inserts can also make shoes feel more comfortable.

A podiatrist or orthotic specialist can prescribe and construct a custom orthotic for you. They can also recommend a shoe with good arch support to help slow down the progression of hammertoe or prevent the condition in people who are at risk.  

Use A Pumice Stone 

A pumice stone is formed by mixing lava and water to create a light, abrasive product to remove dry, dead skin. It can soften calluses and corns to reduce pain, as well. You can use a pumice stone after a foot soak. You can also apply a thick cream to keep the area soft after using the pumice stone.  

Try Foot Exercises  

If you have risk factors for hammertoe, your doctor may recommend exercises for your toes to keep them flexible and to strengthen the muscles that help move the toes. Your healthcare provider can refer you to a foot specialist if you start to notice signs and symptoms of hammertoe.  

Long-Term Outlook

The outlook for most people with hammertoe can be good. Recurrences of hammertoe are rare, but the condition can come back if the underlying problem wasn’t resolved with surgery. It is also possible for bone healing to be delayed or a surgical complication to occur.  

Summary

Hammertoe is a condition that affects the second, third, or fourth toe at the middle joint of the toe. It causes the toe to bend downward and resemble a hammer. Hammertoe results from the imbalance of the structures that surround the toe joint.

The main cause of hammertoe is a muscle and tendon imbalance, but other causes include ill-fitting shoes, age, and medical conditions such as arthritis and diabetes. Symptoms of the condition include pain, swelling, and problems with walking. Hammertoe shouldn’t be ignored and can get worse if you do not get treatment. If hammertoe becomes severe, you may need surgery to repair the affected joint.  

A Word From Verywell

Hammertoe generally isn’t a serious condition. After treatment, it can go away without any complications. However, it is important you get treatment as soon as you are diagnosed to avoid damage to the affected toe and the surrounding joints.

Frequently Asked Questions

  • Can you fix a hammertoe yourself?

     

    Mild to moderate hammertoe can be treated at home. At-home treatment can include OTC pain relievers, stretching and exercising the affected foot and toe, using orthotics, wearing properly fitting shoes, and splinting of the affected toe.

  • Are hammertoes bad?

    Hammertoe is a treatable condition. However, left untreated, the condition can become worse and require the need for surgery.

  • How can I permanently fix my hammertoe?

    Surgery can permanently fix a toe affected by hammertoe. This is a simple procedure that straightens the affected toe to relieve symptoms and improve the appearance of the affected toe.

 

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14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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