Treatment of Hammer Toes

Hammer toes are a common forefoot deformity in which one or more lesser toes bend at the middle joint, producing pain, corns, and difficulty with footwear. Treatment focuses first on relieving symptoms and preventing progression with conservative measures, and only then on corrective surgery if deformity and pain persist.

Goals of treatment

Management of hammer toes aims to:

• Reduce pain and pressure from shoes and ground contact.
• Correct or control the deforming forces (muscle imbalance, tight tendons, poor footwear).
• Prevent secondary problems such as corns, calluses, ulceration, and difficulty walking.
• Straighten the toe and restore function when possible, particularly with surgery in rigid cases.

The choice between non‑surgical and surgical treatment depends mainly on whether the toe is still flexible, the intensity of pain, and the impact on daily activities.

Conservative (non‑surgical) treatment

Non‑surgical treatment is the first line for flexible or mildly symptomatic hammer toes and often gives substantial relief.

1. Footwear modification
   • Patients are advised to avoid tight, narrow, and high‑heeled shoes that crowd the toes and increase pressure on the bent joint.
   • Recommended shoes have a wide, deep toe box and low heels, and are about half a size longer than the longest toe so that there is space for the deformity and any protective padding.
2. Padding, cushioning, and taping
   • Soft pads, sleeves, or cushioning over the prominent joint redistribute pressure and reduce friction, which helps relieve pain and prevents corns and calluses.
   • Taping or splinting the toe can hold it in a straighter position, temporarily correcting muscle imbalance and lessening irritation in shoes.
3. Orthotic devices and shoe inserts
   • Prefabricated or custom orthotic insoles support the arch and alter load distribution, reducing stress on the metatarsal region and toe joints
   • By improving foot biomechanics, orthotics may slow progression of the deformity, especially when hammer toe is associated with flat feet or other structural problems.
4. Exercises and stretching
   • Toe‑strengthening and stretching exercises are often prescribed when the toe is still flexible, such as picking up marbles with the toes or scrunching a towel, to improve intrinsic muscle balance.
   • Gentle manual stretches of the affected toe and calf‑muscle stretching can help reduce tendon tightness and maintain joint motion.
5. Medications and injections
   • Oral non‑steroidal anti‑inflammatory drugs (NSAIDs) can reduce pain and inflammation around the affected joints in symptomatic periods.
6. Skin and nail care
   • Regular debridement of corns and calluses by a podiatrist, combined with ongoing padding and proper footwear, reduces pain and risk of skin breakdown.
   • Patients at higher risk, such as those with diabetes or poor circulation, need careful monitoring to prevent ulcers over the prominent joints

Conservative care of hammer toes does not typically “reverse” an established deformity, but it often controls symptoms sufficiently that many patients avoid or delay surgery.

Indications for surgery

Surgery is considered when non‑surgical measures fail and the patient continues to have significant pain, difficulty wearing shoes, or functional limitations. Rigid toes that cannot be passively straightened, recurrent corns despite adequate footwear, and deformities causing ulceration are common indications.

Before surgery, clinicians assess:

• Flexibility of the toe (flexible vs fixed deformity).
• Condition of adjacent joints and overall foot alignment.
• Patient health, activity level, and expectations for recovery.

Most procedures are performed as day surgery with local or regional anesthesia.

Surgical techniques

The specific operation is tailored to the severity and rigidity of the toe deformity.

1. Soft‑tissue procedures (flexible hammer toes)
   • In flexible deformities, the main problem is often tendon and ligament imbalance, so operations aim to lengthen or transfer tendons without removing much bone.
   • Tendon lengthening reduces the excessive pull that keeps the toe bent, while tendon transfer (typically from the underside of the toe to the top) repositions the tendon so that it helps straighten and hold the toe down.
2. Bone procedures and joint resection (rigid hammer toes)
   • When the joint is stiff and fixed, surgeons may remove a small piece of bone from the proximal phalanx or the joint surfaces (arthroplasty) to allow the toe to straighten.nyp+3
   • In more severe deformities, the joint may be fused (arthrodesis) using pins, screws, or other implants, so the bone ends heal together into a single, straight segment that eliminates the painful motion.
3. Fixation and minimally invasive methods
   • Temporary pins are sometimes placed across the joint to maintain alignment while soft tissues and bone heal; they are usually removed after a few weeks once stability is achieved.
   • Some centres use key‑hole or minimally invasive techniques with small skin portals to cut bone and release soft tissues, aiming for less postoperative pain and swelling and quicker recovery.

Overall, the goal of surgery is to correct the deformity sufficiently to relieve pain and allow comfortable shoe wear, rather than to create a perfectly “normal‑looking” toe.mayoclinic+2

Postoperative care and outcomes

After hammer toe surgery, patients typically go home the same day in a protective shoe, with instructions to elevate the foot and limit weight‑bearing initially. Stitches and any external pins are removed after a short healing period, and patients gradually progress to normal footwear as swelling and tenderness settle, often over 4–6 weeks, with fuller return to all footwear and activities by around three months depending on the procedure.

Pain usually decreases significantly once healing has occurred, and most patients report improved shoe comfort and walking ability. However, there are recognised risks, including infection, stiffness, residual deformity, recurrence, or dissatisfaction with toe appearance, so careful patient selection and realistic preoperative counselling are essential. Even after surgery, ongoing attention to shoe choice and, where appropriate, orthotics and exercises remains important to protect the operated toe and prevent problems in adjacent toes.