Hammer Toes: Causes, Treatment and Exercise
What Are Hammer Toes?
Hammer toes are a common foot condition in which one or more of the smaller toes develop an abnormal bend, most often at the proximal interphalangeal (PIP) joint, or middle joint of the toe. The condition can remain flexible in its earlier stages but may become increasingly stiff or fixed over time.
Some hammer toes cause few symptoms, while others can lead to pain, stiffness, corns or calluses, difficulty finding comfortable footwear, and discomfort during walking or other activities.
Hammer toes can develop for several reasons, including foot structure, muscle and tendon function, joint mechanics, footwear, previous injury, and certain medical or neurological conditions. Rather than focusing only on the visible position of the toe, effective management begins by understanding what may be contributing to the problem and how it is affecting the individual.
Treatment depends on the severity and flexibility of the deformity and the symptoms it produces. Conservative care may include footwear modification, exercise, activity modification, padding or orthotics, and manual therapy when appropriate, while more advanced or persistent cases may require further medical or surgical evaluation.
Article Index
Understanding Hammer Toe
A hammer toe is a deformity that most commonly affects the second, third, or fourth toe. It is characterized primarily by abnormal flexion at the proximal interphalangeal (PIP) joint, creating the characteristic bent appearance of the toe.
Hammer toes can initially be flexible, meaning the toe can still be moved toward a more neutral position. Over time, changes in the joint capsule, tendons, and other surrounding tissues may cause the deformity to become increasingly rigid or fixed.
Hammer toe is also different from other lesser-toe deformities. A claw toe typically involves extension at the metatarsophalangeal (MTP) joint combined with flexion of both the PIP and distal interphalangeal (DIP) joints. A mallet toe primarily involves flexion of the DIP joint. Distinguishing between these patterns can be important when determining appropriate management.
Why Do Hammer Toes Develop?
Hammer toes are usually multifactorial rather than the result of a single muscle imbalance. The position of the toe reflects the interaction between the bones and joints, the long flexor and extensor tendons, and the intrinsic muscles of the foot, including the lumbricals and interossei.
Several factors may contribute to the development or progression of a hammer toe, including:
Foot structure and toe anatomy
Muscle and tendon function
Changes in MTP and interphalangeal joint mechanics
Narrow or poorly fitting footwear
High-heeled footwear that increases pressure on the forefoot
Previous injury or joint disease
Certain neurological or systemic conditions
Foot structure may also influence how forces are distributed across the toes. Both higher and lower arches can alter loading patterns, but neither should automatically be considered the cause of a hammer toe.
As the deformity progresses, pressure between the bent toe and footwear can contribute to pain, irritation, corns, calluses, and difficulty walking comfortably. This is why assessment should look beyond the appearance of the toe and consider its flexibility, joint mobility, muscle and tendon function, footwear, foot structure, and the activities that reproduce symptoms.
Exercise & Rehabilitation for Hammer Toes
Exercise can be an important part of conservative management for hammer toes, particularly while the affected toes remain flexible. The goals are to maintain available joint mobility, improve active control of the toes, strengthen the foot and ankle, and support comfortable walking and other activities.
Exercise cannot be expected to reverse a rigid structural deformity. The program should therefore be individualized according to the flexibility of the toe, symptoms, joint mobility, strength, and functional requirements.
Specific Exercises
Gentle Toe Extension: Using your fingers, gently move the affected toes toward a straighter position within a comfortable range. This can help maintain available mobility at the toe joints and stretch tissues that may have become shortened or restricted. Avoid forcing a rigid toe.
Active Toe Flexion and Extension: Slowly move the toes through their available range, emphasizing both bending and straightening. The goal is to improve active control and maintain mobility, rather than simply strengthening the toe flexors.
Toe Stretch Sit-Backs: This exercise places the toes into extension while gradually loading the plantar surface of the foot. It can provide a broader stretch through the toes and plantar tissues. The amount of pressure should be adjusted according to comfort and toe flexibility.
Standing Toe Stretches and Calf Raises: Toe stretches can help maintain available extension, while calf raises strengthen the muscles of the lower leg and improve the foot and ankle's capacity to tolerate weight-bearing activity.
Toe Spreading and Active Toe Control: Practicing spreading, lifting, and independently controlling the toes can engage the intrinsic foot muscles without relying primarily on repeated gripping or curling.
