Hammer Toe (Toe Deformities) in Singapore

If one or more of your toes have started to curl, bend, or rub against the inside of your shoes, you are not alone. Hammer toe is one of the most common toe deformities we see at ACME Orthopaedics. Many people live with the discomfort for months, assuming it will resolve on its own or that it is simply part of ageing. In reality, toe deformities are usually progressive. A flexible hammer toe that can still be straightened today may gradually become a rigid, fixed deformity that is far more difficult to treat. Early assessment often allows for simpler treatment, and in some cases, surgery may be avoided altogether.

This page explains the different types of toe deformity, their causes, how they are diagnosed, and the treatment options available — from simple footwear modifications to minimally invasive surgery — so you can make an informed decision about your care.

Dr Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)MMed (SG)MRCS (Glasgow)FRCSEd (Orth)

Overview Types Causes & Risks Symptoms When to see a Doctor Diagnosis Treatment Recovery Risks Insurance Prevention FAQ

What is a Hammer Toe?

Hammer toe is a deformity in which one or more toes bend abnormally at the middle joint, known as the proximal interphalangeal (PIP) joint, creating a downward curl that resembles the head of a hammer. It most commonly affects the second, third, or fourth toes and develops gradually when the muscles and tendons controlling toe movement become imbalanced.

In the early stages, the affected toe usually remains flexible and can still be straightened manually. Over time, the tendons may tighten, causing the joint to become rigid and fixed. This progression from a flexible to a rigid deformity is one of the key reasons early assessment is important.

What begins as mild discomfort when wearing enclosed shoes can progress to painful corns, skin breakdown, and difficulty walking. At ACME Orthopaedics, we treat patients across the full spectrum of toe deformities, with management tailored to the severity of the condition and individual needs.

Types of Toe Deformities

Although hammer toe, mallet toe, and claw toe are often grouped together, they affect different joints and have distinct characteristics. Identifying the specific deformity is an important first step in determining the most appropriate treatment.

Hammer Toe

Hammer toe involves abnormal bending at the proximal interphalangeal (PIP) joint, the middle joint of the toe. The toe bends downward at this point, while the tip may press against the floor or the top of the toe may rub against footwear. It most commonly affects the second toe and is frequently associated with bunions.

Mallet Toe

Mallet toe affects the distal interphalangeal (DIP) joint, the joint closest to the toenail. The tip of the toe curls downward, often causing a painful corn or callus to develop where it contacts the ground. Although less common than hammer toe, it is often mistaken for it despite involving a different joint.

Claw Toe

Claw toe involves abnormal bending at both the middle and end joints, causing the toe to curl under into a claw-like shape. It commonly affects all four smaller toes and is more frequently associated with neurological conditions such as diabetic peripheral neuropathy, Charcot-Marie-Tooth disease, or the effects of stroke. When claw toes are present, assessment for an underlying neurological or systemic condition is often recommended.

Flexible vs Rigid Deformities

Regardless of the type of deformity, toe deformities are classified as either flexible or rigid. A flexible deformity means the toe can still be manually straightened. At this stage, non-surgical treatments such as footwear modification, orthotics, and physiotherapy are often most effective.

A rigid deformity means the toe can still be manually straightened. At this stage, non-surgical treatments such as footwear modification, orthotics, and physiotherapy are often most effective.

A rigid deformity means the joint has become fixed and can no longer be manually corrected. In these cases, surgical treatment may be considered if symptoms significantly affect daily activities.

The distinction between flexible and rigid deformities is one of the most important factors in treatment planning, which is why a thorough clinical examination is always the first step.

Causes and Risk Factors

Structural and Biomechanical Factors

Muscle and tendon imbalance: When the muscles and tendons controlling the toe no longer work in balance, one side gradually pulls the joint into a bent position. This imbalance often develops gradually and may worsen over time.
Flat feet or high arches: Both can alter how weight is distributed across the foot during walking, increasing mechanical stress on the smaller toe joints.
Bunions: A bunion at the base of the big toe can push the second toe out of alignment, increasing the likelihood of a hammer toe developing over time.
Toe length: A second toe that is longer than the big toe may be more likely to bend when repeatedly compressed inside footwear.

