The middle phalanx bend downwards at its joint with proximal phalanx forms a hammer like deformity. 2^nd , 3^rd and 4^th toe affect commonly. Sometimes proximal phalanx bends upwards at metatarsophalangeal joint then it is called complex hammer toe. To begin with the deformity is flexible but with time it become fixed.

Hammer toe deformity occurs due to muscle strength imbalance at middle phalanx joint. Various factors are responsible for this weakness and imbalance. Few are unavoidable and some can be modified.

• Repeated use of certain type of shoe like high heel, small and narrow toe box shoe can forced the toes to bend and remained curled up for long that they may not be able to straight on bare foot.
• Bunion/Hallux valgus deformity forces 2^nd toe to develop hammer toe deformity
• Longer 2^nd toe than great toe has a greater chance of developing hammer toe
• Female gender and old age increases the chance of developing hammer toe
• Osteoarthritis and trauma can also develop hammer toe

Due to deformity upper surface of PIP joint faces abnormal friction with foot ware. The deformity itself pushes ball of the toe downwards thus results abnormal weight transfer at sole aspect of ball of the toes. Both these factors results in development of painful corns and calluses which makes it  difficult to wear a normal foot ware even sometimes normal walking and standing.  

When the deformity become rigid and painful you should visit a specialist foot & Ankle surgeon or podiatrist to sought definitive treatment. Even in very early stage whenever you noticed the deformity you should visit a specialist foot & Ankle surgeon or podiatrist to prevent the progression of it.

Clinical examination is enough to identify this deformity but your doctor may examine your foot evaluate the severity of the deformity or to identify any predisposing factor. He may ask you to get an x-ray to evaluate the degenerative changes if any and any other associated condition.

Selfcare and prevention: 

• If your toes are still flexible, performing regular exercises of foot intrinsic muscle may help alleviate your symptoms or prevent them from getting worse
• Move your toes passively toward their natural position using your hands.
• Wear shoes with soft, roomy toe boxes and avoid tight shoes and high-heels
• Using friction protecting silicone gel cap, sheet and spreader also helps in preventing painful corn formation.

Based on your symptoms your doctor may advice you

• A special insole or metatarsal pad that can redistribute your weight and relieve pressure on the ball of your foot as well as toe tip.
• Wear a splint to keep them in the right position.
• You may advised a surgical correction of toe deformity as well as any predisposing foot deformity like hallux valgus deformity with soft tissue release in severe deformity and related symptom