Hammertoe
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Hammertoe is a bend in one of your four smaller toes. The middle joint of the toe bends down, so the toe looks like a hammer. One or more toes can be affected. Some people have no symptoms at all, while others get pain, or corns and calluses (patches of hard skin) where the toe rubs on a shoe. The toe is usually flexible at first, but it can become fixed in its bent position if it is left untreated. Care usually starts without surgery, with roomier shoes, pads, taping or shoe inserts. Surgery is kept for people who don't improve.
What is it?
Hammertoe is a change in the shape of one of your four smaller toes. The middle joint of the toe (the PIP joint) bends down, and the toe ends up looking like a hammer. Sometimes the joint where the toe meets your foot is also bent up, but not always. It can happen in one toe or in several.
The toe is usually flexible to begin with, which means you can still straighten it with your hand. Over time it can become fixed in its bent position, particularly if nothing is done about it.
It comes from an imbalance between the muscles and tendons that hold the toe straight and those that bend it. The bending side wins, and the toe curls.
Who does it affect?
Any of the four smaller toes can be affected. A hammered second toe is often seen together with a bunion (a bump at the base of the big toe).
Some things make it more likely. These include a bunion, arthritis such as rheumatoid arthritis, a past toe injury, and conditions that affect the nerves, brain or spinal cord, such as cerebral palsy, Charcot-Marie-Tooth disease or muscular dystrophy. Nerve damage from diabetes can also play a part. Poorly fitting shoes are linked to it too, and so is the shape of your feet that you inherit from your family.
Signs and symptoms
The most obvious sign is that the toe looks different. Some people have a changed toe shape and no other problem.
Others have:
- pain or irritation when wearing shoes
- redness or swelling around the joint
- corns or calluses on the top of the toe joints or at the tip of the toe
- a stiff toe that doesn't move as well as the others
- a change in the way you walk, because your smaller toes help with walking and balance
A corn or callus forms because the bent toe rubs on the inside of your shoe or takes extra pressure.
What causes it?
The basic cause is the muscle and tendon imbalance described above. Several things can set it off.
Tight shoes, narrow pointed toe boxes and high heels are often blamed. People whose shoes don't fit well are more likely to have toe deformities, corns and calluses. Even so, it isn't proven that shoes alone cause hammertoe.
Other causes include a bunion, an inflammatory condition such as rheumatoid arthritis, an injury to the toe, and nerve or neurological conditions. Poor blood supply to the foot and diabetes can also contribute. Often it is a mix of causes, and it is hard to say exactly which one started it for you.
How is it diagnosed?
Your podiatrist can usually tell from looking at your toe and asking about your symptoms. They will see which toe and which joint is bent, where corns or calluses sit, and whether your shoes rub. They will also check whether the toe still straightens and moves, and how you walk.
Bring the shoes you wear most often. An X-ray is used if surgery is being considered.
Your podiatrist will also think about other problems that can look or feel similar:
- Mallet toe: a similar bend, but at the joint nearest the tip of the toe.
- Claw toe: the joint where the toe meets the foot bends up, while the other two joints bend down.
- Morton's neuroma: a burning or shooting pain, often with less feeling, between the 3rd and 4th toes. It gets worse on walking and eases with rest or when you take your shoe off.
- Other conditions: inflammatory arthritis, gout, osteoarthritis, sesamoiditis (pain under the big toe joint) and nerve pain can sometimes be mistaken for hammertoe.
If arthritis could be involved, your practitioner will rule it out and may refer you to a rheumatologist (an arthritis specialist).
Treatment
Treatment starts without surgery. The aim is to take pressure off the toe and ease the bend with simple aids. It isn't yet known which of these options works best, so your podiatrist will help you find what suits your toe.
Looking after it at home
The most useful step is the right footwear. Look for shoes with:
- a soft upper (the top part of the shoe)
- a wide and deep toe box (the part around your toes), with extra depth above the toes
- laces or Velcro, which stop your foot sliding forward and reduce the work your toes do
- no seams over the sore area
Avoid narrow shoes. Have your feet measured, so you know your size and foot width.
If you use ice on sore toes, never put it over numb skin or open wounds. Keep each session to about 10 to 20 minutes, and stop if pain, swelling or skin soreness gets worse.
Treatment from your podiatrist
Your podiatrist can give you advice on footwear and fitting. They may suggest silicone gel pads to cushion the toe, or taping or strapping to hold it in a better position. Shoe inserts (orthotics) are another option. All of these aim to ease pressure and help correct the bend.
