Hammertoes: Causes, Prevention, and When to Act

That toe that used to lie flat but now curls upward at the middle joint — and hurts in almost every shoe you own — is almost certainly a hammertoe. The good news: when caught early, most hammertoes can be managed without surgery. The catch is that they almost never get better on their own, and they almost always get worse with time.

Hammertoes are among the most common forefoot problems we see at our Meridian clinic, and they account for a meaningful share of all foot and ankle complaints treated across the country. Yet many patients wait years before asking for help — partly because the toe "doesn't look that bad yet," and partly because they've learned to live with the discomfort. This guide explains what's actually happening inside a hammertoe, what drives it to progress, and how to stop it while you still have good options.

What exactly is a hammertoe?

A hammertoe is an abnormal bend in the middle joint (the proximal interphalangeal joint) of one of the lesser toes — most often the second, third, or fourth. Instead of lying flat, the toe curls upward in the middle while the tip angles back down toward the ground, creating a shape that vaguely resembles a hammer. The result is a toe that rubs against the top of your shoe, develops painful corns and calluses, and eventually becomes stiff and difficult or impossible to straighten.

Hammertoe is distinct from a related condition called mallet toe, which involves a bend at the joint closest to the toenail, and from claw toe, which involves abnormal bending at multiple joints. If you're not sure which you have, that's fine — a podiatrist can sort it out quickly.

Flexible vs. rigid: the distinction that changes everything

The single most important thing to know about hammertoe is whether yours is flexible or rigid. This determines your treatment options more than almost anything else.

The practical takeaway: if your toe still bends when you push on it, you have more time and more choices. If it feels frozen in place, conservative care can still relieve pain but it won't change the shape of the toe.

What causes a hammertoe?

Hammertoe develops from an imbalance between the muscles and tendons that control the toe. When the forces pulling the toe upward chronically overpower the forces keeping it flat, the joint gradually migrates into a bent position. Several things can set that imbalance in motion:

• Ill-fitting footwear. Shoes with a narrow or pointed toe box, high heels, or insufficient depth force the toes to curl for hours at a time. Over years, this chronic position shortens the tendons on top of the toe.
• Bunions crowding the second toe. When a bunion pushes the big toe toward the smaller toes, the second toe gets displaced upward and inward. This is one of the most common reasons the second toe develops a hammertoe deformity.
• Foot structure. High arches, flat feet, and naturally long second toes all create mechanical conditions that increase hammertoe risk.
• Previous injury. A stubbed or jammed toe — even one that seemed minor at the time — can alter the joint mechanics enough to start the process.
• Underlying conditions. Rheumatoid arthritis and diabetes can both affect the tendons and joints of the foot in ways that accelerate hammertoe development.

Women develop hammertoes more often than men, which likely reflects both anatomical differences and years of wearing shoes with narrower toe boxes and elevated heels.

Symptoms: more than just a bent toe

Patients usually notice the bent appearance first, but pain — not cosmetics — is usually what brings them in. Common symptoms include:

• Pain or pressure on top of the toe where it rubs the inside of your shoe.
• Corns and calluses at the top of the bent joint or at the tip of the toe.
• Pain at the ball of the foot, directly under the affected toe.
• Stiffness and reduced ability to straighten or wiggle the toe.
• Swelling and skin discoloration around the affected joint.
• Open sores in severe or diabetic cases, where skin breakdown occurs at pressure points.

If you have diabetes or poor circulation, even a small corn or pressure sore over a hammertoe warrants prompt professional evaluation — these can progress to more serious wound complications faster than you'd expect.

Conservative treatments: what can actually help

For flexible and semi-rigid hammertoes, conservative care is often effective at managing pain and slowing progression. The key is starting early, before the joint stiffens permanently.

• Wider, deeper footwear. The single most impactful change. Shoes with a roomy toe box stop the friction that causes corns and ease the pressure on the bent joint. Look for shoes with at least a half-inch of space beyond your longest toe.
• Toe pads and cushions. Gel or foam pads placed over the prominent joint reduce rubbing against shoe material.
• Custom orthotics. Custom orthotic inserts can redistribute weight across the forefoot and address the underlying arch or structural mechanics that contributed to the hammertoe. They won't straighten a rigid deformity, but they can meaningfully reduce ball-of-foot pain.
• Toe exercises and stretching. For flexible hammertoes, exercises that stretch the toe tendons and strengthen the intrinsic foot muscles may help maintain joint mobility.
• Taping or splinting. Gentle taping in a more neutral position can provide short-term relief and, in early flexible cases, may help slow progression.

When is surgery needed?

Surgery becomes the right conversation when conservative measures no longer control the pain, or when the hammertoe has progressed to a rigid, fixed deformity that won't respond to non-surgical care. The most common procedures involve releasing or lengthening tight tendons, removing a small portion of bone to allow the joint to straighten, or fusing the joint in a corrected position for more severe deformities.

Most hammertoe surgeries are outpatient procedures performed under local anesthesia, and many patients can walk (in a surgical shoe) the same day. Full return to regular shoes typically takes several weeks to a few months. Learn more about what to expect from foot and ankle surgery at our clinic.

How to prevent hammertoes from developing or worsening

You can't change your genetics or your foot structure, but footwear choices account for a large portion of hammertoe risk. A few practical habits make a real difference:

• Choose shoes with a wide, deep toe box that lets your toes lie flat without being crowded.
• Limit time in high heels or pointed-toe shoes. When you do wear them, give your feet recovery time in supportive footwear afterward.
• Replace athletic shoes when they're worn out — a compressed midsole offers less support and changes the mechanics of every step.
• If you have a bunion, get it evaluated early, before it starts pushing the second toe out of alignment.
• Consider custom orthotics if you have high arches or flat feet, since both can accelerate toe deformities.

When to see a doctor — and when it's urgent

See a podiatrist if:

• You notice a toe that is beginning to curl and the problem is new or progressing.
• You have pain in a toe or at the ball of your foot that affects your daily walking or choice of footwear.
• You have corns or calluses that keep returning after you trim them.
• You have a rigid hammertoe that you'd like corrected — the sooner surgery is discussed, the more options remain open.

Seek same-day or urgent care if:

• You have an open sore, ulcer, or wound over a hammertoe — especially if you have diabetes or poor circulation.
• The toe is red, hot, and swollen with fever, which can signal an infection rather than a simple hammertoe.
• There is rapid worsening of pain, spreading redness, or red streaks traveling up the foot.

Frequently asked questions

The bottom line

Hammertoe is a progressive condition — it rarely stays the same and almost never improves on its own. The earlier you intervene, the more likely you are to manage it without surgery. If your toe is beginning to curl, you're dealing with recurring corns, or your footwear options have quietly narrowed over the last few years, it's worth having it evaluated. A quick visit can tell you exactly what type you have, what's driving it, and what your best options are right now.

Dr. Clark Johnson is a board-certified foot and ankle surgeon at Treasure Valley Foot & Ankle in Meridian. He treats hammertoes at every stage, from early conservative management to surgical correction. Request an appointment or call (208) 272-9253 — same-week appointments are often available.

This article is for general education only and is not a substitute for professional medical evaluation or treatment. If you have diabetes, circulatory problems, or an open wound associated with a hammertoe, please seek care promptly rather than waiting.