- Hammertoe is a buckling of one of the smaller toes (usually the second toe) at the middle joint, often paired with a bunion or pressure from poorly fitted shoes.
- Flexible hammertoes — where you can still straighten the toe manually — respond well to splinting, padding, and shoe changes.
- Rigid hammertoes that can no longer be straightened typically require surgery for definitive correction.
- Untreated hammertoes worsen over time and can cause painful corns, calluses, and ulcers at the bent joint.
- Most patients are evaluated and given a clear treatment plan in a single visit.
What is hammertoe?
A hammertoe is a deformity in which one of the smaller toes (most commonly the second toe) bends abnormally at the middle joint, forming a shape that looks like a hammer or claw. The condition usually starts as a flexible deformity — the toe can still be passively straightened — and progresses over years into a rigid deformity that no longer bends back.
Hammertoes typically develop alongside other foot problems. A bunion shifting the big toe toward the second toe pushes the second toe upward and starts the deformity. Tight shoes that crowd the toes accelerate it. Inherited foot types — particularly a longer second toe — make some people more prone. People with flat feet, high arches, or certain neuromuscular conditions are at higher risk as well.
At Northwest Extremity Specialists, our approach depends on whether the toe is still flexible. Flexible hammertoes respond well to splints, toe pads, custom orthotics, and roomier shoes. Rigid hammertoes — those that no longer straighten on their own — typically need surgical correction, performed at our Tigard Locust office by Dr. Mia Horvath or Dr. Thomas Melillo.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
Each of the smaller toes (toes 2–5) has three joints: the metatarsophalangeal joint at the base, the proximal interphalangeal (PIP) joint in the middle, and the distal interphalangeal (DIP) joint near the tip. A hammertoe is a deformity at the PIP joint, where the toe buckles upward. A related deformity, claw toe, also involves the joint at the base. The bent joint at the top of the toe rubs against the inside of shoes, leading to calluses, corns, and sometimes ulcers.
What it feels like
Hammertoes are typically visible to the patient, but symptoms can vary:
- A visible upward bend at the middle joint of one of the smaller toes
- A corn or callus on top of the bent joint where it rubs the shoe
- Pain when wearing closed-toe or tight shoes
- Difficulty straightening the toe
- Calluses on the ball of the foot under the affected toe
- In advanced cases, ulcers over the bent joint (especially in diabetics)
- Toe pain that's worse at the end of the day
Why it develops
Hammertoes develop from a combination of inherited foot structure and environmental factors:
- Inherited foot type — particularly a longer second toe or loose joint ligaments
- Bunion deformity pushing the second toe upward
- Tight, narrow, or high-heeled shoes that crowd the toes
- Diabetes or peripheral neuropathy affecting toe muscle balance
- Rheumatoid arthritis or other inflammatory joint conditions
- Prior toe trauma or fracture that altered alignment
How we diagnose hammertoe
Hammertoe is diagnosed on physical exam. Your podiatrist will assess whether the deformity is flexible (still passively straightens) or rigid (does not), examine all of your toes for related deformities (bunions, claw toes), and check the skin for corns, calluses, or ulcers. Weight-bearing X-rays may be taken in our office to evaluate the underlying bones — particularly if surgery is being considered. Most patients leave the same day with a diagnosis and a stepped plan.
Non-surgical care
Flexible hammertoes often respond well to conservative care. Even rigid deformities can be made more comfortable without surgery if the patient is not a candidate for an operation:
- Wider, deeper toe-box shoes with a soft upper
- Toe splints or straps to hold the toe straighter
- Gel or silicone toe sleeves to cushion the bent joint
- Metatarsal pads to offload the ball of the foot
- Custom orthotics to address underlying foot mechanics
- Toe stretching and strengthening exercises
- Routine debridement of painful corns by a podiatrist
Surgical care
Surgical correction is recommended for rigid hammertoes that are painful, for hammertoes causing recurrent corns or ulcers, and for cases where conservative care has not provided adequate relief. The right procedure depends on whether the deformity is flexible or rigid and whether neighboring deformities (like a bunion) also need to be addressed.
- Tenotomy and capsulotomy — soft-tissue release for flexible deformities
- Arthroplasty — removal of a small portion of bone at the PIP joint
- Arthrodesis (fusion) — fusion of the PIP joint with an implant or pin to permanently straighten the toe
- Combined bunion and hammertoe correction when both are present
Recovery from hammertoe surgery typically involves walking in a surgical shoe for 2–6 weeks, depending on the procedure. Most patients return to athletic shoes around 6 weeks and to normal shoes between 6 and 10 weeks. Swelling can persist for several months. Sport and full activity usually return by 2–3 months.
When to see a specialist
- A toe that is becoming visibly bent and painful
- Recurrent corns or calluses on top of a toe joint
- A toe ulcer — especially urgent if you have diabetes
- Difficulty finding shoes that don't irritate the affected toe
- A toe deformity progressing alongside a bunion
Hammertoe evaluation is performed by any of our board-certified podiatrists across our 8 clinics. Surgical correction is performed by Dr. Mia Horvath and Dr. Thomas Melillo at our Tigard Locust orthopedic office, often in combination with bunion correction when both deformities are present.