Hammer Toe

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Introduction

What is a hammer toe?

Our toes may be small, but they play a big role in how we stand and walk. When standing, our toes continuously help us keep our balance. While walking, our toes give us the last little push off when we take a step. When one of our toes is painful or malformed, it can affect the way we stand and how we walk, throwing off our gait. One common toe deformity is hammer toe, when one of the joints in your toe points up and forms a hammerhead shape.

Unlike mallet toes, which are the result of an abnormal bend in the joint near the tip (distal end) of the toe, a hammer toe occurs when there is an abnormal bend in the middle joint—the proximal interphalangeal, or PIP joint. Most commonly affecting women, hammer toes usually involve the second, third or fourth toe.

For your toes to work properly, muscles in your toes work in pairs to stretch and flex each toe so they can bend and straighten as you move. When the top part of your toe is continually forced in a downward position, it becomes more difficult to move the toe, even after removing shoes. Hammer toes can cause blisters and calluses on top of your toes where they rub against your shoes. This deformity may also make it difficult to find shoes that fit properly.

Hammer toes are often preventable, but if they do occur, the earlier they are treated, the better the outcome.

Symptoms

What are the symptoms of hammer toe?

Unless it is caused by trauma to the toe, hammer toe symptoms start slowly. The toe starts to bend upwards slowly with time and the change may not be noticeable at first. As the joint becomes stiffer, it also may be difficult to move your toe without pain and you may see blisters or calluses on your toe. It may be hard to find shoes that fit comfortably in the toe area. If the deformity is caused by trauma or injury, the toe may suddenly appear bent at the joint.

Causes

What causes hammer toe?

The most common hammer toe causes are ill-fitting shoes. Women are prone to hammer toes if they frequently wear high heels or shoes with narrow toe boxes. If you wear high heels over an extended period, the constant pressure from your body’s weight on your toes keeps the toes in an unnatural position, and the muscles become stiff and tight. If you frequently wear shoes with narrow toe boxes, the pressure on the toes comes from the sides and top, also constricting the toes so they can’t bend properly.

Stubbing your toe or a toe fracture are traumatic causes of a hammer toe.

Risks

What are the risk factors for hammer toe?

The most common risk factor for hammer toe is frequently wear high heels or shoes with narrow toe boxes. Age is also a risk factor.

Other risk factors for hammer toe include:

  • Abnormally high or low arch. This foot structure can put pressure on the toes as you stand and walk. Abnormally long toes may also cause hammer toes. Hammer toe may run in families because foot structure is hereditary.

  • Bunions. If you develop a bunion, it could push the neighboring toe out of place.

  • Arthritis and other medical conditions, such as neuropathy can affect the joint leading to hammer toe

You may be able to lower your risk of developing a hammer toe by:

  • Limiting your use of high heels and shoes with narrow toe boxes, and ensuring your shoes fit properly

  • Stretching and bending your toes to keep them flexible

  • Wearing orthotic shoe inserts if you have abnormally high or low arches in your feet

  • Following your treatment plan if you have a condition such as arthritis

  • Seeking treatment for bunions if they are present

  • Seeking treatment for trauma to the toe

If you have difficulty finding shoes that fit properly or you have frequent foot pain, you may need shoe inserts to help your feet fit into your shoes. Talk with a podiatrist about adaptations you may need to reduce your risk of developing hammer toes.

Treatments

How is a hammer toe treated?

If you have a hammer toe and diabetes or a condition that may affect blood flow to your feet and toes, speak with your doctor about what you can do to treat your hammer toe and any blisters or calluses on your toe. If you do not have such a condition, the first step in hammer toe treatment is to adjust your footwear. Try the following strategies:

  • Switch to shoes that give you at least a half inch of space between the end of your longest toe (often the second toe) and the tip of your shoe. Ensure the toe box is wide enough for your toes to rest comfortably beside each other as you stand and walk.

  • If your feet have an abnormal arch, your doctor may prescribe orthotics for your shoes to lessen pressure on your toes.

  • Use hammer toe pads, usually available at the pharmacy, to cushion your toe and protect it from your shoe.

  • Exercise your toes. Some hammer toe exercises include stretch and flexing your toes regularly and picking up objects, such as pens, from the floor using your toes.

  • Soften calluses by soaking your foot. Gently use a pumice stone to remove the callus.

Surgery may be necessary to straighten the joint if the hammer toe is causing chronic pain or the malformation makes it difficult to wear shoes.

Complications

What are the potential complications of hammer toe?

A deformed toe can make it difficult or painful to walk. This, in turn, can affect how you walk, causing a limp or restricting you from certain activities. Other potential complications of hammer toe include calluses and blisters on your toes.

Surgery to release the tendon and straighten the joint carries a risk of complications too. Prevention and early treatment for hammer toe will help you avoid long-term complications.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2017 Nov 16
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