Manual Therapy for Hammer Toes
Manual therapy may be incorporated into conservative care when examination identifies joint stiffness, restricted toe mobility, soft-tissue sensitivity, or limitations elsewhere in the foot and ankle that may be relevant to the individual’s symptoms and function.
Manual therapy cannot reverse a fixed hammer toe deformity. Its role is to address modifiable restrictions, maintain available movement, reduce symptoms, and support the exercise and rehabilitation program.
Toe Joint Mobilization: Gentle traction, mobilization, and other manual techniques may be applied to the affected toe joints when mobility is restricted. The goal is to maintain or improve available movement without forcing a rigid deformity into a corrected position.
Interdigital Soft-Tissue Treatment: Manual techniques applied between the metatarsals and toes may be used when tenderness or soft-tissue restrictions are identified. Treatment should be based on examination findings rather than the assumption that interosseous tension is causing the deformity.
Plantar Fascia and Flexor Muscle Mobilization: Soft-tissue techniques may be directed toward the plantar tissues and long toe flexors when these structures are sensitive or restricted. This may be combined with mobility exercises and active toe control.
Gastrocnemius and Soleus Treatment: Calf mobility may be addressed when ankle dorsiflexion or calf flexibility is limited. Improving available ankle movement may support overall foot function, although treating the calf muscles should not be expected to correct or prevent a hammer toe.
Exercise and Treatment Demonstration
In this video, Dr. Brian Abelson demonstrates exercises and manual therapy techniques that may be incorporated into the conservative management of hammer toes.
Hammer toes involve an abnormal bend of one or more of the smaller toes and may be associated with pain, stiffness, corns, calluses, and difficulty finding comfortable footwear. Narrow, tight, or high-heeled footwear can increase pressure on the toes and aggravate symptoms, but footwear is only one of several factors that may contribute to the condition.
The exercises and treatment techniques demonstrated should be selected according to the individual’s toe flexibility, joint mobility, symptoms, foot function, and examination findings.
Fascial Expansion: MSR Foot Pain Protocol
This video demonstrates how fascial expansions are incorporated into the MSR approach to foot pain. The procedure integrates concepts from fascial anatomy and regional biomechanics with selected points traditionally used in acupuncture and Traditional Chinese Medicine, including ST44, LV3, LV2, K3, and BL60.
For someone with symptomatic hammer toes, fascial expansion techniques may be combined with joint mobilization, myofascial procedures, exercise, footwear modification, and other conservative interventions when appropriate to the individual examination.
These procedures should not be presented as a method for permanently straightening a hammer toe or reversing a fixed structural deformity. Instead, they may be used as part of a broader strategy aimed at managing symptoms, maintaining available mobility, and supporting foot function.
References
Coughlin, M. J., Dorris, J., & Polk, E. (2000). Operative repair of the fixed hammertoe deformity. Foot & Ankle International, 21(2), 94–104.
Federer, A. E., Tainter, D. M., Adams, S. B., & Schweitzer, K. M. (2018). Conservative management of metatarsalgia and lesser toe deformities. Foot and Ankle Clinics, 23(1), 9–20.
Frey-Ollivier, S., Catena, F., Hélix-Giordanino, M., & Piclet-Legré, B. (2018). Treatment of flexible lesser toe deformities. Foot and Ankle Clinics, 23(1), 69–90.
Formosa, C., Grixti, C., & Gatt, A. (2022). Conservative approach in the management of lesser toe deformities in older adults. Journal of the American Podiatric Medical Association, 112(3).
Plapler, P. G., & Ling, D. (2024). Treatment of lesser toe deformities based on physical therapy. Foot and Ankle Clinics.
Colò, G., Fusini, F., Melato, M., De Tullio, V., Logrieco, G., Leigheb, M., & Surace, M. F. (2025). The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: A review of literature. Musculoskeletal Surgery, 109(3), 225–232.
Goransson, M., & Dixon, M. (2026). Hammertoe. StatPearls. StatPearls Publishing.
Monteagudo, M., & Orejana, Á. M. (2026). Orthotics for the treatment of lesser toe deformities. Clinics in Podiatric Medicine and Surgery, 43(3), 349–361.
Disclaimer
The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
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DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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