Hammertoes occur when the smaller toes of the foot
become bent and prominent. The four smaller toes of the foot are
much like the same fingers in the hand. Each has three bones
(phalanges) which have joints between them (interphalangeal
joints). The toes form a joint with the long bones of the foot
(metatarsals) and it is this area that is often referred to as the
ball of the foot.
Normally, these bones and joints are straight. A hammertoe
occurs when the toes become bent at the first interphalangeal
joint, making the toe prominent. This can affect any number of the
lesser toes. In some cases, a bursa (rather like a deep blister) is
formed over the joint and this can become inflamed (bursitis). With
time, hard skin (callous) or corns (condensed areas of callous) can
form over the joints or at the tip of the toe.
What causes hammertoes?
There are many different causes but commonly it is due to shoes
or the way in which the foot works (functions) during walking. If
the foot is too mobile and / or the tendons that control toe
movement are over active, this causes increased pull on the toes
which may result in deformity.
In some instances trauma (either direct injury or overuse from
walking or sport) can predispose to hammertoes. Patients who have
other conditions such as diabetes, rheumatoid arthritis and
neuromuscular conditions are more likely to develop hammertoes.
Are women more likely to get the problem?
It is more common in women as they tend to wear tighter,
narrower shoes with increased heel height. These shoes place a lot
of pressure onto the joint and predispose to deformity. It is
common for patients to wear shoes that are too small and this can
predispose to the problem. In a study we have performed, 95% of
patients were in the wrong size shoes.
Will it get worse?
At the start of the deformity, it is generally mobile which
means that the toe can be straightened. However, with time, the
joint become fixed or rigid. This can then affect the joint at the
ball of the foot and, in severe cases, the joint capsule ruptures
(tears) so that the joint becomes dislocated and the toe sits up in
What are the common symptoms?
- Deformity / prominence of toe
- Redness around the joints
- Swelling around the joints
- Corn / Callous
- Difficulty in shoes with deformity of the shoe upper
- Difficulty in walking
- Stiffness in the joints of the toe
How is it recognised?
Clinical examination and a detailed history allow diagnosis.
X-rays are often not required but can help to evaluate the extent
of the deformity and the degree of arthritis within the joint.
What can I do to reduce the pain?
There are several things that you can do to try and relieve your
- Wear good fitting shoes with a deep toe box
- Avoid high heels
- Use a toe prop to straighten the toe if it is still mobile
- Wear a protective pad over the toe
- See a podiatrist
What will a podiatrist do?
If simple measures do not reduce your symptoms, there are other
- Advise appropriate shoes
- Advise exercises if the toes are still mobile
- Show you how to strap the toe in a corrected position
- Provide a splint or protection
- Consider prescribing orthotics
- Advise on surgery
The way in which your foot loads during walking can place
increased stress on the ball of the foot and cause increased toe
activity. Special shoe inserts (orthotics) can
help to control foot movement. Whilst these are unlikely to resolve
established deformity they may help reduce discomfort in the ball
of the foot.
Will this cure the problem?
If the deformity is mobile, then this may help prevent
progression although there have been no scientific studies to
analyse the benefit. If the deformity is fixed, then orthotics will
not cure the problem but may reduce the associated symptoms.
What will happen if I leave this alone?
Generally, the deformity becomes worse with time and slowly
becomes fixed (stiff). This can cause discomfort in shoes. The
position of the toe places increased stress on the ball of the foot
and this can become painful. Corn and callous formation on the ball
of the foot is not uncommon. In some cases, the metatarsophalangeal
joint capsule ruptures, causing the toe to sit up in the air.
How can I cure the deformity?
The only effective way of correcting the deformity is to have an
How does the operation correct the deformity?
There are a number of different operations. However, the most
common operations are:
- Tendon transfer
- Digital arthroplasty
- Digital arthrodesis
Tendon transfers involve taking the tendon from under your toe
and re-routing it to the top of the toe so that the toe is pulled
down. This can be used alone if the toe is mobile or in combination
with the other two procedures. This can leave the toe a bit swollen
Digital arthroplasty and arthrodesis involve the removal of bone
from the bent joint to allow correction. An arthroplasty removes
half the joint and leaves some mobility whilst an arthrodesis
removes the whole joint and, following a period of time with a
wire/pin protruding from the end of the toe, leaves the toe
In more severe cases, the tendon on the top of the toe and the
joint at the ball of the foot need to be released to allow the toe
to straighten. If there is severe stiffness at this joint, then the
base of the bone at the bottom of the toe (phalanx) may need
removing (basal phalangectomy) or the metatarsal shortened (Weil
I have heard it is very painful.
The nature of surgery means that there will be pain and
swelling, usually worse the night after surgery. However, with
modern anaesthetic techniques and pain killers, this can be well
controlled. The level of pain experienced varies greatly from
patient to patient with some experiencing no significant
Will I have to have a general anaesthetic (be asleep)?
Not if you did not want one. Many of these procedures are
performed perfectly safely under local anaesthetic (you are awake).
Some patients worry that they may feel pain during the operation
but it would not be possible to perform the operation if this were
Will I have to stay in hospital?
No. As long as you were medically fit and have adequate home
support, many patients are able to have this type of operation
performed as day surgery and go home.
Will I have to have a plaster cast?
Plaster casts are generally not required for this type of
Are there a lot of complications?
There are risks and complications with all operations and these
should be discussed in detail with your specialist. However, with
most foot surgery it is important to remember that you may be left
with some pain and stiffness and the deformity may reoccur in the
future. This is why it is not advisable to have surgery if the
deformity is not painful and does not limit your walking. A
thorough examination of your foot and general health is important
so that these complications can be minimised.
Although every effort is made to reduce complications, these can
occur. In addition to the general complications that can occur with
foot surgery, there are some specific risks with toe surgery:
- Persistent swelling which may be permanent
- Recurrence of deformity / corn (this tends to be more of a
problem with the little toe)
- Regrowth of removed bone
- Residual pain
- Stiffness or flail (floppy) toe
- The toe may not sit on the ground - floating toe (there is an
increased risk of this with arthrodesis)
- You may get discomfort in other parts of your foot during the
recovery period. This generally settles.
- There is always a possibility that the deformity may return in
- You may develop a mallet toe
deformity in the long term
When will I be able to walk again and wear shoes?
In the majority of cases, you will able to walk with the aid of
crutches within 2-4 days but you will remain somewhat limited for
the first 2 weeks.
Some patients are able to return to wider shoes within two weeks
with 60% of patients in shoes at 6 weeks and 90% in 8 weeks. This
period is longer for arthrodesis as shoes cannot be worn until the
wire/pin has been removed (generally 3-6 weeks).
Swelling generally starts to reduce at 6-8 weeks and the foot
will be beginning to feel more normal at 3 months although the
healing process continues for 1year.
When will I be able to drive again?
When you feel able to perform an emergency stop. This is
generally between 4-8 weeks post operatively but you should always
check with your insurance company first.
When will I be able to return to work?
If you are able to get a lift and have a job that is not active
and you can elevate your foot, you may be able to return after 1-2
weeks. Generally, patients return to work between 4-8 weeks
depending on the type of job, activity levels and response to
When will I be able to return to sport?
Although the healing process continues for up to 1 year, you
should be able to return to impact type activity at around 3
months. This will depend on the type of operation you have and how
you respond to surgery.