Hammer toe without surgery: a realistic nonsurgical plan
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- Hammer toe straightener with crest pad. Best for: A flexible hammer toe that still straightens by hand. See options on Amazon
- Non-medicated gel corn pads or toe caps. Best for: A painful corn on the raised knuckle or toe tip. See options on Amazon
- Extra-depth shoes with a soft toe box. Best for: Anyone whose knuckle presses on the top of the shoe. See options on Amazon
- Soft cushioned or arch-support insoles. Best for: Pressure at the toe tip or ball of the foot, or a flattened arch. See options on Amazon
What nonsurgical care can and cannot do
The answer depends on the stage. AAOS OrthoInfo explains that early on the toe is flexible and simple measures can often correct it, but if it is left untreated it can become fixed and require surgery. A doctor decides which stage you are in by examining whether the joint is flexible or rigid. AAOS points readers to an orthopaedic surgeon, and MedlinePlus notes a podiatrist can make custom straighteners.
| Stage | What nonsurgical care aims for |
|---|---|
| Flexible toe | Relieve pain, restore muscle balance and keep the bend from setting |
| Rigid toe | Relieve pain and pressure; the bend itself stays |
An NHS hospital leaflet makes a useful point: treatment is not recommended if the foot is not painful. Nonsurgical care comes first, and surgery is kept for toes that stay painful when it fails.
Step 1: change the shoes
Every source puts footwear first, because pressure from the shoe is what keeps the toe bent and the knuckle sore.
- Length. AAOS advises shoes one-half inch longer than your longest toe, which is often the second toe.
- Toe box. Soft and roomy, with enough depth that the raised knuckle does not press on the top. A deep toe box or having a shoe repair shop stretch the toe box may help.
- Heels. MedlinePlus advises avoiding high heels as much as possible.
- Insoles. MedlinePlus suggests soft insoles to reduce pressure on the toe. If a collapsed arch is part of the cause, the NHS leaflet says insoles may help.
- Sandals. AAOS notes sandals may help if they do not pinch or rub.
Step 2: pads, cushions and straighteners
| Aid | What it does | Limit |
|---|---|---|
| Non-medicated corn pad or felt pad | Protects the raised joint from the shoe | Does not change the bend |
| Toe strap or cushion | AAOS lists straps and cushions among aids that can relieve pain | Can slip; needs room in the shoe |
| Hammer toe straightener or regulator | MedlinePlus says these can be worn to help keep the toes straight | Only useful while the toe is flexible |
A review in American Family Physician found that pads and inserts that spread contact pressure more evenly have longer-term benefits for corns and calluses, and that checking shoes for poor fit is more likely to prevent the problem coming back than short-term measures. In mild cases in children, MedlinePlus notes the toe can be manipulated and splinted.
AAOS advises people with diabetes, poor circulation or reduced feeling in the feet to talk to a doctor before using these aids.
Step 3: daily toe exercises
AAOS recommends gentle stretching and strengthening to restore muscle balance in a flexible toe. MedlinePlus notes stretching helps only if the toe is not yet fixed in position.
- Manual stretch. Gently straighten the toe with your fingers and hold it.
- Towel curls. Sit with a small towel flat under your foot and scrunch it toward you with your toes. The AAOS foot and ankle conditioning program lists 20 repetitions daily.
- Marble pickup. Pick up 20 marbles one at a time with your toes and drop each into a bowl, daily, as in the same AAOS program. Cotton balls work too.
The AAOS program says you should not feel pain during an exercise, and to talk to your doctor or physical therapist if you do.
When it is time to talk about surgery
AAOS says surgery is considered if the joint is rigid or if nonsurgical care does not relieve symptoms. Signs it may be time to ask:
- The toe no longer straightens by hand.
- Pain stops you walking or wearing shoes comfortably, despite roomy footwear and pads.
- Corns keep coming back or the skin over the knuckle breaks down.
What the procedures involve and how recovery goes is covered on our hammer toe surgery page. To check your stage first, see hammer toe symptoms.
What to look for when you buy
Hammer toe straightener with crest pad
Best for: A flexible hammer toe that still straightens by hand
MedlinePlus notes that hammer toe regulators or straighteners, sold in stores or made by a podiatrist, can help keep the toes straight while the toe is still flexible.
Watch out: No use on a rigid toe, and it adds bulk under the toes; check for rubbing or numbness.
See options on AmazonNon-medicated gel corn pads or toe caps
Best for: A painful corn on the raised knuckle or toe tip
AAOS lists non-medicated corn pads among aids that can relieve pain, and the AAFP review found pads that spread pressure have longer-term benefits for corns.
Watch out: Choose non-medicated pads. With diabetes, poor circulation or reduced feeling, AAOS advises talking to a doctor before self-treating.
See options on AmazonExtra-depth shoes with a soft toe box
Best for: Anyone whose knuckle presses on the top of the shoe
AAOS recommends a soft, roomy, deep toe box and shoes one-half inch longer than the longest toe.
Watch out: Try them with any pad or straightener in place, since these change the fit.
See options on AmazonSoft cushioned or arch-support insoles
Best for: Pressure at the toe tip or ball of the foot, or a flattened arch
MedlinePlus suggests soft insoles to reduce pressure on the toe, and the NHS leaflet says insoles may help when arch collapse is part of the cause.
Watch out: Thick insoles reduce toe room; you may need a deeper shoe.
See options on AmazonQuestions people ask
- Can a hammertoe be fixed without surgery?
- A flexible hammer toe can often be corrected with simple measures, AAOS says. A rigid one will not straighten without surgery, though nonsurgical care can still relieve pain.
- Do hammer toe straighteners work?
- They can help hold a flexible toe straight, according to MedlinePlus. They do not reverse a rigid toe.
- How long do toe exercises take to help?
- Sources do not give a set time. Do them daily, keep them pain-free, and review progress with your doctor or physical therapist.
- Can I treat a hammer toe at home if I have diabetes?
- Talk to your doctor first. AAOS advises people with diabetes, poor circulation or reduced feeling in the feet to consult a doctor before using over-the-counter aids.
Sources
- Hammer Toe: Comprehensive Guide (orthoinfo.org), AAOS OrthoInfo
- Hammer toe (medlineplus.gov), MedlinePlus (NIH)
- Foot and Ankle Conditioning Program (orthoinfo.org), AAOS OrthoInfo
- Common Foot Problems: Over-the-Counter Treatments and Home Care (aafp.org), American Family Physician (AAFP)
- Claw, Hammer and Mallet Toe Deformities (patient information) (nnuh.nhs.uk), Norfolk and Norwich University Hospitals NHS Foundation Trust