illustration of hammertoe with a corn | Annapolis Hammer Toe PodiatristAt Annapolis Foot & Ankle Center, our podiatrists have seen—and treated—a lot of hammer toes

Hammer toes are among the most common deformities of the forefoot. Typically, it develops in your second, third, and fourth toes. The problem begins when the middle joint in the toe bends abnormally, making the tip of your toe turn downward rather than point straight out. The deformity resembles the shape of a hammer.

Here, we break down the ins and outs and explain when surgery is your best treatment option.

Underlying Causes of Hammer Toe

Improperly fitting shoes are the primary cause of hammer toe. Narrow-toed shoes can squish your toes into a bent position. High heels cause a similar problem, as they force your toes against the front of the shoe. When shoes constrict and bend your toes over an extended time, the muscles shorten to accommodate the position.

You’re more likely to develop a hammer toe if you have an inflammatory joint disease like arthritis. Bunions also raise your risk because they push your big toe into your second toe, which may force your second toe into a downward, hammer toe position. 

Pain and Other Symptoms 

Not being able to straighten your toe is a prominent symptom, but hammer toe is also painful, affecting the top or the base of your bent toe. You may also experience pain in the ball of your foot and when you move your toe.

Painful corns often develop as the top of the bent toe rubs against your shoe. Patients with hammer toes also tend to develop calluses, contributing to foot discomfort. 

Non-Surgical Treatment Options at an Early Stage 

If your toe is still flexible, we can treat the problem with various non-surgical options. These may include one or more of the following: 

  • Splinting or taping to realign the toe
  • Shoes with a larger toe box and low heels
  • Exercises to stretch muscles in the hammer toe
  • Shoe padding to prevent ongoing irritation
  • Prescription orthotics to relieve pressure and restore muscle balance
  • Corticosteroid injections or topical medications to reduce inflammation and alleviate pain

Without early treatment, hammer toe usually worsens. The muscles and tendons stay tight, and the toe becomes rigid and fixed in its bent position. Now the toe is in a state of permanent contracture.

When Hammer Toe Requires Surgery 

Surgery is likely necessary for relief if your toe is stiff and causing pain. There are several types of hammer toe surgery. 

Flexible Hammer Toe

Even when your toe is still flexible, it’s possible to have enough pain and difficulty moving to consider surgical intervention.

The most common surgery for flexible hammer toe is straightening the toe with a tendon transfer. This procedure involves rerouting tendons to maneuver the bent joint back into a straight position. 

Rigid Hammer Toe

In this case, we may recommend a joint resection or a bone fusion. During a joint resection, part of your bone is removed to allow your toe to return to its normal position. In a fusion, the toe is straightened, and the bones are fused together, preventing the toe from bending.

Hammer toe surgery is usually an outpatient procedure, so you go home the same day. Full recovery can take weeks, however, depending on the type of surgery. After surgery, you need to keep your foot elevated, so you should plan for downtime.

Eric Harmelin, DPM
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Experienced Amputation Prevention Specialist and Podiatrist in Annapolis, Stevensville, and Glen Burnie, MD.