Hammertoes

• What causes it?

  A hammertoe is a deformity in which one or more of the smaller toes bends downward at the middle joint instead of lying flat. It develops when the muscles and tendons that control toe position become imbalanced — one side pulls harder than the other, causing the toe to contract.

  Causes include wearing shoes that are too short or narrow (which forces the toes to bend), flat feet, bunions (which crowd the lesser toes), nerve damage, and arthritis. Some people have a genetic tendency toward toe deformities. Early on, hammertoes are flexible and can be straightened manually. Over time, they become rigid and fixed.

• How do I know if I have it?

  Your doctor will examine the toes for flexibility — whether they can be straightened by hand (flexible) or are stuck in the bent position (rigid). The skin over the bent joint is checked for corns and calluses, which develop from shoe pressure.

  X-rays show the bone position and joint involvement and help plan treatment. In the case of an associated neuroma or nerve symptoms, additional testing may be done.

• How is it treated?

  For flexible hammertoes: wider and deeper shoes, toe splints, padding to protect the corn or callus, and custom orthotics to address the underlying foot mechanics.

  For rigid or painful hammertoes that have failed conservative care, surgery is the definitive treatment. A simple in-office or outpatient procedure straightens the toe by releasing the contracted tendon (tenotomy) or removing a small piece of bone from the bent joint (arthroplasty/arthrodesis). In some cases, a small pin or implant holds the toe straight while it heals.

  Recovery is straightforward — most patients walk in a surgical shoe immediately.