Hammer toe is one of the most common toe deformities we see at ModPod Podiatry in Sydney. It develops gradually, often starting as a mild bend in the middle joint of the toe — easy to dismiss at first. Over time, that bend becomes more fixed, leading to pain, corns on the top of the toe and difficulty fitting into shoes.
The important thing to understand is that a hammer toe caught early is a flexible deformity — meaning it still responds well to conservative treatment. Left too long, the joint stiffens permanently and surgical correction becomes the main option. This post explains what causes hammer toes, how to recognise the stages, and what your Sydney podiatrist can do before surgery becomes necessary.
What Is a Hammer Toe?
A hammer toe is a deformity of the proximal interphalangeal (PIP) joint — the middle joint of a lesser toe. The joint bends downward, causing the toe to curl in a shape resembling a hammer. It most commonly affects the second, third or fourth toe.
Hammer Toe vs Claw Toe vs Mallet Toe
These three deformities are closely related but distinct:
- Hammer toe: the middle joint (PIP) bends downward. The base joint (MTP) may be slightly elevated.
- Claw toe: both the middle joint and the end joint bend downward, while the base joint bends upward. The toe curls like a claw.
- Mallet toe: only the end joint (DIP) bends downward. The tip of the toe points toward the floor.
The treatment approach differs between these conditions. Our podiatrists examine the full range of joint movement, the toe’s position during weight-bearing and the overall biomechanics of the foot before recommending a plan.
What Causes a Hammer Toe?
Hammer toes develop over years, typically from a combination of footwear and foot mechanics.
Ill-fitting footwear is the most common cause. Shoes that are too tight or too short at the toe box, or that push the toes upward — such as high heels — force the toes into a bent position for extended periods. The muscles and tendons gradually adapt to this position and hold the toe there.
Muscle imbalance plays a role when the intrinsic foot muscles (the small muscles inside the foot that straighten the toes) weaken relative to the extrinsic muscles (the larger calf and shin muscles that flex them). This imbalance allows the toe to drift downward.
Other contributing factors include:
- Flat feet and overpronation, which alter forefoot load distribution
- Bunions on the big toe pushing the second toe out of alignment — one of the most common causes of second-toe hammer toe
- Rheumatoid arthritis, which causes joint damage across multiple toes
- A second toe longer than the big toe, which is forced to bend in shorter shoes
The Two Stages: Flexible vs Rigid Hammer Toe
The most clinically important distinction in hammer toe is the stage of the deformity:
Flexible hammer toe: The joint still moves. You can straighten the toe by hand. This stage responds well to conservative treatment — footwear adjustments, padding, exercises and custom orthotics can all slow or reverse the deformity.
Rigid hammer toe: The joint is fixed in position. The ligaments, tendons and joint capsule have permanently shortened and the toe cannot be straightened passively. Conservative treatment manages symptoms but cannot correct the deformity. Surgery becomes the main corrective option at this stage.
A flexible hammer toe becomes rigid when the joint structures permanently shorten — a process that takes months to years depending on the cause and severity. Acting during the flexible stage is critical.
Symptoms of Hammer Toe
The visible bend in the toe is usually the first sign, but hammer toe produces a range of related symptoms:
- A corn or callus on the top of the bent joint, caused by friction against the shoe
- Pain in the toe when walking or wearing enclosed shoes
- Redness or swelling at the affected joint
- Difficulty finding comfortable footwear, particularly for work or formal occasions
- In advanced cases, an open pressure sore on the top of the toe
People living with diabetes should see a podiatrist promptly if a hammer toe develops. Reduced circulation and peripheral neuropathy (nerve damage) mean that ongoing pressure from a deformed toe can create wounds that are slow to heal and serious in their consequences.
Non-Surgical Hammer Toe Treatment in Sydney
For flexible hammer toes, conservative treatment is effective when started early. At ModPod Podiatry, our approach combines several strategies depending on the stage, severity and underlying cause.
Footwear Changes
The first priority is removing the mechanical cause. Shoes with a wide, deep toe box allow the toes to sit in a natural position rather than being held bent. Heel height should be reduced — ideally to under 4 cm for everyday wear. We advise on specific brands and styles suited to your foot shape and lifestyle.
Padding and Strapping
Toe padding protects the corn or pressure site on top of the joint while strapping holds the toe in a straighter alignment during activity. These are not permanent corrections but reduce pain significantly and slow progression during treatment.
