Hammertoe Treatment on Long Island

What Is a Hammertoe?

A normal toe depends on a coordinated relationship between the bones, joints, muscles, tendons, and ligaments that control movement and maintain alignment.

A hammertoe develops when this balance is disrupted. The muscles and tendons that bend and straighten the toe no longer work in equilibrium, causing the toe to buckle at one or more joints.

Most commonly, the middle joint of the toe—the proximal interphalangeal joint (PIP joint)—bends downward. At the same time, the toe may extend upward at its base where it meets the foot at the metatarsophalangeal (MTP) joint.

Over time, persistent abnormal positioning can cause the surrounding soft tissues to tighten. A deformity that was initially flexible may therefore become progressively more rigid and difficult to straighten.

The abnormal position also changes how pressure is distributed across the toe and the ball of the foot. This is why patients may develop pain not only over the bent joint, but also beneath the forefoot or at the tip of the affected toe.

Hammertoe, Claw Toe, and Mallet Toe

Hammertoe

In a hammertoe deformity, the middle joint of the toe—the PIP joint—bends downward. The toe may also extend upward at the MTP joint where it connects to the foot. This creates the characteristic raised or “hammered” appearance of the toe.

Claw Toe

Claw toe involves a more extensive pattern of deformity. The toe extends upward at the MTP joint while both the PIP joint and the distal interphalangeal (DIP) joint bend downward. This produces a curled or claw-like position and may cause painful pressure at several points along the toe.

Mallet Toe

Mallet toe primarily affects the joint closest to the tip of the toe—the DIP joint. This joint bends downward while the remainder of the toe may remain relatively well aligned.

Although these deformities differ anatomically, they can produce similar symptoms and may develop from related mechanical or muscular imbalances. Determining the precise deformity is important because treatment should address the specific joints and structures involved.

Flexible vs. Rigid Hammertoes

Flexible Hammertoe

In the earlier stages, the affected toe can usually still be straightened manually. The joints retain movement, and symptoms may be intermittent. Conservative treatment is often most effective during this stage because the toe has not yet become fixed in its abnormal position.

Rigid Hammertoe

As the deformity progresses, the tendons, ligaments, and joint capsule may become increasingly contracted. Arthritis and stiffness may also develop within the affected joint. Eventually, the toe can become fixed in the bent position and can no longer be manually straightened.

Rigid hammertoes are more likely to produce persistent pain, pressure points, corns, difficulty with footwear, and problems during walking. When these symptoms remain significant despite appropriate conservative treatment, surgical correction may be considered.

What Causes Hammertoes?

Hammertoes usually develop from a combination of structural, mechanical, and muscular factors rather than from a single cause. At the center of the deformity is an imbalance between the muscles and tendons responsible for bending and straightening the toe. When these forces become unequal, the toe is gradually pulled away from its normal alignment.

Foot Structure and Genetics

• A family history of hammertoes or other toe deformities
• A second toe that is longer than the big toe
• High arches
• Flat feet
• Structural differences that alter the distribution of pressure across the forefoot

Muscle and Tendon Imbalance

The position of each toe is controlled by a complex interaction between several muscles and tendons. When these forces become imbalanced, the toe may gradually move into an abnormal position. As the imbalance persists, the surrounding tendons and soft tissues can shorten and tighten, making the deformity progressively more difficult to correct.

Footwear

Shoes do not necessarily represent the sole cause of hammertoes, but inappropriate footwear can aggravate an existing structural tendency and increase symptoms. Narrow or pointed shoes can crowd the toes together, while high heels shift additional body weight toward the front of the foot and increase pressure on the smaller toes.

Trauma

• Stubbing or jamming the toe
• Previous fractures or dislocations
• Direct trauma
• Repetitive stress associated with certain activities

Associated Foot Deformities

Hammertoes frequently occur together with other structural conditions of the foot. A bunion, for example, may gradually push the big toe toward the second toe, reducing the available space and contributing to instability and deformity. For this reason, successful treatment requires evaluation of the entire forefoot rather than focusing exclusively on the visibly bent toe.

