Fixing a hammertoe depends entirely on whether the affected joint is still flexible or has stiffened into a rigid position. A flexible hammertoe can often be managed with exercises, padding, and better footwear. A rigid one typically requires surgery. The sooner you address it, the more non-surgical options you have, because hammertoes progressively worsen over time as the muscle imbalance that caused them deepens.
What Causes Hammertoe in the First Place
A hammertoe forms when the muscles that bend and straighten your smaller toes fall out of balance. Your toes are controlled by two groups of muscles: small intrinsic muscles inside the foot and larger extrinsic muscles that run down from the leg. When the larger muscles overpower the smaller ones, they pull the middle joint of the toe into a bent position. Over time, that bent position becomes the toe’s default.
The most common trigger is excessive pronation, where your foot rolls inward too much when you walk. This destabilizes the forefoot, and in response, the flexor muscles along the bottom of the foot start firing harder and longer than they should, overpowering the smaller stabilizing muscles. Calf weakness can cause a similar chain reaction: when the calf can’t do its job during push-off, the deep toe flexors try to compensate and end up pulling the toes into a curled position. Tight, narrow shoes accelerate the process by physically forcing the toes into flexion for hours at a time.
Flexible vs. Rigid: Why It Matters
The single most important thing to figure out is whether your hammertoe is flexible or rigid, because that determines your options. You can test this yourself: try to straighten the bent toe with your hand. If it moves back into a normal position without much resistance, it’s still flexible. If the joint won’t budge, or only moves with significant pain, it’s rigid.
A flexible hammertoe means the joint hasn’t undergone permanent structural changes yet. The tendons, ligaments, and joint capsule are tight but haven’t fused or contracted beyond the point of correction. This is the window where conservative treatments can genuinely work. A rigid hammertoe means the soft tissues have tightened to the point where the joint is locked. At that stage, no amount of stretching or taping will straighten it, and surgery becomes the primary fix.
Non-Surgical Fixes for Flexible Hammertoes
Toe Exercises
Strengthening the small muscles in your foot can help rebalance the forces pulling your toe out of alignment. Two exercises come up consistently in podiatric recommendations:
- Towel curls: Sit in a chair with your feet flat on a towel spread on the floor. Curl your toes to scrunch the towel toward you, then extend them to push it forward. Do 10 repetitions, three times a day.
- Marble pickups: Place marbles on the floor and use your toes to pick them up one at a time and drop them into a bowl. This strengthens the same small muscles while also improving the toe’s range of motion.
These exercises won’t reverse a hammertoe overnight. They work by gradually rebuilding strength in the intrinsic foot muscles that have been overpowered. Consistency over weeks and months is what matters. They’re most effective for early-stage, flexible deformities.
Splints and Toe Straighteners
For early-stage hammertoes, splints or toe straighteners can gently encourage the toe back toward a normal position. These are typically worn inside your shoe during the day or at night while sleeping. They work by holding the toe in extension, which counteracts the flexor pull and helps maintain range of motion in the joint. They won’t fix the underlying muscle imbalance on their own, so pairing them with exercises gives you the best shot.
Padding and Cushions
Gel sleeves, toe cushions, and non-medicated pads won’t straighten the toe, but they protect it from friction and pressure inside the shoe. The top of a hammertoe’s bent joint rubs against the shoe with every step, creating painful corns and calluses. Padding reduces that irritation and can make a significant difference in daily comfort, even if the deformity itself hasn’t changed.
Custom Orthotics
If overpronation or an arch problem is driving the imbalance, custom orthotics can address the root cause. By improving foot alignment and distributing weight more evenly across the forefoot, orthotics reduce the compensatory gripping that forces toes into flexion. They’re particularly useful for the flexor stabilization pattern, where the foot’s rolling motion is triggering the muscles to overwork.
Choosing the Right Shoes
Footwear is both a cause and a treatment lever. Shoes with a deep toe box give your toes vertical space so the bent joint isn’t pressed against the top of the shoe. Soft uppers are equally important because they conform to the foot rather than squeezing it. Look for shoes with extra depth, which also leaves room to fit pads, orthotics, or crest supports inside without crowding your toes.
Avoid heels higher than about two inches. High heels shift your body weight forward onto the ball of the foot, increasing pressure on the toe joints and worsening the muscle imbalance. Pointed or narrow toe boxes are the other major culprit. If your toes can’t spread out naturally inside the shoe, they’re being trained into a bent position with every step. Supportive athletic shoes or sandals with contoured footbeds (like Birkenstocks or Hokas) are frequently recommended by podiatrists during and after treatment.
When Surgery Becomes the Fix
If your hammertoe is rigid, or if conservative measures haven’t helped a flexible hammertoe after several months, surgery is the next step. Two main approaches exist: joint fusion and joint resection.
Joint fusion (arthrodesis) permanently straightens the toe by removing the cartilage surfaces from both sides of the bent joint and allowing the bones to grow together in a corrected position. This eliminates the joint’s ability to bend, but since the middle joint of a lesser toe doesn’t contribute much to normal walking, most people don’t notice a functional difference. Joint fusion provides more reliable long-term correction and is considered the more durable option.
Joint resection (arthroplasty) removes a small piece of bone from one side of the joint, which allows the toe to straighten while preserving some motion. The trade-off is that the retained motion can sometimes lead to the deformity returning or causing pain over time.
To hold the toe straight while it heals, surgeons traditionally use a temporary metal pin (called a K-wire) that exits through the tip of the toe and is removed at about six weeks. Newer options include internal screws, bioabsorbable pins, and intramedullary implants that stay inside the toe permanently and don’t require a second procedure for removal. Patients have historically been dissatisfied with the appearance and discomfort of an exposed pin, so these internal devices are becoming increasingly popular.
What Recovery Looks Like
Hammertoe surgery recovery follows a fairly predictable timeline broken into three phases:
For the first two weeks, you won’t bear any weight on the foot and will get around on crutches or a knee scooter. No movement of the surgical toe during this period. From weeks two through six, you transition to heel-only weight bearing in a post-operative shoe and gradually wean off crutches around the four-week mark. If a pin was used, it stays in until the six-week appointment.
Between weeks six and eight, you move into full weight bearing in supportive shoes, though you’ll still need to avoid stressing the toes. By weeks 10 to 12, you’re typically back in regular supportive footwear with full activity. The entire arc from surgery to normal daily function is roughly three months.
How Successful Is Surgery?
Surgical correction significantly reduces pain. In studies tracking outcomes, patients’ average pain scores dropped from 4.0 out of 10 before surgery to 1.5 afterward, and overall physical function scores improved meaningfully as well.
Recurrence is the main long-term concern. Among patients with few or no other health conditions, about 17% experienced some degree of deformity returning, though only about 2% needed a second surgery. For patients with multiple health conditions (diabetes, peripheral neuropathy, vascular disease), the picture is less favorable: 16% required revision surgery, with significantly higher odds of needing another operation. This doesn’t mean surgery fails for those patients, but the risk-benefit conversation is more nuanced.
Slowing Progression Before It Gets Worse
If you’ve noticed a toe starting to curl but it’s still flexible, you’re in the best possible position to intervene. Combine daily toe exercises with properly fitting shoes that have a deep, wide toe box. If you overpronate or have flat feet, get assessed for orthotics. Use a toe splint or straightener at night to maintain the joint’s range of motion. These steps won’t guarantee you avoid surgery, but they can delay progression for years and, in mild cases, prevent the toe from reaching the rigid stage at all.