Hammer Toe Exercises
Targeted exercises rebuild the intrinsic foot muscles that help maintain toe alignment. Towel scrunches, marble pickups and toe extension stretches all work the relevant muscle groups. In the flexible stage, consistent daily exercise can genuinely improve the deformity. We demonstrate correct technique and provide a written plan at your appointment.
Custom Orthotics
When flat feet, overpronation or forefoot overloading are driving the hammer toe, custom prescription orthotics address the underlying mechanics. An orthotic redistributes load away from the forefoot and reduces the forces that cause the toe to curl. For hammer toe linked to a bunion, offloading the first toe often reduces the pressure deflecting the second.
We use a comprehensive hammer toe assessment that includes computerised gait analysis to design orthotics specific to your foot structure and footwear requirements.
Managing Corns from Hammer Toe
Corns form on the top of the bent joint as a direct response to pressure from the shoe. They are a symptom of the deformity, not a separate condition.
Our podiatrists remove a corn on the foot safely using a scalpel under sterile conditions during a standard appointment — no anaesthetic required. A medical pedicure can address multiple pressure sites in a single session. The corn will recur unless the underlying pressure is reduced, so padding, footwear changes or orthotics are necessary alongside corn removal.
When Does a Hammer Toe Need Surgery?
Surgery is considered when:
- The hammer toe is rigid and causing persistent pain that conservative treatment cannot manage
- There is an open wound or ulcer on the toe, particularly in patients with diabetes or peripheral arterial disease
- The deformity is severe enough to prevent normal footwear and walking function
ModPod does not perform surgical procedures, but we refer patients to orthopaedic surgeons and podiatric surgeons we trust in Sydney when surgery is the right option. Surgical techniques typically involve straightening the joint through a small tendon release, joint fusion or Kirschner wire fixation. Recovery takes several weeks with gradual return to normal footwear.
Hammer Toe, Medicare and Private Health Insurance in Australia
Most hammer toe appointments at ModPod are claimable through private health insurance Extras cover. The rebate amount depends on your insurer and level of cover — Medibank, BUPA, HCF and NIB all include podiatry in ancillary cover, with typical rebates of $30–$55 per consultation.
If you have a chronic condition such as type 2 diabetes or rheumatoid arthritis, your GP may be able to refer you for up to five Medicare-subsidised podiatry visits under a Chronic Disease Management (CDM) plan. Ask your GP whether you qualify.
High heels and narrow dress shoes remain the dominant cause of hammer toe in Australian women. A 2022 survey by Sports Medicine Australia found that over 60% of Australian women wear shoes they consider uncomfortable on a regular basis — and forefoot deformities, including hammer toe, are a direct long-term consequence.
Frequently Asked Questions
Q: Can hammer toes be corrected without surgery?
A: Yes — in the flexible stage. A flexible hammer toe still moves at the joint, which means it can respond to conservative treatment. Footwear changes, toe exercises, strapping and custom orthotics can slow progression or reduce the deformity. Once the hammer toe becomes rigid, surgery is the only way to correct the position, though conservative measures still manage pain.
Q: What causes hammer toes?
A: The most common cause is footwear that is too tight, too short or that forces the toes upward — particularly high heels and narrow dress shoes. Muscle imbalance, flat feet, bunions and rheumatoid arthritis also contribute. The condition develops gradually over months to years.
Q: Do hammer toe splints or straighteners work?
A: Splints hold the toe in a straighter position while worn and can reduce pain in the flexible stage. They do not produce permanent correction on their own and are most useful as part of a broader plan that includes footwear changes and exercises. They are not effective for rigid hammer toes.
Q: When does a hammer toe need surgery?
A: Surgery is indicated when the deformity is rigid, when conservative treatment has not controlled pain adequately, or when there is skin breakdown — particularly in patients with diabetes or circulatory problems. At your first appointment we assess the stage and discuss whether conservative or surgical management is the right path.
Q: Can orthotics help with hammer toe?
A: Custom orthotics are most effective when the hammer toe is driven by foot mechanics — such as flat feet, overpronation or forefoot overloading. An orthotic redistributes pressure and reduces the forces that curl the toe. They work best in the flexible stage and in combination with appropriate footwear.
If you have a hammer toe that is causing pain, limiting your footwear choices or progressing in severity, early assessment gives you the best chance of avoiding surgery. Our podiatrists treat hammer toes at ModPod Podiatry clinics across Sydney — CBD, Mosman, Dee Why, Rose Bay and North Ryde. Book online to see one of our podiatrists this week.
