The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Foot & Ankle

Hammertoe Deformity

Hammertoe is the most common lesser-toe deformity in adults, and yet it is frequently dismissed as merely cosmetic. When progressive or rigid, hammertoe causes painful corns, shoe-fitting difficulties, and can lead to joint dislocation if untreated. Maryland Orthopedic Specialists evaluates the full spectrum of toe deformity — from flexible hammertoes correctable with conservative measures to rigid deformities requiring surgical correction.

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What is hammertoe deformity?

Lesser-toe deformities involve abnormal flexion or extension contractures at one or more toe joints. Three clinically distinct patterns exist: Hammertoe: Flexion deformity at the proximal interphalangeal (PIP) joint with extension at the metatarsophalangeal (MTP) joint. The toe adopts a "hammer" shape.

Lesser-toe deformities involve abnormal flexion or extension contractures at one or more toe joints. Three clinically distinct patterns exist:

Hammertoe: Flexion deformity at the proximal interphalangeal (PIP) joint with extension at the metatarsophalangeal (MTP) joint. The toe adopts a "hammer" shape. The most common of the three patterns.

Mallet toe: Isolated flexion deformity at the distal interphalangeal (DIP) joint. The tip of the toe curls downward. The PIP joint is uninvolved.

Claw toe: Flexion deformity at both the PIP and DIP joints, with MTP dorsiflexion/extension. Most severe pattern; often associated with neuromuscular conditions (Charcot-Marie-Tooth, cavus foot), rheumatoid arthritis, or severe progressive hallux valgus.

Contributing Factors

  • Hallux valgus (bunion): A deviated great toe crowds the 2nd toe, progressively forcing it into a hammered posture. Hammertoe is very commonly a secondary consequence of an untreated bunion.
  • Tight footwear and high heels: Narrow toe boxes compress the toes laterally; high heels load the MTP joints and force lesser toes against the shoe tip, encouraging buckling.
  • Intrinsic muscle weakness: Relative imbalance between intrinsic foot muscles (which extend the IP joints) and extrinsic flexors/extensors perpetuates deformity.
  • Inflammatory arthritis: Rheumatoid and psoriatic arthritis cause synovitis and ligament destruction at the MTP joint, leading to dorsal subluxation and claw toe deformity.

Flexible vs. Rigid

This distinction drives management:

  • Flexible deformity: the toe can be manually corrected to a neutral position. Responsive to conservative treatment.
  • Rigid deformity: contracture is fixed and non-reducible. Surgical correction is required for symptomatic relief.

Treatment options

Treatment depends on whether the toe can still be straightened by hand (flexible) or is fixed in the bent position (rigid).

Non-Operative Management

For flexible hammertoes, wider shoes that give the toes room to extend relieve most of the discomfort. Silicone toe sleeves and pads cushion the top of the toe where it rubs in the shoe. Taping or splinting helps hold the toe in a more corrected position, particularly overnight.

Surgical Procedure

Hammertoe Correction

Correction of flexible or rigid hammertoe deformities using arthroplasty (joint resection) or arthrodesis (joint fusion), matched to the degree of rigidity. Frequently combined with bunion surgery for complete forefoot realignment.

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Frequently Asked Questions

Will my hammertoe keep getting worse?
Flexible hammertoes tend to progress to rigid deformities over years, especially if contributing causes (bunion, footwear habits) are not addressed. Conservative care slows progression; it does not reverse an established structural deformity.
Can I have both my bunion and hammertoe corrected at the same time?
Yes — simultaneous correction is commonly performed and is often preferable. Correcting the hallux valgus eliminates the deforming force on the 2nd toe, improving hammertoe outcomes and reducing recurrence.
What is a "floating toe" after surgery?
A floating toe is a common outcome of PIP resection arthroplasty where the straightened toe does not fully contact the ground. It is generally painless and cosmetically acceptable, but some patients prefer fusion to maintain a more "grounded" toe.
How long is recovery after hammertoe surgery?
Recovery after hammertoe correction typically requires four to six weeks of protected weight-bearing in a surgical shoe, during which you can walk but should limit prolonged standing. Swelling in the toe can persist for three to six months, and it may take up to a year for the final surgical result to be fully apparent. If a pin was used to hold the toe straight during healing, it is usually removed in the office at four to six weeks. Your MOS surgeon will guide you through each stage of recovery and advise when you can return to normal footwear.
Can hammertoes be prevented from coming back after surgery?
Hammertoe recurrence is less likely when the underlying cause — such as abnormal foot mechanics, a too-long second toe, or an untreated bunion — is also addressed at the time of surgery. Wearing properly fitted, wide-toed footwear after recovery is one of the most important steps to prevent recurrence. Avoiding shoes with a narrow toe box or high heels significantly reduces the forces that cause the toes to buckle over time. Your MOS care team will provide guidance on footwear and foot care to protect your surgical result long-term.

Meet the specialists

Gary Feldman, DPM, FACFAS

Gary Feldman, DPM, FACFAS

Podiatry (Foot & Ankle Surgery)

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Related conditions

Bunion (Hallux Valgus)Metatarsalgia
Medically reviewed by Gary Feldman, DPM, FACFAS, DPM, FACFAS
Last reviewed May 1, 2026

References

  1. Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot & Ankle International. 2000;21(2):94–104. doi:10.1177/107110070002100203
  2. Schrier JC, Louwerens JW, Verheyen CC. Opinions on lesser toe deformities and hammertoe surgery among Dutch orthopaedic surgeons and podiatric surgeons. Foot & Ankle International. 2007;28(2):172–179. doi:10.3113/FAI.2007.0172
  3. Shirzad K, Kiesau CD, DeOrio JK, Parekh SG. Lesser toe deformities. Journal of the American Academy of Orthopaedic Surgeons. 2011;19(8):505–514. doi:10.5435/00124635-201108000-00006
  4. OrthoInfo — AAOS. Hammertoe. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/hammertoe