In Pakistan, hammer Toe is managed by podiatrys. Hammer toe is a fixed flexion deformity of the proximal interphalangeal (PIP) joint of one or more lesser toes, leaving the toe bent downward in a hammer-like shape. The American Podiatric Medical Association's National Foot Health Assessment estimates that around 7-9% of US adults have at least one hammer toe, rising to nearly 30% in adults over 60.
Hammer toe (ICD-10: M20.4) is an acquired flexion deformity of the proximal interphalangeal joint of one or more lesser toes (2nd through 5th), often accompanied by hyperextension of the metatarsophalangeal joint and either hyperextension or neutral position of the distal interphalangeal joint. The deformity develops from an imbalance between the long flexor and extensor tendons and the intrinsic foot muscles. The extensors fire at the metatarsophalangeal joint without effective intrinsic muscle support, and the long flexors overpull at the proximal interphalangeal joint, leaving the toe permanently bent. Hammer toe is classified as flexible (passively correctable), semirigid, or rigid (fixed), and surgical planning depends on this assessment.
The key symptoms of Hammer Toe are: Visible upward bending of the proximal interphalangeal joint of a lesser toe with the toe tip pointing downward., Painful corn (hyperkeratosis) developing on the dorsal aspect of the proximal interphalangeal joint where the toe rubs against the top of the shoe., Callus on the ball of the foot under the corresponding metatarsal head from altered weight distribution., Pain on walking, especially in closed-toe shoes, that improves when barefoot or in open sandals., Stiffness in the affected toe that worsens through the day and persists in established rigid deformities., Difficulty fitting shoes; previously comfortable footwear now feels tight over the toes., Redness, swelling, or skin breakdown over the bent joint, especially in tight footwear..
Diagnosis is clinical. The history covers pain, footwear difficulties, occupation and lifestyle demands, comorbidities (diabetes, vascular disease, inflammatory arthritis, neuromuscular conditions), and any history of trauma. Examination begins with the patient standing and walking to assess overall foot posture (pes cavus, planus, hallux valgus, hindfoot alignment). The affected toes are inspected for the characteristic dorsiflexed MTP and flexed PIP appearance, dorsal corns, plantar metatarsal callus, and skin breakdown. The deformity is tested for reducibility by passively pushing up on the metatarsal head and seeing whether the toe straightens — full correction indicates a flexible deformity, partial correction a semirigid one, and no correction a rigid one. The plantar plate is assessed with the dorsal drawer test of the second MTP joint to detect attenuation or rupture. Neurovascular examination documents pedal pulses, capillary refill, monofilament sensation, and tendon reflexes. Weight-bearing radiographs (anteroposterior, lateral, oblique views) confirm the deformity in three planes, identify associated bunion, metatarsus primus varus, MTP subluxation, and any degenerative changes. Vascular assessment with ankle-brachial index is essential before surgery in any patient with diabetes, smoking history, or claudication.
Mild flexible hammer toes respond well to footwear changes, padding, and exercises, with most patients reporting good symptom control over years. Untreated deformity tends to progress slowly from flexible to rigid over 5-15 years. Surgical correction delivers patient satisfaction in 80-90%, full cosmetic correction in 70-80%, and durable symptom relief in over 85% at 5 years; recurrence is 10-15% and depends on whether underlying biomechanical drivers (bunion, plantar plate, equinus) have been addressed. Complications include floating toe (the toe sits dorsally above the floor), nonunion at fusion sites, transfer metatarsalgia, neuroma, and persistent stiffness. Major adverse outcomes are rare in non-diabetic patients with normal vasculature. In diabetes or peripheral vascular disease, the principal risks are ulceration over the bent joint, infection, and amputation — which justifies more aggressive prophylactic correction in selected high-risk feet.
Podiatric referral is appropriate for any painful or progressive hammer toe, recurrent corns, plantar callus, or ulceration risk. Foot and ankle orthopedic surgery is involved when surgical correction is being considered, particularly in combination with bunion or plantar plate procedures. Patients with diabetes or vascular disease benefit from coordinated care including vascular surgery and endocrinology.
Find specialists →Conservative management: symptomatic improvement within 2-4 weeks of footwear change and padding. Postoperative recovery depends on procedure: percutaneous tenotomy, return to normal shoes in 1-2 weeks; PIP arthroplasty with K-wire, wire removal at 4-6 weeks, full activity at 6-8 weeks; PIP arthrodesis with implant, bony union at 6-12 weeks, full athletic activity at 10-16 weeks.
Low-impact aerobic activities (swimming, cycling, elliptical training) are well tolerated. Walking is encouraged in supportive footwear. Daily intrinsic foot strengthening exercises (towel scrunches, marble pickups, short-foot exercise) and calf-stretching reduce extensor overpull on the lesser toes. After surgery, weight-bearing in a postoperative shoe begins immediately for most procedures; full sport returns at 8-12 weeks.
Choose a podiatrist or foot and ankle surgeon experienced in lesser toe deformity correction and high-risk diabetic foot care. Centers that offer same-day imaging, biomechanical assessment, custom orthotics, and high-volume forefoot surgery deliver the best outcomes. Verify experience with both arthroplasty and arthrodesis techniques.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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