Hammer toe

What is a hammer toe and what can a podiatrist do to fix it?

Hammer toe is a common deformity seen in the feet and happens when your toe bends downwards and looks like a hammer from the side view. Hammer toes tend to develop overtime but sometimes they can be present at birth or occur as a result of trauma to the toe.

Hammer toes appear on the second to fourth toes and are more common in women than men. Having a hammer toe can impact on your daily life and particularly the ability to wear shoes, which can lead to rubbing and sometimes form corns. They can be very painful but the good news is there are various treatments available. Read on to learn more about this condition and how we can help you in our foot clinics.

What is a hammer toe?

A hammer toe is where there is contracture or bending at the first joint in toe, called the proximal interphalangeal joint. A hammer toe can either be flexible or rigid.

Flexible hammer toes are still moveable and can be straightened with applied pressure, these are less severe. However, rigid hammer toes cannot be straightened with force and require more invasive treatment like surgery to be corrected.

What is the difference

Not all digital deformities are hammer toes, there are other issues that can become problematic and it is important to know the difference between them.

The toe bends at the first joint and can make shoes uncomfortable and cause pain and corns at the top of the toe.

Where your toes bend into a claw-like position and can dig down into the soles of your shoes, causing callouses.

The joint at the end of the toe buckles. It often happens to the second toe and puts extra pressure on the tip of the toe.

What causes a hammer toe?

Hammer toes are caused by an imbalance in the muscles, tendons and ligaments surrounding a toe that usually work together to keep it straight. If that contracted position remains over time, these structures become rigid and permanently fixed in that position. They are more common in the fifth and sixth decades of life, therefore progressive in nature, however trauma to the toe can cause a hammer to form at any time.

The following are factors that can lead to hammer toes developing:

Bunions
Medical conditions: diabetes mellitus, arthritis, synovitis, and some neurological conditions can cause hammer toes to develop
Tight fitting shoes
Trauma: blunt force trauma to the toe or plantar plate injuries
A longer second toe
Gender: women are more commonly affected than men
Genetics
Age

Symptoms of a hammer toe

The visual appearance of a hammer toe is its main symptom: a bent toe that resembles a hammer from the side view.

Pain on top of the toe especially when wearing enclosed footwear
Corns or callouses forming on top of the toe
Redness and swelling where the toe bends
Restriction or pain when straightening the toe
Callouses forming on the ball of the feet at the base of the affected toe

Treatment for hammer toes

If you have any pain, you should see a podiatrist for treatment. Hammer toes are progressive in nature, if left untreated they can become rigid and will require complex treatment to correct.

What can a podiatrist do for a hammer toe? Firstly, all hammer toes will be assessed to rule out any underlying conditions or injuries such as plantar plate tears. Our podiatrists will conduct a thorough assessment and if needed refer for any further investigations. During your initial assessment we will listen to your concerns and expectations regarding any pain or disability as well as cosmetic appearance issues and recommend treatment accordingly.

Most treatment of hammer toes is non-surgical, and the majority of patients find relief from it.

Treatment can consist of the following:

Footwear changes: wearing wider shoes with a flexible upper, can reduce pressure on the toe
Toe sleeves or padding: this can reduce pressure and irritation within footwear
Taping: simply taping the affected toe can help reduce symptoms
Corn and callous removal: removing hard skin and corns on the top of the toe can cause symptom relief
Orthotic therapy: cushioning and offloading the base of the affected toe can help reduce symptoms by offloading those areas
Surgical referral for rigid and extremely painful hammer toes your podiatrist can refer for surgical opinion and management

How to prevent hammer toes

Here are some ways you can prevent a hammer toe:

Wear supportive well fitted shoes. Make sure they aren’t too narrow and have a reduced heel allowing space for your toes.
If prescribed custom orthotics for certain foot conditions wear them to help prevent hammer toes forming as a complication.
Visit your podiatrist at the first signs of a hammer toe developing

frequently asked questions

How do you tape a hammer toe?

