Hammer Toe
Hammer toe is a progressive deformation of the toes that can cause painful corns and limit your choice of footwear. Early treatment with foot orthotics slows progression and relieves symptoms.
What is hammer toe?
Hammer toe is a joint deformity affecting the lesser toes of the foot (second to fifth). The toe bends in flexion at the proximal interphalangeal joint (middle joint of the toe), while its base may be in a neutral or extended position, giving the toe the characteristic hammer shape.
Several forms of toe deformity are distinguished. Hammer toe involves flexion of the middle joint. Claw toe shows flexion of both distal joints with hyperextension at the base. Mallet toe is characterised by flexion of the distal joint only. These three conditions share similar causes and benefit from the same type of orthotic treatment.
The deformity can be flexible (manually reducible) or rigid (fixed). Flexible forms are easier to treat with conservative methods. Without intervention, flexible toes progressively become rigid due to tendon contracture and joint fibrosis.
Hammer toe affects approximately 20% of the population, with a higher prevalence among women. The second toe is most often affected, frequently related to a hallux valgus that pushes the big toe under or over the second toe.
Causes of hammer toe
- Muscular imbalance: an imbalance between the toe flexor and extensor muscles causes abnormal flexion of the joint.
- Hallux valgus: deviation of the big toe pushes the second toe upward and contributes to its hammer deformity.
- Inappropriate shoes: shoes that are too short, too narrow or have high heels compress the toes and force flexion.
- Biomechanical abnormalities: high arches, flat feet and forefoot instability alter toe mechanics and promote deformities.
- Toe length: a second toe longer than the big toe (Greek foot) is particularly vulnerable to deformity.
- Neurological diseases: certain conditions affecting the foot nerves can cause muscular imbalance and toe deformities.
- Arthritis: rheumatoid arthritis and other inflammatory diseases can deform the toe joints.
Symptoms of hammer toe
- Visible deformity: the toe bends abnormally at the middle joint, taking on a hammer shape.
- Corns and calluses: formation of painful corns on top of the bent joint due to friction with the shoe, and calluses under the corresponding metatarsal head.
- Pain: pain at the deformed joint, worsened by wearing closed shoes.
- Difficulty wearing shoes: the deformity makes standard shoes uncomfortable or impossible to wear.
- Metatarsalgia: forefoot pain caused by altered mechanics of the deformed toe.
- Progressive stiffness: the toe becomes increasingly difficult to straighten manually as the deformity becomes fixed.
Treatment of hammer toe with orthotics
Custom foot orthotics address the biomechanical causes of hammer toe:
- Muscular rebalancing: by optimising the position and biomechanics of the foot, the orthotic restores balance between the toe flexor and extensor muscles, reducing the tendency to flexion.
- Transverse arch support: the orthotic can include a support under the transverse arch of the forefoot that helps maintain toe alignment.
- Pressure redistribution: by relieving overload zones under the forefoot, the orthotic reduces the often-associated metatarsalgia.
- Slowing progression: by correcting contributing factors, the orthotic prevents worsening of the deformity and delays or avoids the need for surgery.
Complementary accessories such as toe separators, gel protectors and metatarsal pads can supplement orthotic treatment. Toe mobility and strengthening exercises are also recommended.
When to consult an orthotist?
Consult an orthotist if:
- You notice a progressive deformity of your toes
- Painful corns or calluses form on your toes
- You have difficulty finding comfortable shoes
- Forefoot pain worsens with walking
- You have a hallux valgus and your other toes are starting to deform
Our orthotists are members of the OTPQ and AOPQ. Early treatment, while the toes are still flexible, offers the best results and helps avoid surgery.
Treat your hammer toes
Book an appointment with a orthotist for a comprehensive evaluation and custom orthotics.
Frequently asked questions about hammer toe
What is hammer toe?
Hammer toe is a deformity in which one or more toes bend in flexion at the proximal interphalangeal joint, giving the toe a hammer or claw shape. The second toe is most often affected.
What is the difference between hammer toe and claw toe?
Hammer toe shows flexion of the middle joint of the toe while the base is in extension. Claw toe involves flexion of both distal joints with hyperextension of the base. Both are treated with orthotics.
Can a foot orthotic straighten a hammer toe?
The foot orthotic does not directly straighten the toe, but it addresses the biomechanical causes of the deformity. By restoring muscular balance in the foot and redistributing pressure, it slows progression and relieves pain.
Does hammer toe require surgery?
No, in early stages. As long as the toe remains flexible (reducible), conservative treatment with orthotics, exercises and adapted footwear is effective. Surgery is only considered for rigid, painful deformities.
What are the complications of untreated hammer toe?
Without treatment, the toe can become rigid and irreducible, develop painful corns on top of the joint, cause calluses under the forefoot and worsen conditions like metatarsalgia and hallux valgus.
How can I prevent a hammer toe from worsening?
Wear wide-toe shoes with enough height for the toes, use custom foot orthotics, practise toe flexibility exercises and avoid high-heeled shoes that compress the forefoot.