Medical and Neuromuscular Conditions

• Rheumatoid arthritis
• Osteoarthritis
• Diabetes
• Neuromuscular disorders

Age-Related Changes

The structures supporting the toes can change with age. Ligaments and tendons may gradually lose strength and elasticity, while muscle strength and flexibility may decrease. These changes can make the smaller toe joints less stable and allow an existing imbalance to become progressively more pronounced.

Symptoms of Hammertoes

Symptoms vary depending on the severity of the deformity, the joints involved, and whether the toe remains flexible or has become rigid. Some patients initially notice only a visible change in the position of the toe. Others develop increasing pain and difficulty with footwear or walking.

Pain and Discomfort

• Pain over the prominent middle joint of the toe
• Pain at the tip of the affected toe
• Pain beneath the affected toe at the ball of the foot
• Discomfort during prolonged standing or walking
• Pain when wearing shoes that place pressure on the deformity

Corns, Calluses, Swelling, and Redness

Abnormal pressure and friction can cause thickened skin on the top or tip of the toe, between adjacent toes, or beneath the ball of the foot. Repeated irritation may also produce redness, swelling, and sensitivity around the affected joint. Patients with diabetes, impaired circulation, or reduced sensation require particular attention because persistent pressure can sometimes contribute to skin breakdown or ulceration.

Difficulty Wearing Shoes and Changes in Walking

As the deformity becomes more pronounced, previously comfortable shoes may begin to cause pressure and pain. Some patients also modify their gait to avoid pressure on the painful toe, which can contribute to discomfort elsewhere in the forefoot and may affect balance or walking efficiency.

Non-Surgical Treatment for Hammertoes

For mild and flexible hammertoes, non-surgical treatment is usually the first approach. These measures are designed to reduce pressure, relieve discomfort, improve function, and help prevent further irritation. Once a hammertoe becomes rigid, however, non-surgical measures cannot permanently straighten the structural deformity.

Footwear Modifications

• Shoes with a wide and deep toe box
• Soft, flexible materials that minimize pressure against the toes
• Adjustable laces or straps
• Avoiding narrow or pointed shoes
• Limiting high heels that shift pressure toward the front of the foot

Padding, Orthotics, Splinting, and Taping

Cushioned toe pads, gel sleeves, metatarsal pads, orthotic devices, toe spacers, taping, or splinting may help reduce pressure and improve comfort. These measures are most useful while the affected joints remain flexible and do not permanently correct a fixed structural deformity.

Exercises, Pain Management, and Activity Modification

Stretching, range-of-motion exercises, strengthening when appropriate, short-term pain or anti-inflammatory medication when medically suitable, and temporary modification of aggravating activities may help manage symptoms and maintain function.

When Is Hammertoe Surgery Considered?

Surgery is generally considered when the deformity causes persistent pain or functional problems that are no longer adequately controlled with appropriate non-surgical treatment.

• Pain persists despite conservative treatment
• The toe has become rigid or progressively deformed
• Corns or painful pressure points repeatedly develop
• Wearing normal footwear becomes increasingly difficult
• The deformity interferes with walking or everyday activities
• Associated forefoot problems contribute to persistent symptoms

The decision to proceed with surgery is based on symptoms and function rather than appearance alone. A careful examination is important because hammertoes can occur together with instability at the base of the toe or other structural abnormalities of the forefoot.

Surgical Treatment of Hammertoes

There is no single surgical procedure that is appropriate for every hammertoe. The surgical plan depends on whether the deformity is flexible or rigid, which joints are involved, its severity, the condition of the joints, surrounding tendon and ligament balance, and the presence of additional forefoot abnormalities.

Soft-Tissue Correction

Flexible deformities may sometimes be corrected by releasing or lengthening tight soft tissues, releasing a contracted joint capsule, or rebalancing the structures controlling toe position.