There are many ways to tape a hammer toe. We recommend using a toe strap which we can provide in our clinics for daily use. Constant taping can lead to skin irritation

Can a hammer toe be fixed?

Hammer toes can only be corrected by surgery. Padding and taping can help temporarily straighten or cushion painful joints

Do hammer toe corrections work?

Hammer toe correctors can help straighten toes when wearing shoes but they do not permeantely correct hammer toes. Reduction or resolution in symptoms is good outcome for many people

Can you reverse a hammer toe?

Surgery can correct hammer toes.

Can hammer toe cause knee pain?

If you have a painful hammer toe and are compensating when walking, it can cause you to limp and lead to other conditions such as knee pain

Is a hammer toe painful? Why does my hammer toe hurt?

Hammer toes can be painful due to the joint rubbing in shoes or lack of movement when walking.

Do bunions cause hammer toes?

Bunions in some cases can cause hammer toes to form on the adjacent toe

Hammer-Toe. Cal West Med. 1936;45(2):177-8.
What is a hammer toe, and what causes it? Mayo Clin Health Lett. 2002;20(7):8.
Angirasa AK, Augoyard M, Coughlin MJ, Fridman R, Ruch J, Weil L, Jr. Hammer toe, mallet toe, and claw toe. Foot Ankle Spec. 2011;4(3):182-7.
Bus SA, Maas M, de Lange A, Michels RP, Levi M. Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity. J Biomech. 2005;38(9):1918-25.
Coltart WD. Hammer-toe. Practitioner. 1949;162(970):338.
Coughlin MJ. Mallet toes, hammer toes, claw toes, and corns. Causes and treatment of lesser-toe deformities. Postgrad Med. 1984;75(5):191-8.
Garcia Font D, de Pablo Marquez B, Pedrazas Lopez D. [Acute hammer toe]. Semergen. 2016;42(2):137-8.
Hedegaard Andersen J, Rasmussen A, Frimodt-Moller M, Rossing P, Kirketerp-Moller K, Engberg S. The effect of needle tenotomy on hammer, mallet and claw toe deformities in patients with diabetes, a retrospective study. J Clin Transl Endocrinol. 2019;18:100208.
Henriques M. Hallux valgus and hammer toe. Acta Med Port. 2013;26(6):758.
Johnson S, Branthwaite H, Naemi R, Chockalingam N. The effect of three different toe props on plantar pressure and patient comfort. J Foot Ankle Res. 2012;5(1):22.
Kwon OY, Tuttle LJ, Commean PK, Mueller MJ. Reliability and validity of measures of hammer toe deformity angle and tibial torsion. Foot (Edinb). 2009;19(3):149-55.
Kwon OY, Tuttle LJ, Johnson JE, Mueller MJ. Muscle imbalance and reduced ankle joint motion in people with hammer toe deformity. Clin Biomech (Bristol, Avon). 2009;24(8):670-5.
Lacaze E. [Hammer toe and hallux valgus in the elderly]. Soins Gerontol. 2011(92):43-4.
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;26(4):320-5.
Oliver TP, Armstrong DG, Harkless LB, Krych SM. The combined hammer toe-mallet toe deformity with associated double corns: a retrospective review. Clin Podiatr Med Surg. 1996;13(2):263-8.
Pietrzak WS, Lessek TP, Perns SV. A bioabsorbable fixation implant for use in proximal interphalangeal joint (hammer toe) arthrodesis: Biomechanical testing in a synthetic bone substrate. J Foot Ankle Surg. 2006;45(5):288-94.
Reuter BH. Taping the hammer toe. J Athl Train. 1995;30(2):178-9.
Schrier JC, Verheyen CC, Louwerens JW. Definitions of hammer toe and claw toe: an evaluation of the literature. J Am Podiatr Med Assoc. 2009;99(3):194-7.