ConditionBones, joints & muscles
Hammer Toe
A hammer toe is a toe, usually the second, third or fourth, that bends downward at its middle joint so the knuckle sticks up like a hammer. The raised joint rubs on shoes, causing corns, calluses and pain. It is much more common in women, largely because of narrow, high-heeled shoes, and often occurs with bunions. Early on the toe is flexible and can be straightened by hand; later it becomes rigid. Roomier shoes, pads and exercises help, and surgery can correct a painful, fixed toe.
Also called: Hammertoe, hammer toe deformity, claw toe and mallet toe (related deformities)
At a glance
- What it is
- A toe bent down at the middle joint, with the knuckle raised.
- Who gets it
- More common in women and with age; often with bunions.
- Causes
- Tight or high-heeled shoes, a long second toe, muscle imbalance, arthritis, nerve damage.
- Symptoms
- Pain on top of the bent joint, corns, calluses, stiffness, ball-of-foot pain.
- Treatment
- Wide, deep shoes, pads, toe exercises, splints; surgery for rigid, painful toes.
When to get help
See a doctor within a day or two
- A corn or blister over a hammer toe that becomes red, hot, swollen or drains, especially with diabetes
- An open sore on a toe in someone with diabetes, poor circulation or numb feet
Book a routine appointment
- Toe pain that makes shoes uncomfortable or limits walking
- A toe becoming stiff and unable to straighten
- Toes crossing over one another
Usually safe to manage at home
- A flexible bent toe with mild rubbing, managed with roomier shoes and pads
What a hammer toe looks like
Each of the smaller toes has three bones and two joints. In a hammer toe:
- the middle joint (proximal interphalangeal joint) bends downward
- the knuckle on top of the toe rises and rubs the shoe
- the tip of the toe may press into the ground, causing a callus
Hammer toe vs claw toe vs mallet toe
| Deformity | Joints affected | Appearance |
|---|---|---|
| Hammer toe | Middle joint bent down | Raised middle knuckle |
| Claw toe | Base joint bent up; middle and end joints bent down | Toe curls like a claw; often several toes |
| Mallet toe | End joint bent down | Tip of toe points down |
Symptoms
- a visibly bent toe
- pain or irritation over the top of the middle joint when wearing shoes
- corns on top of the toe and calluses on the tip or ball of the foot (calluses and corns)
- redness, swelling or a burning feeling
- stiffness and inability to straighten the toe
- pain in the ball of the foot (metatarsalgia)
- open sores in severe cases, particularly with poor circulation or diabetes
Symptoms of hammer toe in women
Women are affected several times more often than men. Symptoms are often worst in narrow, pointed, high-heeled shoes, which push the toes forward and bend them. Women frequently have a bunion at the same time, which crowds the second toe and forces it to buckle. Pain may also come from a callus under the ball of the foot, and the second toe can drift and overlap the big toe.
Causes and risk factors
- Footwear: tight, narrow, short or high-heeled shoes
- Foot shape: a second toe longer than the big toe, high arches, flat feet
- Muscle and tendon imbalance that pulls the toe into a bent position
- Bunions pushing the toes together
- Arthritis: rheumatoid arthritis and osteoarthritis
- Nerve and muscle conditions: diabetic neuropathy, stroke, Charcot-Marie-Tooth disease
- Injury: stubbing or breaking a toe
- Age and family history
Diagnosis
A doctor or podiatrist examines the foot standing and sitting, checks whether the toe can be straightened (flexible or rigid), assesses circulation and sensation, and looks at your shoes. X-rays show the joints and any arthritis and help plan surgery.
Treatment
Without surgery
- Shoes: a deep, wide toe box, low heels (under about 5 cm or 2 inches), and soft uppers. A shoe repairer can stretch shoes over the toe.
- Pads and cushions: gel toe sleeves or non-medicated corn pads over the knuckle.
- Toe splints or straps to hold flexible toes straight.
- Orthotic insoles to redistribute pressure and support the arch.
- Exercises: picking up marbles or a towel with the toes, and gently stretching the toes, help flexible hammer toes.
- Corn care: a podiatrist can safely pare corns. Avoid medicated corn plasters containing acid, especially if you have diabetes.
- Pain relief: ice, and acetaminophen (paracetamol) or ibuprofen at the label dose.
Surgery
Surgery is considered when pain persists despite these measures, or the toe is rigid. Options include:
- Tendon release or transfer for flexible toes
- Joint resection (arthroplasty) to remove part of the bone
- Joint fusion (arthrodesis) to permanently straighten the toe, often held with a pin or implant
Recovery usually takes several weeks in a special shoe, with swelling that can last several months.
Complications
- painful corns and calluses
- open sores and infection, particularly in people with diabetes or reduced circulation (diabetic foot problems)
- toe dislocation at the base joint
- difficulty finding comfortable shoes and reduced activity
Prevention
Choose shoes with enough room for your toes, avoid prolonged use of high heels, and treat bunions and foot pain early.
Frequently asked questions
What are the symptoms of hammer toe in women?
Women typically notice a bent toe with a raised knuckle, a painful corn on top, calluses on the toe tip or ball of the foot, and pain in narrow or high-heeled shoes. A bunion often coexists and worsens crowding of the second toe.
Can hammer toe be fixed without surgery?
Flexible hammer toes often improve or stop getting worse with roomier shoes, pads, splints and toe exercises. Rigid hammer toes cannot be straightened without surgery, but symptoms can still be eased with footwear and padding.
What is the difference between hammer toe and claw toe?
A hammer toe bends at the middle joint only. A claw toe bends upward at the base joint and downward at the middle and end joints, making the toe curl. Claw toes often affect several toes and can be linked to nerve conditions.
How long does hammer toe surgery take to heal?
Most people wear a post-surgical shoe for about 4 to 6 weeks. Swelling can last 3 to 6 months, and full recovery and return to normal shoes may take several months.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Hammer toe
- American College of Foot and Ankle Surgeons (FootHealthFacts): Hammertoes
- American Podiatric Medical Association: Hammertoes
- NHS: Hammer toes
- MedlinePlus: Hammer toe