The Many Causes of Hammertoe and How It's Treated

A hammertoe is a foot deformity that occurs on the second, third, and/or fourth toes on either or both feet. The toe bends upward at the middle joint, also called the proximal interphalangeal (PIP), giving the whole toe a hammer-like appearance. 

Hammertoes can be flexible, where you can move the joint; these are easily correctable. Or, they can be rigid, which requires surgery.

At Florida Foot & Ankle, podiatrist Dr. Mark A. Matey and our staff understand just how unsightly and uncomfortable hammertoes can be, which is why they provide a number of conservative and surgical options for treating them. 

Most of our patients want to know what caused the condition and what their treatment options are. Here’s what the experts have to say.

The many causes of hammertoe

Hammertoes develop due to an imbalance of muscles and tendons in the toes. The toe muscles work in pairs to flex and extend the digit. When the pairs don’t sync properly, they put pressure on the tendons and joints, pushing and pulling soft tissue and bones into a hammertoe formation. 

If the toe stays in the hammertoe position long enough, it can become rigid, and you won’t be able to straighten it.

The muscle imbalance can happen for any number of reasons:

• Shoes with small toe boxes (squeeze toes together)
• High-heeled shoes, especially pointy-toed ones (push body weight onto toes)
• Genetics
• Arthritis
• High arches
• Flat feet
• Feet that rotate inward when you walk
• Long toe bones
• Bunions
• Trauma, such as stubbing or breaking your toe
• Preexisting diseases like arthritis or diabetes

Hammertoes can also develop if you have a strong tendon holding the toe straight. If it tugs too strongly, it can pull the toe out of position.

Women are more likely than men to get hammertoes because of the kinds of shoes they wear.

Hammertoe symptoms

The most characteristic symptom of a hammertoe is the hammer-like shape of the middle toes. Shoes with narrow toe boxes or heels that push your weight forward squish the toes together until the pressure forces the middle three toes into the bent position. 

Bunions (misaligned metatarsophalangeal joint) on the big toe (and tailor’s bunions on the pinky toe) cause the toes to push against the ones next to them, sometimes sliding under the adjacent toe so it has to bend at the PIP joint to accommodate the pressure from below.

It’s possible you may not experience any symptoms other than the bending, but it’s quite common for the hammertoe to cause pain, both at the PIP joint and around the ball of your foot.

Other symptoms include:

• Restricted motion
• Redness or swelling around the joint (inflammation)
• Blisters, corns, and calluses where the joint rubs against the top of shoes
• Trouble walking

Symptoms vary from mild to severe, usually depending on how flexible the hammertoe is.

Hammertoe treatments

It doesn’t matter whether your hammertoe is flexible or rigid — we can treat it successfully. We always start with conservative treatments, including:

• Shoes with larger toe boxes
• Shoes with added depth
• Orthotics (shoe inserts)
• Physical therapy (toe muscle stretches)
• Over-the-counter anti-inflammatory medication

Dr. Matey might also administer cortisone injections. Cortisone is a steroid. When injected into the affected joint, it can reduce inflammation and related swelling, decreasing your pain and discomfort. 

It’s a short-term solution, but it may give you enough time to master stretching exercises and get a pair of proper shoes so the joint no longer bothers you.

If you have a rigid hammertoe with a great deal of pain, or if you have an open sore on the top of the toe from rubbing against the shoe, Dr. Matey may recommend a surgical option.

There’s no reason you have to struggle with the pain and discomfort of hammertoe. Florida Foot & Ankle can help. To get started, give us a call at 904-268-3686, or book a consultation online today with one of our two Jacksonville, Florida, locations.