What are hammer toes? A plain guide to the bent middle joint
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- Walking shoes with a deep, roomy toe box. Best for: Anyone who has noticed a toe starting to curl or rub. See options on Amazon
- Non-medicated felt or gel corn pads. Best for: A sore spot on top of the bent middle joint. See options on Amazon
- Hammer toe straightener or crest pad. Best for: A flexible toe that still straightens by hand. See options on Amazon
The short definition
A hammer toe is a deformity of one of the smaller toes in which the toe bends at the middle joint, which doctors call the proximal interphalangeal or PIP joint. AAOS OrthoInfo describes it as affecting the second, third or fourth toe.
MedlinePlus describes the shape as claw-like: the middle joint rises and the end of the toe bends downward. It most often affects the second toe. Rarely, all of the toes are affected, which MedlinePlus says may point to a nerve or spinal cord problem.
The raised knuckle is the part that causes trouble. It rubs against the top of the shoe, and over time a corn can form there. The tip of the toe can also press into the sole of the shoe or the ground.
Hammer toe, mallet toe and the other toe deformities
Several bent-toe problems sound alike. The difference is mainly which joint bends.
| Name | Where the bend is | Typical pressure point |
|---|---|---|
| Hammer toe | The middle joint of the toe | A corn on top of the middle joint, or at the tip |
| Mallet toe | The joint nearest the toenail | The tip of the toe |
| Claw toe and curly toe | Related deformities of the smaller toes | Varies; a clinician tells them apart on examination |
Mayo Clinic covers hammertoe and mallet toe together as bends in the toe that usually occur in the second, third or fourth toes. An NHS hospital leaflet lists mallet, hammer, claw and curly toe as the main lesser toe deformities and notes that the second toe is the one most often affected.
Flexible or rigid: the detail that matters most
Hammer toes change over time, and the stage shapes what can be done about them.
- Flexible. Early on you can still move the toe and straighten it with your fingers. AAOS says a flexible hammer toe can often be corrected with simple measures such as roomier shoes and toe exercises.
- Rigid or fixed. If the cause goes on, the tendons and joint tighten until the toe stays bent even when you try to straighten it. MedlinePlus notes that a fixed toe can no longer be moved and becomes painful. FootCareMD says a rigid toe may need more involved surgery to correct.
A doctor checks which stage you are in with a physical exam, and AAOS says X-rays may be used to confirm the diagnosis. This is the main reason not to wait if a toe is starting to curl: the flexible stage is the one with the most options.
Who tends to get hammer toes
Anyone can develop a hammer toe, but some people are more likely to:
- Women, who Mayo Clinic says are more likely than men to develop hammertoe or mallet toe. MedlinePlus links this to poorly fitting shoes and frequent high heels.
- Children in outgrown shoes, which MedlinePlus lists as a risk.
- People with arthritis or diabetes, conditions that Mayo Clinic says raise the risk of foot problems. Genes may also play a part.
- People born with it. MedlinePlus notes a hammer toe can be present at birth or develop over time.
The full list of causes, from shoe shape to muscle imbalance and injury, is on our page about what causes hammer toes.
Is a hammer toe serious?
For many people a hammer toe mainly causes trouble in shoes. Mayo Clinic lists pain in shoes, trouble moving the toe, stiffness, swelling and corns or calluses as the usual symptoms. Our hammer toe symptoms page walks through each one.
It becomes more serious when the skin breaks down. MedlinePlus says to contact a provider if sores over the toes become red and swollen. AAOS advises further testing for people with diabetes or decreased sensation, to check for a nerve cause, and says they should talk to a doctor before treating the toe themselves.
Treatment usually starts without surgery: shoe changes, pads and exercises, covered in hammer toe treatment without surgery. When a toe is rigid or stays painful, hammer toe surgery is an option.
What to look for when you buy
Walking shoes with a deep, roomy toe box
Best for: Anyone who has noticed a toe starting to curl or rub
AAOS recommends a soft, roomy toe box and shoes about one-half inch longer than your longest toe. Taking pressure off the knuckle is the first step in every nonsurgical plan.
Watch out: Width matters as much as length; try shoes on late in the day when feet are largest.
See options on AmazonNon-medicated felt or gel corn pads
Best for: A sore spot on top of the bent middle joint
MedlinePlus says corn pads or felt pads can protect the raised joint, and AAOS lists non-medicated corn pads among simple aids that can relieve pain.
Watch out: Choose the non-medicated kind AAOS lists. With diabetes, poor circulation or reduced feeling, AAOS advises talking to a doctor before self-treating.
See options on AmazonHammer toe straightener or crest pad
Best for: A flexible toe that still straightens by hand
MedlinePlus notes that hammer toe regulators or straighteners, sold in stores or made by a podiatrist, can be worn to help keep the toes straight.
Watch out: It holds a flexible toe in position; it will not straighten a rigid one, and it needs room in the shoe.
See options on AmazonQuestions people ask
- What is the difference between a hammer toe and a mallet toe?
- A hammer toe bends at the middle joint of the toe. A mallet toe bends at the joint nearest the toenail, according to Mayo Clinic.
- Which toe gets hammer toe most often?
- The second toe, according to MedlinePlus. AAOS says hammer toe affects the second, third or fourth toe.
- Can a hammer toe go back to normal?
- A flexible hammer toe can often be corrected with simple measures, AAOS says. Once the toe is rigid, nonsurgical care eases pain but does not straighten it.
- Do hammer toes always need surgery?
- No. Surgery is considered when the joint is rigid or when shoe changes, pads and exercises do not relieve the pain.
- Is a hammer toe the same as a bunion?
- No. A bunion affects the big toe joint, while a hammer toe affects one of the smaller toes. An NHS leaflet notes that a bunion can contribute to a lesser toe deformity, so the two often appear together.
Sources
- Hammer Toe: Comprehensive Guide (orthoinfo.org), AAOS OrthoInfo
- Hammer toe (medlineplus.gov), MedlinePlus (NIH)
- Hammertoe and mallet toe: Symptoms and causes (mayoclinic.org), Mayo Clinic
- Hammertoe (footcaremd.org), FootCareMD (American Orthopaedic Foot and Ankle Society)
- Claw, Hammer and Mallet Toe Deformities (patient information) (nnuh.nhs.uk), Norfolk and Norwich University Hospitals NHS Foundation Trust