Do you have a toe that bends back on its own, rubs in your shoes or hurts when you walk? You may have a hammertoe (also known as a mallet toe or claw toe).
This is a common deformity more prevalent in women.
In this article I explain to you how to recognise a hammertoe, what causes it and what to do to improve and relieve pain.
I rely on my knowledge as a radiographer and of course on published medical studies.
Happy reading!😀and feel free to ask questions in the comments or share your own experience.🙏
Last updated: Oct, 2025. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: Amazon affiliate links, full disclosure in the legal section.
▶️What is a hammertoe?
A basic understanding of the anatomy of the lesser toes is important to better appreciate the pathologic changes that occur with hammertoes (claw toes).
The feet are composed of five toes (1,2,3,4, and 5th) where each lesser toe has three bones the proximal, middle and distal phalanges, apart from the 1st big toe that has only two phalanges. And three joints: the metatarsophalangeal (MTP), the proximal and distal interphalangeal joints.
The structural components that contribute to toe function also include muscles (extrinsic and intrinsic), joints, tendons, ligaments, and the plantar plate.
These work together to maintain proper toe alignment, distribute weight, and ensure stability during walking
Hammertoe anatomy involves the abnormal bending at the proximal interphalangeal (PIP) joint, the middle joint of a toe. Due to an imbalance between the intrinsic and extrinsic muscles and tendons that normally keep the toe straight.
(Jastifer,2025)
Image shows a representation of sagittal plane deformation forces of the toe. This includes extension across the MTP joint and flexion at the PIP joint and is often caused by an imbalance between the intrinsic and extrinsic muscles. Image retrieved Jastifer,2025)
▶️Is Hammer toe a form of arthritis or seen as a hallux valgus.
Hammertoe is a common foot deformity, Initially, the toe might be flexible, but it can become rigid over time.
Hammertoe deformity can be complicated by the involvement of the metatarsophalangeal joint.
I have had people confuse it with a form of arthritis or hallux valgus.
| No, hammer toe is not arthritis rather it’s a hallux valgus, it is a foot deformity where a toe bends downward at the middle joint, but it can be a symptom of arthritis, among other conditions. |
Hallux valgus is a deformity of the big toe that causes a bony lump and inward deviation of the toe, while a hammer toe is a bending of the middle joint of a lesser toe.
It’s very common to have a hallux valgus problem in addition to a hammertoe problem.
▶️How can you be sure it’s a hammertoe?
Have you noticed one of your toes is starting to bed downwards, as if forming a little hook? It could be a hammertoe.
When you see a doctor or a podiatrist, normally foot evaluation will be done both standing and seated. This helps to identify visual inspection deformity and malalignment of the lesser toes in the standing position.
Examination of the skin will help to identify callosities or ulcerations dorsally over the proximal interphalangeal joint
Your doctor will be looking for a bent toe that resembles a hammer, often accompanied by symptoms like pain, corns or calluses on the toe, and difficulty moving the joint.
Patients usually complain of joint pain, intensified under weight-bearing, associated with malalignment of the toe.
X-ray is normally not needed to diagnose hammer toe; the only time I see a request for an x-ray is when the doctor wants to:
♦️Assess the severity of the deformity.
♦️Evaluate bone or tendon damage.
♦️Need to identify underlying conditions such as arthritis.
♦️For surgical planning purposes
X-ray image showing a hammer toe deformity of the third toe associated with brachy-metatarsia of the fourth metatarsal (Jastifer,2025)
So, after examination a healthcare professional can surely confirm to you that you have a hammertoe condition.
▶️What is the main cause of hammer toes?
In most cases, hammertoes are caused by several factors, but none of them can be identified with certainty.
🟢Hammertoe deformity is thought to be caused by imbalance between the intrinsic and extrinsic muscles of the foot or from capsule-ligament stabilizer failure (Jastifer,2025)
Other contributing factors include:
🟢A family history of hammertoes increases the risk of developing the condition
🟢The risk of developing hammertoe increases with age, as the toe may become more rigid and stiff over time.
🟢Conditions like bunions which can disrupt the alignment of the toes increasing pressure on the surrounding toes.
🟢Ill-fitting Footwear: Tight, narrow, or high-heeled shoes can force toes into a bent position over time, leading to muscle and tendon tightening.
🟢Conditions like rheumatoid arthritis, osteoarthritis, and diabetes can cause inflammation, weakened joints, nerve damage, or muscle imbalances that lead to hammertoes.
▶️What do podiatrists do for hammer toes?
Treatment for hammer toes will depend on the nature of the deformity to achieve a successful outcome.
It is crucial to understand that not all hammer-toe deformities are the same, and although hammer-toe correction can be straightforward, evaluation and treatment will investigate your health history to help assess for pathology that could be contributing to the deformity.
Non-surgical treatment options
Nonsurgical treatment of hammertoe deformities remains the primary and first-line treatment for patients with symptomatic deformities.
Usually, you will be advised to take these measures to help ease the pain of the toe despite a lack of high-quality evidence on the effectiveness of these treatment modalities
🟢Changing your footwear by wearing shoes with a high and wide toe will help reduce friction pain.
