Hammer toe is a foot deformity where one or more of the smaller toes bend downward at the middle joint, creating a shape that resembles a hammer. It develops when the muscles and tendons that control toe movement fall out of balance, allowing the stronger muscles running along the top of the foot to overpower the smaller ones inside the foot itself. The result is a toe that curls instead of lying flat, and over time, that curl can become permanent.
How Hammer Toe Develops
Your toes stay straight because two sets of muscles work together to keep them in position. Small intrinsic muscles inside the foot pull the toes down and stabilize them, while larger extrinsic muscles running from the lower leg extend and flex the toes during walking. When the intrinsic muscles weaken or the extrinsic muscles tighten, the balance tips. The base of the toe gets pulled upward while the middle and end joints buckle downward, locking the toe into a bent position.
This imbalance can be made worse by limited ankle flexibility. When the ankle doesn’t bend well, the long extensor muscle on top of the foot works harder to compensate, pulling the toes into an extended position at the base. Over time, this shortens the top muscles and stretches the smaller ones underneath, reinforcing the deformity.
Common Causes and Risk Factors
Footwear is the most controllable factor. Shoes with narrow toe boxes compress the toes into a bent position for hours at a time, and high heels shift body weight forward, forcing the toes against the front of the shoe. Years of this repeated pressure can trigger the muscle imbalance that leads to hammer toe.
But shoes aren’t the only cause. Other risk factors include:
- Toe length: Naturally long toes are more likely to get cramped in standard shoe sizes, creating extra pressure.
- Bunions: A bunion on the big toe can push neighboring toes out of alignment.
- Diabetes and peripheral neuropathy: Nerve damage weakens the small foot muscles, and hammer toes in people with diabetes are linked to higher forefoot pressure and a greater risk of skin ulceration.
- Inflammatory arthritis: Conditions like rheumatoid arthritis damage the joints and soft tissues that keep toes straight.
- Foot mechanics: Flat feet, high arches, and other structural differences change how force is distributed across the toes.
- Genetics: Over half of people with hammer toe report a family history of the condition.
Women are affected far more often than men. In one study of over 2,600 adults, about 74% of those with hammer toe were female. The overall prevalence in that population was roughly 9%.
What Hammer Toe Looks and Feels Like
The most obvious sign is a toe that visibly bends at the middle joint. The second toe is affected most often, though any of the smaller toes can develop the deformity. In the early stages, the bend may only be noticeable when you’re standing or walking. As it progresses, the toe stays curled even at rest.
The bent joint rubs against the top of your shoe, which commonly produces a corn or callus right over the knuckle of the affected toe. You may also develop a callus on the ball of the foot beneath the bent toe, because the altered position shifts pressure downward. Pain tends to be worst when wearing closed shoes and improves when barefoot or in open-toed footwear. Some people also notice difficulty finding shoes that fit comfortably, or pain when pushing off during walking.
Flexible vs. Rigid: The Two Stages
Hammer toes are classified by how much movement remains in the joint. In the flexible stage, you can still manually straighten the bent toe. The joint moves freely, and the deformity is mostly caused by muscle imbalance rather than structural changes in the joint itself. This is the stage where conservative treatment is most effective.
Over time, flexible hammer toes can become rigid. The tendons tighten permanently, and the joint itself stiffens or fuses in the bent position. At this point, you can no longer straighten the toe by hand. Rigid hammer toes are more painful, more likely to develop severe corns or calluses, and generally require surgery to correct.
Non-Surgical Treatment Options
If the toe is still flexible, several strategies can slow progression and manage discomfort. The most important change is footwear. Shoes with a wide, deep toe box give the toes room to lie flat without being compressed. Low or flat heels promote natural foot alignment and reduce strain on the toe joints. Simply switching away from narrow or pointed shoes can provide significant relief.
Padding and splinting can also help. Small cushioned pads placed over the bent joint reduce friction inside the shoe and protect against corns. Toe splints or straps gently hold the toe in a straighter position while worn. These devices won’t permanently correct the deformity, but they do a good job of relieving day-to-day pain. Custom-molded toe appliances, made from a soft putty-like material shaped directly to your foot, can cushion, align, or separate deformed toes. They typically cost $19 to $30 each and last about a year.
Supportive orthotic insoles placed inside your shoes help redistribute pressure across the foot, taking strain off the affected toes and the joints at the ball of the foot. For corns and calluses that have already formed, trimming and padding them reduces irritation. Avoid cutting corns yourself if you have diabetes or circulation problems.
Exercises to Maintain Flexibility
Strengthening the small intrinsic muscles of the foot can help counteract the muscle imbalance that drives hammer toe. These exercises are simple and can be done at home while sitting in a chair.
Towel scrunches are a good starting point. Place a hand towel flat on a smooth floor, press your heel down, and use your toes to scrunch the towel toward you. Grip, pull, release, and repeat for 10 repetitions across three sets. This targets the small muscles on the underside of the foot.
Toe swapping builds independent toe control. With your foot flat on the floor, raise your big toe while keeping the other four pressed down. Hold for a few seconds, then reverse: press the big toe down and lift the four smaller toes. This teaches your brain to activate the intrinsic muscles separately from the larger ones.
Doming is particularly useful because it specifically activates intrinsic muscles without engaging the extrinsic ones that contribute to the problem. Press the undersides of your toe knuckles into the floor so the arch of your foot rises slightly, forming a dome shape. The key is to keep the toes long and straight. If they curl under, the wrong muscles are doing the work.
Piano toes build on the swapping exercise. Lift your big toe first, then add the second toe, third, fourth, and pinky one at a time. Once all five are raised, lower them back down starting with the pinky. The goal is individual toe control, which directly strengthens the small stabilizing muscles.
When Surgery Becomes Necessary
Surgery is typically considered when the hammer toe is rigid, painful, and no longer responds to conservative measures. The most common procedure fuses the bent joint in a straight position by removing a small amount of bone and securing the joint with a pin or implant. This permanently straightens the toe but eliminates movement at that joint, which most people don’t notice in daily life since the small toe joints contribute little to walking mechanics.
Other surgical options include removing part of the bone to allow the joint to straighten without fusion, releasing tight tendons or joint capsules, or lengthening the extensor tendon on top of the toe. The approach depends on the severity of the deformity and whether other foot problems like bunions need to be addressed at the same time.
Most people return to regular activity about six weeks after surgery, though some swelling and mild discomfort in the toe can persist beyond that. Wide shoes and activity modifications are commonly needed for several additional weeks, and some patients benefit from physical therapy during recovery.
Preventing Hammer Toe
The most effective prevention is choosing shoes that don’t force your toes into unnatural positions. Look for a toe box wide enough that your toes can spread without touching the sides, and deep enough that the top of the shoe doesn’t press down on your toe joints. Low or flat heels keep your weight distributed evenly across the foot rather than jamming it forward.
If you spend long hours on your feet, periodic toe stretches and the intrinsic muscle exercises described above help maintain the balance between the muscle groups that keep toes straight. People with diabetes, arthritis, or a family history of foot deformities benefit from paying extra attention to foot health early, before a flexible hammer toe has a chance to become rigid.