What causes hammer toes, and which causes you can change
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- Lace-up shoes with a wide, deep toe box. Best for: Daily wear for anyone with crowded or curling toes. See options on Amazon
- Foot measuring device for length and width. Best for: Families checking growing children's feet, or adults whose size has changed. See options on Amazon
- Low-heeled shoes or sandals with adjustable straps. Best for: Work or dress wear for people who usually wear heels. See options on Amazon
The core cause: a muscle imbalance
Toe muscles work in pairs. One set bends the toe, the other straightens it. AAOS OrthoInfo explains that a hammer toe develops when this balance is lost, which puts pressure on the toe's tendons and joints. If a toe stays in a bent position long enough, the muscles tighten and cannot stretch back out.
Mayo Clinic adds that early on the toe may still be straightened, but over time the tendons and joints can tighten and keep it bent. That is the point where a flexible hammer toe becomes a rigid one.
So the question "what causes hammer toes" really has two parts: what pushes the toe into a bent position in the first place, and what keeps it there long enough for the bend to set.
Shoes: the most common trigger
MedlinePlus names shoes that are short, narrow and too tight as the most common cause. They force the toe into a bent position, and over time the muscles and tendons tighten and shorten.
- Narrow, pointed toe boxes. AAOS says shoes that narrow toward the toe push the smaller toes into a bent position.
- High heels. A higher heel forces the foot forward and down, pushing the toes against the front of the shoe and increasing the bend.
- Shoes that are too short. This includes children's shoes that have been outgrown, which MedlinePlus lists as a risk.
- Rubbing. AAOS notes that corns and calluses from shoe friction can make the condition worse, so the problem can feed itself.
This is also why women, who MedlinePlus says are more likely to develop hammer toe when they wear poorly fitting shoes or high heels often, are affected more than men.
Other causes and risk factors
| Factor | How it contributes | Can you change it? |
|---|---|---|
| Toe injury | Mayo Clinic lists a stubbed, jammed or broken toe as a cause | Partly: get a hurt toe checked |
| Arthritis or diabetes | Mayo Clinic says both raise the risk of foot problems | Manage the condition and check feet often |
| Nerve or spinal cord problems | MedlinePlus says these may be behind rare cases where all the toes are affected | Needs medical assessment |
| A bunion or a collapsed arch | An NHS hospital leaflet lists both as causes of lesser toe deformities | Get it assessed; the NHS leaflet says insoles may help when arch collapse is the cause |
| Genes and birth | Mayo Clinic says genes may play a role; MedlinePlus notes it can be present at birth | No |
Mayo Clinic also points out that often no clear cause is found. AAOS advises further testing for people with diabetes or reduced feeling in the feet, to see whether a nerve condition is driving the imbalance.
How to buy shoes that do not crowd your toes
Because footwear is the cause you control, shoe fitting is the best prevention. A review in American Family Physician and Mayo Clinic's advice line up closely:
- Shop late in the day, when feet are largest, and fit both feet while standing.
- Measure both feet, including width, and buy for the larger foot. Mayo Clinic notes foot size can change with age.
- Leave room at the front. About 1/2 inch between your longest toe and the end of the shoe, and up to 1 inch in athletic shoes.
- Choose a toe box that matches your toes, not a pointed one, and keep heels low.
- Pick laces or straps so you can adjust the fit.
- Buy shoes that feel right in the store. Properly fitted shoes should be comfortable right away without breaking in.
If you wear inserts or orthotics, take them with you, since they change the fit.
Can hammer toes be prevented?
Not always, since genes, injury and some medical conditions play a part. But MedlinePlus advises avoiding shoes that are too short or narrow and checking children's shoe sizes often, especially during growth spurts. AAOS says that early on, the toe is flexible and simple measures can often correct it.
If you already see a toe starting to curl, read about hammer toe symptoms to see which stage it is in, and nonsurgical hammer toe treatment for the next steps. For a basic overview, see what are hammer toes.
What to look for when you buy
Lace-up shoes with a wide, deep toe box
Best for: Daily wear for anyone with crowded or curling toes
AAOS and Mayo Clinic both point to narrow toe boxes and tight shoes as the main cause you can change. Laces let you adjust the fit as Mayo Clinic suggests.
Watch out: A wide shoe that is too short still bends the toes; check the length at the front too.
See options on AmazonFoot measuring device for length and width
Best for: Families checking growing children's feet, or adults whose size has changed
Mayo Clinic advises measuring both feet, including width, and buying for the larger foot. MedlinePlus advises checking children's shoe sizes often during growth spurts.
Watch out: Measure standing up, late in the day, and use the result as a starting point for trying shoes on.
See options on AmazonLow-heeled shoes or sandals with adjustable straps
Best for: Work or dress wear for people who usually wear heels
AAOS says a higher heel forces the foot down and increases pressure on the toes. Mayo Clinic advises against high heels and says shoes with laces or straps are easier to make comfortable.
Watch out: Straps should not cross the raised knuckle of a bent toe.
See options on AmazonQuestions people ask
- Can tight shoes cause hammer toes?
- Yes. MedlinePlus says short, narrow, tight shoes are the most common cause, because they hold the toe bent until its muscles and tendons tighten.
- Do high heels cause hammer toes?
- They contribute. AAOS explains that a higher heel forces the foot forward and increases pressure on the toes, and Mayo Clinic lists high-heeled shoes among the causes.
- Are hammer toes hereditary?
- Genes may play a role, Mayo Clinic says, and MedlinePlus notes that a hammer toe can be present at birth. Shoes and muscle imbalance are still the main drivers.
- Can an injury cause a hammer toe?
- Yes. Mayo Clinic lists a stubbed, jammed or broken toe as a possible cause.
- Why do I have hammer toes if I wear sensible shoes?
- Muscle imbalance, arthritis, diabetes, a bunion, a collapsed arch or family traits can all play a part, and Mayo Clinic notes that often no cause is identified. A doctor can check for an underlying cause.
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
- 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