🟢Some people believe using corrective toe braces for reducible deformities or protective braces for irreducible deformities.
🟢Tube bandages and corrective strappings and tapings is also recommended to reduce friction and pressure on corns and calluses, see examples on Amazon.
🟢Plantar orthoses with retro capital support improve footwear in reducible deformities.
Darcel,2023
🟢Toe separators to realign and prevent overlapping
🟢Ice and over-the-counter nonsteroidal anti-inflammatory medications
🟢Lifestyle modifications to avoid activities that exacerbate toe pressure
🟢Patient education is important, especially in cases where the skin may compromise, such as ulceration in diabetic patients where expectant treatment may lead to worsening of the condition (Jastifer,2025)
Surgical treatment options.
Failed nonoperative treatment with continued pain and deformity may lead to surgical options.
There are different existing techniques for surgical treatment of hammer toe and these aim to correct:
🟠Skeletal and soft tissues interventions to obtain a durable correction of the deformity.
🟠Help balance the musculotendinous forces of flexion and extension of the toe.
🟠And normalization of the relations between interosseous muscles and metatarsal bones.
🟠Specific physiotherapy is helpful, based on stretching in metatarsophalangeal plantar posture, intrinsic muscle exercises, and gastrocnemius stretching in case of retraction.
🟠Intra-articular corticosteroid injections may be proposed for synovitis without PP lesion.
Ceccarini,2015
Types of surgery
1️⃣Arthrolysis or Arthroplasty is an orthopaedic procedure for partially or completely resurfacing, remodelling, rebuilding, or replacing an arthritic, dysfunctional, or necrotic joint (Sheikh 2009)
2️⃣Osteotomy or capsulotomy of the metatarsophalangeal joint.
3️⃣Tendon transfer helps to stabilize the metatarsophalangeal with a Kirschner wire to restore balance.
4️⃣Broach fitting, etc.
Hammer-toe correction procedures performed with temporary K-wire fixation for 3 to 6 weeks are highly successful. Complications seem to be exceedingly rare in most series (Doty, 2018)
Here is a foot of which had both hammer toe and a hallux valgus toe which were both operated on.
A foot showing at 18 months after surgery of 1st toe hallux valgus and 2nd toe deformity of metatarsophalangeal (MTP) arthrolysis and open horizontal proximal interphalangeal (PIP) fusion using a radiotransparent monobloc implant. (Darcel,2022)
▶️What is the downside of hammer toe surgery?
Numerous studies dating back decades have demonstrated generally good results from the surgical treatment of hammertoe deformities, although several complications are possible
According to research studies that have followed up people for over 3 to 5 years who underwent a distal subtraction osteotomy of the proximal phalanx neck surgery of the hammer toe had these observations (Ceccarini,2015)
Over 40 people with a second hammer toe deformity were followed up after 3 years of the operation. The rate of excellent and good results was >90%
Outcome:
♦️No one showed other deformities.
♦️ All patients reported pain at the PIP Joint due to friction between the hammer toe and the shoe.
♦️6 people had complications.
In a classic study involving 67 patients and 118 toes, Coughlin et al examined the outcomes for an average of 5 years following PIP arthrodesis and intramedullary Kirschner wire fixation
Results:
♦️81% of the cases achieved fusion of the proximal interphalangeal joint.
♦️84% of the patients reporting satisfactory results.
♦️92% of patients observed pain alleviation with no notable difference between those with fibrous or bony unions.
Jastifer,2025
Hammer-toe correction with PIP joint resection arthroplasty or fusion and intramedullary Kirschner wire fixation are generally successful and safe procedure with low rates of reported major complications
▶️However, some people have reported complications after surgery such as:
♦️Pin tract infection.
♦️Pin migration or breakage
♦️ Non-union/malunion
♦️Nerve damage
♦️Recurrent Deformity
♦️Latrogenic mallet toe deformity
♦️Instability and implant failure.
♦️Toe swelling and shortening.
♦️Vascular insult causing toe necrosis
Doty et al 2018 and Jastifer, 2025
▶️What happens if the hammer toe is left untreated?
If left untreated, a hammer toe will progress from flexible to rigid, making the toe’s joint permanently bent.
This condition can lead to:
🔴Pain in the whole foot.
🔴Difficulty finding comfortable shoes.
🔴The formation of corns and calluses due to friction.
🔴In severe cases, open sores can develop.
🔴Muscle imbalances worsen and the toe’s function may be reduced or lost entirely.
▶️Is walking barefoot good for hammer toes?
People who have had hammer toe diagnosis claim:
⚫Walking on soft surfaces like sand or grass helps in natural toe movement
⚫Improves foot strength.
⚫Promotes better posture.
However, it’s important to only walk barefoot in safe, debris-free environments to avoid injuries from sharp objects or bacteria.
For severe or persistent hammer toe, consulting a podiatrist is essential to get a proper treatment plan, as barefoot walking provides only temporary relief and may not correct the underlying issue.
▶️What kind of shoes are best for hammer toes?
First, why do you think footwear matters? In an average lifetime, we walk around 100,000 miles, which is the equivalent of five times around the earth.