Lifestyle and External Factors

Ill-fitting footwear: Shoes with a narrow toe box or high heels repeatedly force the smaller toes into a bent position. This is one of the most modifiable risk factors and is commonly associated with hammer toe.
Previous injury: A previous fracture or dislocation may alter the mechanics of the toe and contribute to deformity over time.
Age: Tendons and ligaments naturally become less flexible with age, making progressive toe deformities more likely.

Underlying Health Conditions

Diabetes: Peripheral neuropathy associated with diabetes can weaken the intrinsic muscles of the foot, affecting toe alignment. People with diabetes may also have a higher risk of skin breakdown overlying toe deformities.
Rheumatoid arthritis: Inflammatory joint disease can damage and destabilise the toe joints, contributing to deformity progression.
Neurological conditions: Conditions affecting nerve function — including Charcot-Marie-Tooth disease, cerebral palsy, and the effects of stroke — are commonly associated with claw toe and other toe deformities.

Signs and Symptoms

Symptoms usually develop gradually and may worsen over time. Many patients first notice changes in their footwear choices before seeking medical advice.

Early and Mild Symptoms
- Visible bending or curling of one or more toes.
- Mild discomfort or rubbing in enclosed shoes.
- Difficulty finding comfortable footwear.
- A toe that can still be straightened by hand (flexibility deformity).
Moderate Symptoms
- Persistent toe pain, especially when walking
- Recurrent corns or calluses over the bent joint or toe tip
- Redness or swelling around the joint
- Pain under the ball of the foot (metatarsalgia) due to altered weight distribution
Advanced Symptoms
- A rigid toe that cannot be straightened manually
- Open sores or skin breakdown over pressure points, particularly in people with diabetes or poor circulation
- Difficulty walking or bearing weight comfortably
- Changes in walking pattern to compensate for pain

A healthcare professional carefully examining a patient's foot while wearing blue gloves in a clinical setting.

When to See a Doctor

Consider seeing an orthopaedic surgeon if you notice any of the following:

Your toe can no longer be straightened manually, even with gentle pressure
A painful corn or callus keeps returning despite padding, gel sleeves, or footwear changes
Toe pain is changing the way you walk or affecting your daily activities
You have diabetes, poor circulation, or reduced sensation in your feet and notice any skin changes over a toe
Your symptoms have not improved despite appropriate self-care and footwear modification over several weeks.

Early assessment may provide more treatment options. Flexible deformities can often be managed without surgery, whereas rigid deformities are more likely to require surgical correction if symptoms are significant.

Clinical Examination

Weight-bearing Inspection: We observe the foot at rest and while standing to see how gravity and body weight affect the deformity.
Flexibility Assessment: We determine if the deformity is flexible or rigid—this is one of the most important factors in deciding between conservative and surgical care.
Gait Analysis: We evaluate your walking pattern to identify whether the toe deformity is contributing to compensatory pain in your ankle, knee, or hip.
Skin Integrity Check: We examine bony pressure points for corns, calluses, or signs of impending skin breakdown.
Neurovascular Screening: Where indicated (particularly in patients with diabetes), we assess blood flow and nerve sensation to help determine the foot’s healing capacity.

Imaging

Weight-bearing X-rays: To assess joint alignment and check for any arthritic changes or associated foot deformities such as bunions. Weight-bearing views are preferred because they reflect the foot under normal load conditions.
Further imaging: MRI or ultrasound may be requested if there is uncertainty about soft tissue involvement or the underlying diagnosis.

The findings from this assessment help guide an individualised treatment plan. Our surgeon will explain the findings and discuss the most appropriate treatment options before any decisions are made.

Treatment Options

Treatment for hammer toe, mallet toe, and claw toe depends on the type of deformity, whether it is flexible or rigid, its severity, and how much it affects daily life. Our surgeon will discuss the treatment options that are appropriate for your condition during your consultation.

Non-Surgical Treatment (Conservative Management)

For flexible deformities, conservative measures may help relieve symptoms and, in some cases, slow progression. These are often the first-line treatment for patients whose toes can still be straightened manually.

