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Hammer Toe Deformity


James C. Connors

, DPM, Kent State University College of Podiatric Medicine

Reviewed/Revised Nov 2023
Topic Resources

Hammer toe deformities result from an imbalance of the digital extensor and flexor tendons that typically causes a contracture at the proximal interphalangeal joint. This progresses to a rigid Z-shaped deformity that can lead to dorsal subluxation and eventual dislocation at the metatarsophalangeal joint. Diagnosis is clinical. Weight-bearing radiographs are helpful to determine severity. Treatment is modification of footwear, taping/splinting, and/or orthotics.

The usual cause of hammer toe deformity is a tendon imbalance that leads to a misalignment of the joint surfaces. This imbalance may originate as an injury or is due to a genetic predisposition toward aberrant foot biomechanics and tendon contractures. Rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is a chronic systemic autoimmune disease that primarily involves the joints. Rheumatoid arthritis causes damage mediated by cytokines, chemokines, and metalloproteases.... read more Rheumatoid Arthritis (RA) and neurologic disorders such as Charcot-Marie-Tooth disease (see Hereditary Neuropathies Hereditary Neuropathies Hereditary neuropathies include a variety of congenital degenerative peripheral neuropathies (eg, Charcot-Marie-Tooth disease). (See also Overview of Peripheral Nervous System Disorders.) Hereditary... read more ) are other causes. The second toe is the most common digit to develop a hammer toe deformity (see figure ). Second digit hammer toes commonly result from an elongated second metatarsal and from pressure due to an excessively abducted great toe (hallux valgus deformity or bunion Bunion Bunion is a prominence of the medial portion of the head of the first metatarsal bone. The cause is often variations in position of the first metatarsal bone or great toe, such as lateral angulation... read more Bunion ). Unusually long toes often develop hammer toe deformities.

Painful corns Calluses and Corns Calluses and corns are circumscribed areas of hyperkeratosis at a site of intermittent pressure or friction. Calluses are more superficial, cover broader areas of skin, and are usually asymptomatic... read more Calluses and Corns often develop in hammer toe deformity, particularly at the dorsal aspect of the proximal interphalangeal joint or the dorsal lateral aspect of the fifth toe. Reactive adventitial bursas often develop beneath corns, which may become inflamed. Calluses may develop on the plantar aspect adjacent to the metatarsal head. As the deformity becomes more rigid, the altered function of the toe creates a retrograde buckle force at the metatarsal head causing excessive plantar pressure during ambulation. This leads to both sagittal and transverse plane deformity of the toe at the metatarsophalangeal joint.

How to Examine the Foot
How to Examine the Ankle

Hammer Toe

In hammer toe, usually the second toe, or sometimes another lesser toe, develops a fixed Z-shaped deformity.

Hammer Toe

Treatment of Hammer Toe Deformity

  • Wide toe box, taping/splinting, toe pads, orthotics, or a combination

People with hammer toe should wear shoes with a wide toe box. Taping/splinting the toe in plantarflexion may decrease the deformity temporarily. Toe pads sold in pharmacies also help by shielding the affected toes from the overlying shoe. If conservative measures are ineffective, surgical correction of the deformity often relieves symptoms. If there is accompanying metatarsalgia, over-the-counter or prescription orthotic devices with metatarsal pads and cushioning may help alleviate the pain.

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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