So, footwear that you choose to wear can either help you to maintain a healthy pain free foot or cause stress to your foot.
It is important that you choose footwear that is deep enough to accommodate any hammer toe or clawing deformities or increase your risk of falls or injury.
⚫Shoes with a high and wide enough at the front toe will help reduce friction pain.
⚫Plantar orthoses with retro capital support or stretch fabric may help improve footwear in reducible deformities.
⚫No significant heel with pointed narrow tips and stiff shoes.
Darcel,2022
Ideally you should try on your shoes at the end of the day, with any orthotic you may have, you should feel comfortable in them from the very first step.
▶️Are splints useful for straightening a hammertoe?
Splints are typically used for managing hammertoe symptoms, but they won’t permanently correct a hammertoe deformity on their own.
Opinions on splints also differ:
Argument in favour of splints
People who have used things like toe splints, wraps, separators, and crest pads in conjunction with proper footwear, have seen:
1️⃣Improved alignment and reduced calluses /corns that form due to friction and overlapping toes.
2️⃣Reduced friction pain in shoes.
3️⃣Effective in limiting aggravation
Arguments against splints
1️⃣They do not correct rigid or old deformities.
2️⃣Poorly adapted they can cause pain.
3️⃣Some people find them uncomfortable in shoes.
Splints apply passive gentle pressure to help gradually straighten the toe and relieve pain and discomfort. Here are the 3 types of splints or orthosis for hammertoes.
⚫Rigid night splints: gently hold the toe in extension during sleep.
⚫Soft orthotics or daytime silicone orthotics: more discreet, these are used in shoes to limit conflicts and slightly reposition the toe.
⚫Custom-made ortho plastics made by a podiatrist, they are often more comfortable and better adapted to your foot.
For custom-made splints, a doctor’s prescription may be required, others you can get them without prescriptions,
see on Amazon for example.
▶️Can hammertoes be straightened with exercises?
Opinions are divided on this point. Some professionals believe that exercises can permanently straighten the toes, while others are more reserved.
Yes, hammertoes can sometimes be straightened or improved with exercises, especially in the early stages of the condition.
But for severe or long-standing cases, surgery may be the only option.
Performing targeted exercises to strengthen and stretch affected muscles.
Exercises such as:
⚫Manual stretching of the toes.
⚫Scrunching a towel with your toes.
⚫Picking up small objects like marbles with your toe
All these are temporary measures that can help to stretch and strengthen the toe muscles and reverse the underlying muscle imbalance causing the deformity when it has not gotten worse.
They are low risk side effects and easy to set up from home and require no special equipment.
▶️Arguments against the effectiveness of exercises.
⚫Inability to correct rigid deformities, they only provide symptomatic relief.
⚫You may require motivation and regularity over the long term as you may loss potential effects disappear if you stop.
⚫For bone deformity, soft tissue and ligaments are not easily reducible.
Exercises will only help to limit the worsening of the deformity, pain and discomfort if your toe is flexible and only slightly deformed but won’t straighten it.
Surgery and non-surgical methods are not a miracle solution, but they can help to elevate pain and discomfort
Hope I have answered some of your questions on hammertoes, wishing you a quick recovery!🙋
All references below, you may also be interested in these articles.
⚫ Hallux valgus treatment options.
⚫ Morton’s Neuroma recovery timeline.
⚫Heat and cold relief, best therapy for swelling.
📚SOURCES:
Jastifer JR, Martin KD. Hammertoes: Anatomy, Pathophysiology, and Comprehensive Treatment Strategies. J Am Acad Orthop Surg. 2025 Apr 10;33(16):e919-e927. doi: 10.5435/JAAOS-D-25-00025. PMID: 40233363.
Darcel V, Piclet-Legré B. Lesser-toe deformity. Orthop Traumatol Surg Res. 2023 Feb;109(1S):103464. doi: 10.1016/j.otsr.2022.103464. Epub 2022 Oct 29. PMID: 36942795.
Sheikh A, Schweitzer M ,Pre- and Postoperative Assessment in Joint Preserving and Replacing Surgery, Rheumatic Disease Clinics of North America, Volume 35, Issue 3,2009, Pages 651-673,ISSN 0889-857X,https://doi.org/10.1016/j.rdc.2009.08.008.
Doty JF, Fogleman JA. Treatment of Rigid Hammer-Toe Deformity: Permanent Versus Removable Implant Selection. Foot Ankle Clin. 2018 Mar;23(1):91-101. doi: 10.1016/j.fcl.2017.09.007. PMID: 29362037.
O’Kane C, Kilmartin T. Review of proximal interphalangeal joint excisional arthroplasty for the correction of second hammer toe deformity in 100 cases. Foot Ankle Int. 2005 Apr;26(4):320-5. doi: 10.1177/107110070502600408. PMID: 15829216.
Jastifer JR, Martin KD. Hammertoes: Anatomy, Pathophysiology, and Comprehensive Treatment Strategies. J Am Acad Orthop Surg. 2025 Apr 10;33(16):e919-e927. doi: 10.5435/JAAOS-D-25-00025. PMID: 40233363.