If you have diabetes and are at moderate or high risk of foot ulcers, your foot-care team can arrange properly fitting therapeutic footwear. This is footwear chosen or made to protect your feet. They may also coach you to check the temperature of your foot skin. If you have had a foot ulcer on the sole before, you should have footwear shown to take pressure off the sole as you walk.
Other options
For a related problem, claw toe, injections of botulinum toxin are tried before surgery. Ask your podiatrist whether anything like this could suit you.
Surgery
Surgery is kept for people who haven't improved with the steps above and still have pain. Your podiatrist may refer you to a surgeon. You will usually have an X-ray first. Surgery is also considered if the bent toe is part of a high-arched foot.
Several operations exist. For claw toe, none is known to be best at fully correcting the toe. For people with diabetes who have a toe that can still be moved and a sore or hard patch at risk of becoming an ulcer, cutting the tendon that bends the toe may be considered.
Infection is one possible complication. Smoking and diabetes raise the risk, so talk about this with your surgeon before you decide. It also helps to ask what operation is planned, how long recovery takes and what the risks are. Keep a note of what you have tried, such as shoe changes, pads, inserts and podiatry care, and for how long.
Recovery
A flexible toe can become fixed over time, so it helps to deal with early changes promptly. Well-fitting shoes with a soft upper, a wide toe box, extra depth and laces reduce pressure and rubbing on the toe.
How long recovery takes isn't clear yet, and it will depend on your toe and the care you have. Ask your podiatrist what to expect. If your symptoms haven't changed after six to twelve weeks of looking after your toe yourself, get it reviewed.
Preventing it
The best step you can take is to wear shoes with room for your toes in both width and length. Replace shoes that are narrow or that rub on your toe. It isn't yet clear whether better shoes stop a hammertoe coming back, but they do reduce pressure and friction.
Having your feet measured helps you choose the right size. Look at your feet regularly for cuts, blisters, sores or colour changes, especially if feeling in your feet is reduced.
When to see a podiatrist
Book an appointment if
Your toe has changed shape and is painful, or rubs on your shoes or has corns or calluses. Also book if the bend is staying the same or getting worse, as a flexible toe can become fixed if it is left. See your podiatrist or GP soon if your symptoms haven't changed after six to twelve weeks of looking after the toe yourself, or if your pain gets a lot worse after doing exercises for it. If you have diabetes or reduced feeling in your feet, book a regular foot check with your podiatrist or GP, and see your podiatrist or GP soon if a corn or callus forms over a bent toe.
Seek prompt assessment if
Your foot or toes suddenly turn cold and pale or blue, with pain or numbness, or you suddenly can't move your leg or foot: call your local emergency number. Also call if you have a foot wound or infection and feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, as this could be sepsis.
You have an open sore or wound on your foot, or the colour or blood flow of a toe seems to change: take the weight off the foot and see your podiatrist or GP today. If you have diabetes or reduced feeling in your feet, this matters even more, including any new wound or spreading redness. Your toe also looks bent after an injury: see your GP or another doctor today, as an injury can cause a different problem. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
Your bent toe comes with symptoms elsewhere in your body, such as several swollen joints: see your GP soon, so that conditions such as inflammatory arthritis can be ruled out.
Frequently asked questions
What is the difference between hammertoe, mallet toe and claw toe?
It depends on which joints are bent. In hammertoe, the middle joint of the toe bends down. In mallet toe, the joint nearest the tip bends. In claw toe, the joint where the toe meets the foot bends up, while the other two joints bend down. Not everyone defines these exactly the same way, so your podiatrist can explain what applies to your toe.
Why does my second toe curl with a bunion?
A bent second toe often shows up together with a bunion. The shape or position of your big toe can change how much space your smaller toes have, and that may push them out of position. If you have a bunion, mention it to your podiatrist, as it can be part of the picture.
Is hammertoe riskier if I have diabetes?
It can be. Around 1 in 10 people with diabetes develop a foot ulcer, and a corn or callus over a bent toe can break down into one. Guidelines recommend a yearly foot check if your risk is very low, and more often if it is higher. They also recommend learning how to care for your feet and not walking without suitable foot protection.
What should I bring to my podiatry appointment?
Bring the shoes you wear most often. It also helps to note which toe is affected, where any corns or calluses are, whether your shoes rub, and any stiffness or change in how you walk. Mention any bunion, arthritis, nerve or neurological condition, or past toe injury, as these can contribute.