How Hammertoes Form

A hammertoe, or mallet toe, occurs as a deformity of your second, third, fourth, or fifth toe. The condition is named for how the affected toe bends down toward the ground in the shape of a hammer.

A hammertoe can begin as a mild deformity, sometimes present at birth. If left untreated, it typically worsens over time. While it may start as a cosmetic issue, it can also cause pain and complications with normal movement if left untreated.

Hammertoe specialists Laura Schweger, DPM, and Evan Ross, DPM, of Optima Foot and Ankle in Bend, Oregon, can diagnose and treat hammertoe at any stage of development. If you’re at risk of hammertoe, Dr. Schweger can advise ways to slow or prevent the onset of this deformity.

What is hammertoe?

When hammertoe occurs, the second or middle joint on your affected toe begins to bend in an unnatural downward position. Most hammertoes involve an imbalance in the ligaments, muscles, and tendons that bend your toe and keep it straight.

When one of these muscles weakens, it loses the ability to bend or straighten the toe. When it remains bent long enough, the muscles tighten, and the toe won’t straighten.

While a hammertoe can make you feel embarrassed to bare your feet in sandals or open-toe shoes, it can be more than a cosmetic issue. This deformity can cause muscle imbalances, chronic stress on other areas of your feet and toes, and ill-fitting shoes.

Causes of hammertoe

Hammertoe can develop as a result of several factors. In some cases, hammertoe occurs after a traumatic toe injury like a toe fracture. More often, the condition develops over time as a result of other factors.

These circumstances can make you more susceptible to hammertoe:

Wearing improper shoes

High heels over two inches can increase your risk of hammertoe by increasing weight on the forefoot and toes, leading to an imbalance of toe muscles. Any shoes that are narrow and tight through the toe box with little to no arch support can force your toes into a flexed position.

Wearing these types of shoes can permanently force your toes into a bent position, even when you’re not wearing shoes. Women are more likely to develop hammertoe than men, most likely because they tend to wear shoes with smaller toe boxes.


A certain type of foot can make you more susceptible to hammertoe. Flat, flexible feet can increase your risk of hammertoe as your foot tries to stabilize against a flattening arch. Feet with high arches or a second toe that is longer than your big toe can also make you more likely to develop this deformity.

Certain physical conditions

You have a higher risk of hammertoe if you have certain diseases, including arthritis, Charcot-Marie-Tooth disease, alcoholism, polio, spinal cord tumors, or stroke. Having bunions can push your neighboring toe out of place and make you more susceptible to this deformity.

Preventing hammertoe

Unless your hammertoe is caused by a traumatic injury, you may be able to lower your risk of developing hammertoe by taking the following precautions:

  • Limit your use of high heels and shoes with narrow toe boxes
  • Wear orthotic shoe inserts to offset the effects of abnormally low or high arches in your feet
  • Stretch and bend your toes to keep them flexible
  • Seek treatment for bunions or toe trauma
  • Follow recommended treatment for a joint disease such as arthritis

Hammertoe treatment

If you suspect you’re developing hammertoe, it’s vital to seek treatment as early as possible. In its initial stages, hammertoe can be treated with footwear modifications and appropriate exercises.

Exercising your toes and stretching your foot muscles can often be effective. Custom orthotics, a padded boot, or splint can provide support to offset abnormal foot structure.

If your hammertoe is diagnosed in its advanced stages, the affected toe can become rigid. Surgery may be necessary to achieve correction. Surgical techniques like tendon transfers, bone fusion, or joint sections may be recommended.

Find out more about your risk of hammertoe and what you can do to avoid developing this deformity. Schedule a visit by calling 541-383-3668, or request an appointment online.

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