Hammer Toes

A hammer toe is a contracture of one or both of the joints in the lesser toes. Hammertoes usually start out as mild deformities and get progressively worse over time. In the early stages, hammertoes are often flexible and the symptoms can often be managed with non-invasive treatments. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

What Causes Hammertoes?

  • Muscle/Tendon imbalance which leads to the contracture of the joint(s) of the toe
  • Bunion deformities that cause the great toe to push against the 2nd toe
  • Ill-fitting shoes can cause hammertoes to develop. If one or two of your lesser toes are longer than your great toe and you force your foot into a shoe that is too short, contracture at the joint may develop over time.
  • Occasionally, trauma to the foot or toe can cause hammertoes
  • Neurologic disease processes that affect the intrinsic musculature of your lower limbs, such as diabetes
  • Back injuries or nerve damage
  • Some hammertoes are inherited due to length patterns of the bones in the forefoot.


  • Pain or irritation of the affected toe when wearing shoes
  • Corns and callouses (a buildup of skin) on the toe, between two toes or on the ball of the foot. Corns are caused by friction and pressure from shoe gear. They can be hard (usually on the top of the toe – referred to as heloma dura) or soft (usually between two toes – referred to as heloma molle).
  • Inflammation, redness or a burning sensation on top of toe joints
  • Contracture of the toe joint(s)
  • In severe cases, or in diabetic patients, open wounds or ulcerations can develop over joints


Although hammertoes are readily apparent, to understand why they have developed will require an examination by a podiatrist. The physician will likely take x-rays, perform a range of motion exam and possibly a gait analysis to observe how you walk. Hammertoes are progressive, and the rate they progress will be determined by the cause. Once your physician determines what is causing the deformity, a treatment plan can be developed that is suited to your needs.

Non-Surgical Treatments

  • Padding or over-the-counter products to reduce pressure and provide comfort. Avoid medicated corn pads, especially if you are diabetic or have compromised circulation
  • Shoe gear changes. Choose comfortable, roomy shoes with lace up design
  • Prescription Orthotics. Properly prescribed orthotics can help control muscle/tendon imbalance and prevent furtherance of the deformity
  • Routine trimming of corns and callouses
  • Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to reduce pain and inflammation.

When Is Hammertoe Surgery Needed?

  • When the hammertoe becomes rigid and painful
  • The corns/callouses recur in short intervals and are painful
  • Chronic open sores or ulcerated areas develop on the toe that become easily infected

Often patients with hammertoes have bunions or other foot deformities that can be corrected at the same time. In selecting the appropriate procedure(s) for your particular case, your podiatrist will take into consideration the extent of your deformity, the number of toes involved, your age and activity level. The length of recovery will depend upon the procedure performed, but usually involves wearing a post-operative shoe for one to two months.

Hammertoes will not resolve without intervention, and most of them progress in severity over time. If you have painful hammertoes, call and schedule an appointment with one of our physicians to determine the cause and the best course of treatment.

Call Central Carolina Foot and Ankle Associates at 919-477-9333 for an appointment or click the link below.

Central Carolina Foot & Ankle Associates

2609 N. Duke Street, Ste. 301
Durham, NC 27704
(near the corner of N. Duke St. and Stadium Dr.)

5107 Southpark Drive
Suite 202
Durham, NC 27713
(close to RTP and Chapel Hill)