In some people, a genetic predisposition for long, toe bones can make them susceptible to developing hammer toe, a condition that results in long-term deformity. Even those without long, toe bones can develop the deformity if they don't take proper care of their feet or suffer a foot injury.

A hammer toe is a toe that bends downward, usually at the first knuckle, forming a blunt end that resembles a hammer. Hammer toe can occur in any toe, although it is usually found in the second toe, the one next to the big toe. The deformity can cause pain often resulting in blisters, calluses, and corns. Hammer toe is a gradual condition, and can be caught early and easily treated. If left untreated, however, a hammer toe can stiffen to the point of inflexibility.

Genetics and environmental factors can cause someone to develop a hammer toe.  Common causes include:

• Excessively long toe bones

• Wearing small or tight shoes

• Pressure from a bunion (a bump on the bottom of the big-toe bone) that pushes a big toe into the smaller ones

• Rheumatoid arthritis

• Stroke

• Foot injury

• Muscle or nerve damage caused by diabetic neuropathy

• Flat feet

• Muscle and tendon imbalance within a toe, which can change bone structure over time

• Genetic inheritance of the condition (this is rare)

• Spinal cord or nerve problem that needs further examination by a doctor (this is extremely rare, usually occuring when all five toes are afflicted with hammer toe)

The most obvious symptom of hammer toe is, of course, the hammer or claw-like appearance of the toe. But additional symptoms, most of which result from excessive friction in shoes, can accompany the deformity.

• Redness

• Inflammation

• Irritation

•  Open sores (in severe cases)

• Pain when trying to move the toe

• Corns on the toe, ball of toes or in between toes

• Calluses (hard skin buildup)

• Joint pain

Regular physical exams are the best way to identify a hammer toe for early diagnosis. The doctor can study your toe to see if its muscles and tendons have contracted (gotten shorter) or hardened, both of which indicate the toe is in the process of deforming. If the doctor suspects deformity, he or she might order an X-ray to determine whether hammer toe is forming.

Two treatments exist: surgical and non-surgical. A doctor will decide which treatment is needed based on the flexibility of the hammer toe. 

If the toe is considerably flexible (common in early stages), the doctor can try to force the toe's structure back to normal by wrapping the toe in tape or putting it into a splint. The tape and splints need to be changed regularly, and a doctor can instruct a patient how to do this at home. The doctor might also suggest exercises, such as moving the toe with fingers or making the toe pick up small, light-weight objects (such as a marble). The exercises can help the toe retain the flexibility it has left. 

A doctor might also suggest corrective footwear, such as pads that relieve pain. Icepacks can reduce pain and swelling, and, in severe cases, the doctor might prescribe anti-inflammatory steroids for the same purpose. If neither icepacks nor steroid pills reduce the pain and swelling, the doctor might inject the toe joint with a shot of steroids.

Surgery is usually the option for a hammer toe that is in extremely late or severe stages, when taping and steroids will not help. The surgery often consists of the doctor removing or relocating portions of the tendons in the affected toe. The doctor might also completely realign the tendons. In extreme cases, the doctor may remove the part of the hammer toe that actually bends downward and fuse the remaining pieces into a shorter, but straight toe. Recovery can be unpleasant because activity is limited, but patients generally are able to leave the hospital the same day of the surgery.

The biggest surgical complications arise from infection or if implants (such as a screw or wire a doctor may use to fuse toe joints together) become loose requiring another operation.

Unless hammer toe genes are latent in the body, there are steps to take that can prevent acquiring this painful deformity. Most of them have to do with wearing comfortable shoes (which, inadvertently, also promote leg and ankle health).

Adults should know their correct shoe size and avoid wearing small, narrow shoes or shoes with pointed toes. High-heel shoes should also be avoided because they can worsen an already deforming toe. Avoid plastic and vinyl shoes, which do not allow feet to breathe and can intensify friction on sweaty feet. Wear well-fitting athletic shoes as often as possible, and make sure the insoles are soft and cushioned while the bottoms are stiff.

Parents should ensure children have shoes that fit right. Kids wearing shoes they have outgrown enables hammer toe development.

Repairing a hammer toe is possible in most, if not all, patients. Even the most severe cases of hammer toe, which can include all five toes needing surgery, are treatable. Hammer toe is an unpleasant yet realistic risk for everyone. Ensuring that shoes fit comfortably, watching for unusual buildup of calluses and corns, being aware of the shapes of your toes and if those shapes are changing, and avoiding accidental foot injuries are the best ways to prevent yourself from having an unnecessarily painful experience with hammer toe.