A hammer toe is a toe that is contracted at the middle joint in the toe (PIP joint), potentially leading to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards into a hammer-like shape. Hammer toes may occur in any toe except the big toe. There is often discomfort at the top part of the toe due to rubbing against the shoe. The risk of hammer toes is higher for people with bunions. Also, risks are increased for patients with diabetes and diseases that affect the muscles and nerves of the feet. There are 2 types of hammer toes—flexible and rigid. A flexible hammer toe can be straightened manually. In a rigid hammer toe, the movement is very limited and can be extremely painful.
For a flexible hammer toe, a toe pad and shoes with wide deep toe box may help relieve the pain. As the toe stiffens, other treatments, including exercises, splints, and custom-made orthotics may help to ease the position of the toe.
Surgery may be needed in severe cases. If the toe is still flexible, only a simple procedure that releases the tendon may be involved. If the toe has become rigid, surgery on the bone is necessary. A procedure called PIP arthroplasty involves releasing the ligaments at the joint and removing a small piece of toe bone, which restores the toe to its normal position.