Bone Realignment

More established or rigid hammertoes may require an osteotomy—a controlled bone cut that allows the toe to be brought into improved alignment. Bone correction may be combined with soft-tissue procedures when necessary.

Joint Fusion

For certain rigid hammertoes, arthrodesis may be recommended. The affected joint surfaces are prepared and the toe is positioned in improved alignment so the bones can heal together and create a stable correction.

Fixation

Depending on the procedure, temporary wires, small screws, or other specialized fixation devices may be used to maintain the corrected position while healing occurs.

Minimally Invasive Hammertoe Surgery

In appropriately selected patients, hammertoes can be treated using minimally invasive, or percutaneous, surgical techniques. Specialized instruments are introduced through very small openings in the skin to perform precise bone and soft-tissue correction.

Real-time X-ray imaging, known as fluoroscopy, may be used to visualize the bones, guide surgical instruments, and confirm alignment.

Depending on the individual deformity, minimally invasive correction may include:

• Precise osteotomies to realign the toe
• Release or lengthening of contracted tendons
• Release of tight joint structures
• Correction of associated soft-tissue imbalance
• Fixation when required to maintain alignment during healing

The specific combination of procedures is determined by the anatomy and severity of each hammertoe rather than applying the same operation to every patient.

The Surgical Procedure

Hammertoe correction is commonly performed as an outpatient procedure, allowing patients to return home the same day. Anesthesia is selected according to the procedure and the patient’s individual needs and may include regional anesthesia together with sedation.

More than one toe can be corrected during the same operation when necessary, and associated structural problems may also be addressed as part of the overall surgical plan.

After correction, the foot is protected with appropriate dressings and, depending on the procedure, a postoperative surgical shoe or walking boot. Weight-bearing recommendations vary according to the exact correction performed, making individualized postoperative instructions an essential part of treatment.

Benefits of Minimally Invasive Hammertoe Surgery

When minimally invasive surgery is appropriate for the individual deformity, it can provide effective correction while limiting disruption to the surrounding soft tissues.

Smaller Incisions and Reduced Soft-Tissue Disruption

• Smaller surgical incisions
• Minimal visible scarring
• Reduced soft-tissue disruption
• Preservation of surrounding structures
• Lower risk of certain wound-related problems

Postoperative Pain, Swelling, and Early Mobilization

Swelling is expected after any hammertoe correction and can persist for several weeks or months. Limited soft-tissue disruption may help reduce postoperative discomfort and facilitate early recovery in appropriately selected patients. Many patients can begin protected weight-bearing relatively early, although the amount of weight that can safely be placed on the foot depends on the procedure performed.

Cosmetic Appearance

Because minimally invasive procedures use small skin incisions, postoperative scars are typically limited and generally become less noticeable over time. The primary objective, however, remains a stable, functional, and comfortable correction.

Recovery After Hammertoe Surgery

Recovery varies according to the severity of the deformity, the number of toes corrected, the procedures performed, whether bone correction or fusion was required, additional foot procedures, and individual healing characteristics.

Immediately After Surgery

• Keep the foot elevated
• Protect the surgical dressings
• Keep the incisions clean and dry
• Take prescribed medication as directed
• Limit unnecessary walking
• Follow specific weight-bearing instructions

The First Two Weeks

Protecting the correction and allowing the incisions to heal are the main priorities. Swelling, bruising, stiffness, and mild to moderate discomfort can be expected. Follow-up allows the surgical site and healing to be assessed.

Weeks 2–6

Walking and everyday activity may gradually increase according to instructions. Protective footwear is usually continued until sufficient healing and stability have been achieved. Temporary fixation may be removed when appropriate, and gentle motion exercises may be introduced when the procedure allows.

Weeks 6–12

Bone and soft-tissue healing continue. Follow-up X-rays may be used when necessary, and patients may gradually transition into supportive athletic or walking shoes. High-impact exercise should not resume until adequate healing has been confirmed.

