Hammertoes: Causes, Symptoms and When to Get Help

If one of your smaller toes has started to curl, rub against the top of your shoe or grow a sore corn, you may be dealing with a hammertoe. StatPearls, a medical reference on the NIH's NCBI Bookshelf, calls hammertoes one of the most common deformities of the front of the foot.⁴

Here's what causes them, how they differ from claw and mallet toes, and what you can do about them.

What Is a Hammertoe?

The American College of Foot and Ankle Surgeons (ACFAS) defines a hammertoe as "a contracture (bending) deformity of one or both joints of the second, third, fourth or fifth (little) toes."¹ In plain terms, the middle of the toe bends up while the tip points down.² Cleveland Clinic notes that hammertoes usually develop in the lesser toes, not the big toe.²

Two related problems are often grouped with hammertoes:

• Claw toe bends at more joints. StatPearls describes it as the middle and end joints bending down while the joint at the ball of the foot bends up. It tends to be more severe and to affect several toes.⁴ The American Academy of Orthopaedic Surgeons (AAOS) explains that clawed toes can dig down into the soles of your shoes and cause painful calluses.⁵
• Mallet toe bends only at the joint closest to the toenail.^2,4

What Causes Hammertoes?

ACFAS says the most common cause is an imbalance in the muscles of the foot.¹ StatPearls describes it as weak small muscles inside the foot losing out to stronger muscles that come from the leg.⁴ Other factors include:

• Shoes that are too tight, short or narrow. MedlinePlus calls short, narrow, tight shoes "the most common cause of hammer toe," because the toe's muscles and tendons can shorten over time.³ ACFAS notes that a toe that is too long can be forced into a cramped position by a tight shoe.¹
• High heels. Both MedlinePlus and StatPearls point to high-heeled shoes.^3,4
• Foot shape and family history. High arches, flat feet and longer toes can play a part,² and hammertoes tend to run in families.^1,4
• Bunions. A bunion can push the other toes out of line.^2,4
• Health conditions. Diabetes, rheumatoid and other inflammatory arthritis, and nerve or muscle conditions are linked to toe deformities.^2,4,5
• A past toe injury.^1,5

These deformities are more common in women and with age.⁴

Is My Hammertoe Flexible or Rigid?

Your doctor will check this, because it affects your treatment options.⁵ A flexible hammertoe can still be straightened by hand. A rigid one stays bent.⁴ Cleveland Clinic also describes a middle, semi-rigid stage where the toe is stiff and hard to straighten.²

Hammertoes tend to get worse over time. MedlinePlus explains that at first you can straighten the toe, but it can become fixed and painful.³ ACFAS puts it plainly: hammertoes "never get better without some kind of intervention," and if left untreated they can become more rigid and stop responding to nonsurgical care.¹

What Symptoms Should I Watch For?

Besides a toe that visibly curls, common symptoms include:^1,2,3

• Pain or irritation in the toe when you wear shoes
• Pain on top of the toe or in the ball of the foot
• Redness, swelling, inflammation or a burning feeling
• A toe that is harder to move
• Pain when walking

In severe cases, ACFAS notes, open sores can form.¹

Why Do I Get Corns and Calluses?

A bent toe rubs against the inside of your shoe. MedlinePlus explains that corns tend to form on top of the toe and calluses on the sole of the foot.³ With claw toe, corns can form over the toe or under the ball of the foot.⁵

Resist the urge to cut them yourself. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) warns that cutting corns and calluses, or using over-the-counter corn removal products, "can damage your skin and cause an infection."⁶ StatPearls notes that padding or periodic shaving of painful calluses, done as part of care, may ease some discomfort.⁴ A podiatrist can help with that safely.

What Can I Do Without Surgery?

Conservative care is usually tried first.⁴ MedlinePlus notes that when the problem is treated early, "you can often avoid surgery."³ Options include:

• Roomier shoes. Look for a deep, roomy toe box,¹ and avoid pointed toes and high heels.^3,6 NIDDK notes that people with diabetes and hammertoes may need extra-wide or deep shoes.⁶ Our footwear guide has more tips.
• Pads and cushions. Protective pads and padded insoles can ease pressure on corns.^1,2,3
• Orthotics. Custom or standard inserts may help with toe position and pressure.^1,2,4
• Splinting or taping. These are options for flexible toes.^1,4,5
• Stretching and strengthening. AAOS describes exercises such as picking up marbles with your toes or scrunching a towel.⁵ MedlinePlus suggests gentle stretching.³
• Medicine for pain and swelling. ACFAS lists anti-inflammatory medicines and, in some cases, corticosteroid injections.¹ Cleveland Clinic advises checking with a provider before taking NSAIDs for more than 10 days.²

Be realistic about what these steps can do. StatPearls notes that these measures can help manage symptoms but "are not a permanent solution."⁴

When Is Surgery Considered?

According to ACFAS, surgery is usually considered "when the hammertoe has become more rigid and painful or when an open sore has developed."¹ Cleveland Clinic says it may be an option when other treatments don't relieve symptoms or walking is extremely painful.² StatPearls also lists conservative care that hasn't worked and an unstable joint at the ball of the foot.⁴

Procedures vary. They may involve releasing or lengthening tendons, removing part of a joint, or fusing a joint.^3,4,5 StatPearls lists infection, numbness, stiffness and swelling, and notes that the deformity can come back, with reported recurrence and revision rates of up to 10%.⁴ It also notes that healing may take longer for people who smoke or have diabetes.⁴ A podiatrist or foot and ankle surgeon can talk through whether surgery makes sense for you.

I Have Diabetes. Is This More Serious?

It can be. Diabetes can reduce feeling in your feet, so a sore can go unnoticed. NIDDK recommends checking your feet every day for cuts, sores, red spots, corns and calluses, and getting a thorough foot exam at least once a year.⁶ It warns that foot ulcers that do not get better with treatment "can lead to an amputation of your toe, foot, or part of your leg."⁶ Call your provider right away for a cut, blister or bruise that isn't starting to heal after a few days, or skin that becomes red, warm or painful.⁶ See our diabetic foot care page.

The Bottom Line

Hammertoes, claw toes and mallet toes are common, and they tend to get stiffer over time. Shoes with a roomy toe box, padding and other conservative care may ease pain and pressure, especially when a toe is still flexible. Don't cut corns yourself. If you have diabetes, check your feet daily and call quickly about any sore that isn't healing.

If a curling toe is making shoes uncomfortable, or corns keep coming back, our podiatrists can take a look. Request an appointment and our team will follow up within one business day. You can also find your nearest office on our locations page.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

1. Hammertoe. American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
2. Hammertoes: What It Is, Causes, Relief & Treatment. Cleveland Clinic. my.clevelandclinic.org
3. Hammer Toe. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
4. Goransson M, Dixon M. Hammertoe. StatPearls, NCBI Bookshelf. www.ncbi.nlm.nih.gov
5. Claw Toe. OrthoInfo, American Academy of Orthopaedic Surgeons. www.orthoinfo.org
6. Diabetes & Foot Problems. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). www.niddk.nih.gov