Hammer toe
- The toe flexes downward at its middle joint (think claw-shaped).
- Triggers include tight-boxed shoes, muscle–tendon imbalances, or family history.
- Early warning signs are corns, calluses, and redness on the top of the toe.
- Starts flexible but contracts over time if ignored.
Crossover toe
- Most often the second toe drifts sideways and up, crossing over the big toe.
- Usually begins when the stabilizing ligament at the base of the toe stretches or tears.
- You feel pain or “pebble-in-the-shoe” pressure under the ball of the foot before you notice the overlap.
- Becomes rigid quickly once the ligament fully fails.
Why toes turn
- Shoes that squeeze. When it comes to footwear, approximately 80% of people—especially women—wear the wrong size. A tight toe box crowds joints, forcing them to buckle or drift.
- Biomechanics gone astray. High arches, flat arches, and loose ligaments all shift pressure toward the smaller toes.
- Overuse or trauma. Repetitive sports, an old sprain, or a stubbed toe can stretch the stabilizing ligaments.
- Systemic conditions. Diabetes, rheumatoid arthritis, and collagen disorders soften support structures sooner.
My first prescription is almost always a shoe audit: Visit a shoe store and stand (don’t sit) on a Brannock device (the standard foot measuring tool in the footwear industry) around lunchtime—when feet are naturally swollen. Then, choose a low-heel, wide-toe-box sneaker that lets your toes breathe.
Conservative fixes worth trying
If the deformity is still flexible—meaning I can straighten the toe with my fingers—non-surgical tactics can dial down pain and prevent progression:
Toe-spacer sleeves or “lasso” straps. Silicone or fabric splints that hold the digit neutral while you walk.
Metatarsal pads or orthotics. These shift weight away from overstressed joints and ease burning under the ball of the foot.
Targeted exercises. Marble pickups, towel curls, and calf stretches strengthen the tiny intrinsic muscles that keep toes aligned.
Skin protection. Moleskin, gel sleeves, or corn pads prevent friction blisters that can turn into ulcers—especially if you have diabetes.
Anti-inflammatory care. A short course of NSAIDs, plus icing after long days, calms the -itis before it snowballs.
Give these measures four to six weeks. If pain is still impacting your day-to-day, it’s time for a conversation with your podiatrist or orthopedist.
When surgery makes sense—and what it really involves
Crooked toes become rigid for one reason: scarred-in soft tissue. Once I can’t bend or extend the joint in clinic, splints are largely decorative. Surgical correction then falls into two broad buckets:
Rebalancing soft tissue (for flexible deformities)
- I release tight tendons, shift them to the opposite side, and secure the toe with a temporary pin or permanent implant.
- You’ll walk in a stiff sandal right away, and the pin comes out in three to four weeks.
Realigning bone (for fixed deformities)
- I remove a small wedge of bone or fuse the joint straight—sometimes correcting both hammer and crossover issues in one sitting.
- Expect protected weight-bearing for about six weeks; swelling can linger for three to six months.
Remember: Toe surgery is functional first, cosmetic second. “We’re here to fix pain and restore push-off,” I tell patients. A prettier toe is just a welcome side effect of a well-executed procedure.
Your take-home checklist
- Audit your shoes today. If you can’t wiggle every toe freely, swap them out.
- Start a nightly stretch routine. Calf and plantar fascia stretches keep forefoot forces in balance.
- Listen to early signals. Redness, corns, or that telltale pop of a ligament tear deserve a prompt eval; acting early keeps options simple.
- Find a foot-and-ankle specialist. Toe deformity surgery isn’t one-size-fits-all—choose a surgeon who does these procedures regularly and walks you through every step of the plan.
