Doctor checking patient's hammertoes.

Hammertoes: Causes and Treatment

If my mother and grandmother both have hammertoes, does that mean I will get them too?

Is there anything more fun than planning a spa day with friends? Or just getting together for manicures and pedicures at your favorite salon? It’s important to make time to relax and be pampered once in a while and always better when you can share the experience, helping to pick out nail colors while catching up with each other’s lives.  

Not everyone feels the freedom to enjoy this kind of experience, though. For those with a condition like hammertoe, the idea of a pedicure or even just wearing open-toed shoes or sandals is out of the question.

What Is Hammertoe?

Hammertoe is usually found in the second toe, although it sometimes affects the third or fourth toes. This condition is called “hammertoe” because an abnormal bending takes place around the middle joint, and it takes on the appearance of a hammer. This bending is due to something causing the muscles, tendons and ligaments in the toe to get out of balance, which results in them no longer being able to keep the bones straight. 

There are two types of hammertoes and they are distinguished by whether you can still move your toe or not. The two types are:

Rigid hammertoes – if the condition is severe to the point where the joint is pushed out of alignment and you no longer have the ability to move the toe, it is classified as rigid hammertoe.

Flexible hammertoes – a milder form is flexible hammertoe, which means you can still move the toe. It is important to get treatment as soon as possible to keep flexible hammertoe from progressing to the point of being rigid.

Causes of Hammertoe

  • Shoe style – especially shoes that are too tight or those, like high heels, that force the toes into a restricted and often flexed position
  • Gender – women are typically more prone to developing hammertoe than men
  • Aging – with age, the likelihood of developing hammertoe increases
  • Heredity – hammertoe does appear to run in families
  • Structure – those with a second toe that protrudes beyond the big toe are more likely to develop hammertoe
  • Trauma – injuries to the toe can increase the risk of hammertoe
  • Certain diseases – hammertoe, as well as other types of foot issues, are often associated with conditions like diabetes, arthritis, stroke, polio and alcoholism

Treatment for Hammertoe

Your orthopedist will recommend treatment based on the severity of your condition. If your hammertoe is flexible, there are several non-surgical options. These will typically include some combination of:

  • Switching to shoes that provide more space in the toe area
  • Taping, splinting or using inserts or pads to encourage the toe to remain in the correct alignment
  • Strengthening the muscles in the toe with specially designed exercises
  • Reducing pain and inflammation with medication and cortisone injections

When the condition is more advanced, the stage or type classified as rigid, surgery will likely be suggested. This may be done by removing a small piece of bone from the joint, which then allows the toe to straighten. It could also be done with surgery focused on releasing the pressure in the tendon or inserting a metal pin to keep the toe straight.

If you have questions about hammertoes or about any other foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon with Ortho-Care Wayne in Bergen County New Jersey and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC.