What Causes Hammertoe and What Are My Treatment Options?

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Does it look like one of your toes is trying to make a fist? You might have a hammertoe. Here’s what causes this common foot condition and what you can do about it.

If you have a toe or two that look like they’re trying to make a fist or clutch an object, you may have a common foot deformity called hammertoe or mallet toe. This condition is often hereditary. 

At the Ankle and Foot Institute of Texas in Saginaw, we see a lot of patients with hammertoes, and one of the most frequent questions we get is: What caused it? The next question is: Can you fix it? Here, Dr. Matthew Cerniglia and our team take a deeper dive into hammertoe causes and treatments, starting with a quick anatomy lesson.

Your foot anatomy

Your middle three toes have three joints: One connects your toe to your foot, the second bends back at the center of your toe, and the third bends forward near the tip. 

The middle joint is the one we’re covering today. Called the proximal interphalangeal (PIP) joint, it’s particularly vulnerable to problems in your gait, such as imbalance. 

You have two muscles that work in pairs to keep each toe straight when at rest and to flex them when you walk. Damage or changes to these muscles and the supporting tendons can lead to hammertoe.

Common causes of hammertoe

Anything that forces your toes to bend and stay in an unnatural position for long periods can eventually cause them remain bent permanently — hammertoe. Some of the most common cause of hammertoe are:

Wearing the wrong shoes

Supportive footwear that keeps your arch well-positioned and gives your toes enough room to wiggle is essential for foot health. 

Wearing extremely narrow shoes, especially if they have high heels, forces your toes into an unnatural, cramped environment, causing your toes to fold up in a bent position. Over time, the muscles and tendons shorten and tighten, making it impossible to straighten.


When arthritis attacks your joints, it causes inflammation and stiffness. These changes weaken your joints and the soft tissues in and around them, leaving you at high risk for toe deformities such as bunions and hammertoe.

Physical problems

Sometimes, a hammertoe develops even in people who wear supportive shoes and have no arthritis. Genetic makeup, traumatic injury, neurological issues, and age-related changes in gait can all lead to abnormal contracture of the muscles and lead to hammertoe.

Bunions and corns

Certain foot conditions that seem minor and merely cosmetic at first glance may lead to hammertoes over time. For example, a bunion, which results when the bones in your big or little toe shift out of alignment, can alter the way you walk and shift your balance. This, in turn, puts excess pressure on your middle toes and may lead to hammertoe.

Likewise, corns and calluses that build up on the skin where your toes rub together or against your shoes can lead to the formation of hammerotes. Conversely, hammertoes can also cause corns, calluses, and bunions to develop. 

How we treat hammertoe

If your hammertoe is mild, you may be able to correct it with some simple lifestyle changes. Here are few things to try:

  • Ditch your high heels and narrow shoes
  • Use padding to cushion corns, calluses, and bunions
  • Get some custom-made orthotics that slip into your shoes and support your arches
  • Reduce inflammation with OTC medication
  • Stretch and strengthen your toe muscles by using them to pick up small objects

These remedies take the pressure off your toes, allow the tendons and muscles to flex and stretch, redistribute your body weight, and reestablish proper balance and gait. 

If these measures don’t work, you may need surgery to resolve your hammertoe. There are three main types of surgery Dr. Cerniglia may recommend:

Surgery to lengthen your tendon

If your toe joint is still somewhat flexible, Dr. Cerniglia may surgically lengthen the tendon to restore full mobility.

Tendon transfer surgery

If your tendon is too tight and short, Dr. Cerniglia may need to transfer a tendon from the bottom of your toe to the top side to enable full function again.

Joint fusion surgery

For hammertoe joints that are rigid, you may need both a tendon-lengthening procedure and a joint fusion procedure together. Dr. Cerniglia removes a small portion of the bone tissue so the toe can extend fully. He then implants a pin, plate, or wire to keep it stable as it heals and fuses. 

To find out how far your hammertoe has progressed and which treatment is right for you, book an appointment by phone or online with Dr. Cerniglia at the Ankle and Foot Institute of Texas today, and stop hobbling around on painful, bent toes.