The Following Months

Residual swelling and stiffness may continue to decrease over several months. Return to usual footwear, sports, and higher-impact activity should be individualized according to comfort, strength, healing, and follow-up findings.

Swelling After Hammertoe Surgery

Postoperative swelling is a normal part of healing and often lasts longer than patients expect. Some residual swelling can remain for several months.

Helpful measures may include:

• Regular elevation of the foot
• Gradual progression of activity
• Appropriate postoperative footwear
• Compression when recommended
• Avoiding prolonged standing or excessive walking during early recovery

A temporary increase in swelling after increased activity does not necessarily indicate a problem. Sudden or significant swelling accompanied by increasing pain, redness, warmth, drainage, or fever should be evaluated.

Potential Risks and Complications

All surgical procedures carry potential risks. Modern hammertoe surgery is generally safe when appropriately indicated and performed, but complications remain possible regardless of whether an open or minimally invasive technique is used.

• Infection
• Delayed wound healing
• Persistent swelling
• Toe stiffness
• Numbness or nerve irritation
• Persistent or recurrent pain
• Recurrence of the deformity
• Loss of correction
• Delayed bone healing
• Nonunion
• Malunion
• Irritation related to temporary or permanent fixation
• Transfer of pressure or discomfort to an adjacent toe or area of the forefoot

Some degree of stiffness and swelling is expected during normal recovery and does not necessarily represent a complication. Individual risk depends on overall health, circulation, bone quality, smoking status, severity of the deformity, and the specific procedure performed.

Optimizing Recovery

Following postoperative instructions carefully is an important part of achieving a successful result.

Protect the Surgical Correction

Use the postoperative shoe, walking boot, or other protective device for the recommended period. Even when pain is minimal, bones and soft tissues still require time to heal.

Manage Swelling and Protect the Incisions

Regular elevation is particularly important early in recovery. Incisions should remain clean and dry according to postoperative instructions, and increasing redness, warmth, drainage, fever, or other concerning changes should be reported.

Restore Motion and Strength

Depending on the procedure, gentle range-of-motion exercises may be introduced during recovery, followed by progressive strengthening when healing permits. Rehabilitation should follow individualized instructions, particularly when a joint has been fused.

Attend Follow-Up Appointments

Follow-up allows healing, alignment, swelling, and function to be monitored. When bone procedures have been performed, X-rays may be obtained before activity or footwear restrictions are advanced.

Restoring Comfort and Alignment

Hammertoes can progress from a flexible deformity that causes occasional shoe irritation to a rigid and painful condition that significantly affects walking and everyday activities.

Early treatment focuses on reducing pressure, maintaining flexibility, and controlling symptoms. When a painful or rigid deformity no longer responds adequately to conservative treatment, surgical correction can address the underlying structural problem.

Modern surgical techniques allow treatment to be tailored to the individual toe and the mechanics of the entire forefoot. For appropriately selected patients, minimally invasive techniques can provide effective correction through small incisions while limiting disruption to surrounding soft tissues.

The goal of treatment is a well-aligned, stable, and functional toe that reduces painful pressure and allows a comfortable return to everyday activities.

Your Surgeon for Hammertoe Treatment on Long Island

Kristian Efremov, MD, PhD, is a fellowship-trained orthopedic foot and ankle surgeon. He evaluates and treats hammertoes for patients across Nassau and Suffolk County at NYU Langone Ambulatory Care East Meadow, 1530 Front Street, Suite 200, East Meadow, NY 11554.

Options covered on this page range from footwear changes, padding, orthotics and splinting to soft-tissue correction, bone realignment and joint fusion. The right option depends on your exam, imaging and goals.

Dr. Efremov completed his foot and ankle surgery fellowship at New England Baptist Hospital and is a Clinical Assistant Professor in the Department of Orthopedic Surgery at NYU Grossman Long Island School of Medicine.

To request an appointment, call (516) 324-7500 or read more about Dr. Efremov.

Medical Disclaimer. The information provided on this website is intended for general educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional regarding any medical condition, symptoms, or treatment options.