Hammertoe
What is hammertoe? Hammertoe is a
contracture—or bending—of one or both
joints of the second, third, fourth, or fifth
(little) toes. This abnormal bending can
put pressure on the toe when wearing
shoes, causing problems to develop.
Common symptoms of hammertoes include:
- Pain or irritation of the affected toe when wearing shoes
- Corns (a buildup of skin) on the top, side, or end of the toe,
or between two toes. Corns are caused by constant friction
against the shoe. They may be soft or hard, depending upon
their location
- Calluses (another type of skin buildup) on the bottom
of the toe or on the ball of the foot.
Corns and calluses can be painful and make it difficult to find a
comfortable shoe. But even without corns and calluses, hammertoes
can cause pain because the joint itself may become dislocated.
Hammertoes usually start out as mild deformities and get
progressively worse over time. In the earlier stages, hammertoes
are flexible and the symptoms can often be managed with
noninvasive measures. But if left untreated, hammertoes can
become more rigid and will not respond to non-surgical treatment.
Corns are more likely to develop as time goes on—and corns
never really go away, even after trimming. In more severe cases
of hammertoe, open sores may form.
Because of the progressive nature of hammertoes, they should
receive early attention. Hammertoes never get better without
some kind of intervention.

What Causes Hammertoe?
The most common cause of hammertoe is a muscle/tendonimbalance. This imbalance, which leads to a bending of the toe,
results from mechanical (structural) changes in the foot that occur
over time in some people.
Hammertoes are often aggravated by shoes that don’t fit properly—
for example, shoes that crowd the toes. And in some cases, ill-fitting
shoes can actually cause the contracture that defines hammertoe.
For example, a hammertoe may develop if a toe is too long and
is forced into a cramped position when a tight shoe is worn.
Occasionally, hammertoe is caused by some kind of trauma, such
as a previously broken toe. In some people, hammertoes are inherited.
Treatment: Non-Surgical Approaches
There are a variety of treatment options for hammertoe. The
treatment your podiatric foot and ankle surgeon selects will
depend upon the severity of your hammertoe and other factors.
A number of non-surgical measures can be undertaken:
Trimming Corns and Calluses This should be done by a healthcare professional. Never attempt
to do this yourself, because you run the risk of cuts and infection.
Your podiatric surgeon knows the proper way to trim corns to
bring you the greatest benefit.
Padding Corns and Calluses Your podiatric surgeon can provide or prescribe pads designed
to shield corns from irritation. If you want to try over-the-counter
pads, avoid the medicated types. Medicated pads are generally
not recommended because they may contain a small amount
of acid that can be harmful. Consult your podiatric surgeon
about this option.
Changes in Shoewear Avoid shoes with pointed toes, shoes that are too short, or shoes
with high heels—conditions that can force your toe against the
front of the shoe. Instead, choose comfortable shoes with a deep,
roomy toe box and heels no higher than two inches.
Orthotic Devices A custom orthotic device placed in your shoe may help controlthe muscle/tendon imbalance.
Injection Therapy Corticosteroid injections are sometimes used to ease pain
and inflammation caused by hammertoe.
Medications Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, are often prescribed to reduce pain and inflammation.
Splinting/Strapping Splints or small straps may be applied by the podiatric surgeon
to realign the bent toe.
When is Surgery Needed?
In some cases, usually when the hammertoe has become more
rigid, surgery is needed to relieve the pain and discomfort caused
by the deformity. Your podiatric surgeon will discuss the options
and select a plan tailored to your needs. Among other concerns,
he or she will take into consideration the type of shoes you want
to wear, the number of toes involved, your activity level, your age and the severity of the hammertoe.
The most common surgical procedure performed to correct a
hammertoe is called arthroplasty. In this procedure, the surgeon
removes a small section of the bone from the affected joint.
Another surgical option is arthrodesis, which is usually reserved
for more rigid toes or severe cases, such as when there are multiple
joints or toes involved. Arthrodesis is a procedure that involves
a fusing of a small joint in the toe to straighten it. A pin or other
small fixation device is typically used to hold the toe in position
while the bones are healing.
It is possible that a patient may require other procedures, as well
—especially when the hammertoe condition is severe. Some of
these procedures include skin wedging (the removal of wedges
of skin), tendon/muscle rebalancing or lengthening, small tendon
transfers, or relocation of surrounding joints.
Often patients with hammertoe have bunions or other foot
deformities corrected at the same time. The length of the
recovery period will vary, depending on the procedure or
procedures performed.
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