Footwear modification

Switching to shoes with a wider, deeper toe box and a lower heel is often the most impactful single change a patient can make. This removes the compressive force that is driving the toe into a bent position.
Padding and toe sleeves

Gel or foam pads placed over the knuckle or tip of the toe reduce friction against footwear and relieve pressure on painful corns or calluses. This does not correct the underlying deformity but can significantly improve day-to-day comfort.
Custom orthotics

Insoles designed for your specific foot shape can help redistribute load across the forefoot and reduce the strain on affected toe joints, particularly where flat feet or high arches are contributing factors.
Physiotherapy and toe exercises

Stretching and strengthening exercises address the underlying muscle imbalance that is pulling the toe into a bent position. Your surgeon or physiotherapist can guide you through a programme appropriate to your stage of deformity.
Strapping and splinting

Taping a flexible toe into a more corrected position can be helpful in the early stages to encourage better alignment during daily activities.
Corn and callus management

Regular offloading of pressure points, combined with appropriate footwear, can prevent calluses from becoming painful, cracked, or infected.

Surgical Treatment Options

Surgery may be considered when the deformity has become rigid, conservative treatment has not provided adequate symptom relief, or the condition is significantly affecting daily function or quality of life. The appropriate surgical technique depends on the type and severity of the deformity and joints involved.

Tendon Transfer

A tendon transfer is typically used for flexible hammer toe deformities. The tendon on the underside of the toe that pulls it into a bent position is released and rerouted to the top of the toe, where it can help straighten the joint. This approach corrects the underlying muscle imbalance rather than simply addressing the bony alignment and is generally suitable for patients whose deformity has not yet become rigid.

Arthroplasty (Joint Resection)

Arthroplasty involves removing a small section of bone at the affected joint to allow the toe to lie in a straighter position. It is commonly used for flexible or semi-rigid deformities. The procedure preserves some joint motion and may be appropriate for selected patients with flexible or semi-rigid deformities.

Arthrodesis (Joint Fusion)

For rigid deformities, joint fusion is often the most reliable long-term solution. The joint surfaces are prepared and held in a corrected position while the bone heals, permanently straightening the toe. A small pin or implant is used to maintain the position during healing. Although movement at the fused segment is lost, most patients find this has little practical impact on daily function once recovery is complete.

Minimally Invasive Hammer Toe Surgery (MIS)

ACME Orthopaedics performs minimally invasive hammer toe surgery, which uses very small incisions — typically a few millimetres — and specialised instruments to address the bony and soft tissue components of the deformity under fluoroscopic (real-time X-ray) guidance.

Because the incisions are smaller than those used in conventional open surgery, minimally invasive surgery may be associated with reduced soft tissue disruption and, in appropriately selected patients, may result in less post-operative swelling and scarring. Recovery varies depending on the individual and the procedure performed. Where appropriate, more than one affected toe may be corrected during the same procedure.

Your surgeon will advise whether MIS is appropriate for your particular deformity during your consultation. Not all deformities are suitable for a minimally invasive approach.

Recovery and Aftercare

Recovery timelines vary according to the type of treatment received, the severity of the deformity, and individual healing. The guidance below reflects typical recovery milestones only. Our surgeon will provide a personalised recovery plan during your consultation and follow-up appointments.

Non-Surgical Recovery

Symptom relief from footwear changes, padding, and orthotics is gradual. Many patients notice improvement within 4 to 8 weeks when these measures are used consistently. Physiotherapy and toe exercises require ongoing commitment and may take a similar timeframe before benefits become apparent.

Surgical Recovery: Comparison of Approaches

Timeframe	Conventional Surgery	Minimally Invasive Surgery (MIS)
Immediately after	Walking is typically possible on the same day using a post-operative shoe.	Walking is typically possible on the same day using a post-operative shoe.
Weeks 2–4	Dressings are maintained, and a surgical shoe continues to be worn.	Dressings are maintained. Our surgeon will monitor swelling and wound healing during follow-up appointments.
Weeks 6–8	Return to comfortable, wider footwear may be possible, subject to our surgeon’s assessment.	Return to comfortable footwear may be possible, depending on healing progress and your surgeon’s assessment.
Months 2–3	Gradual return to higher-impact activities may be considered, depending on recovery and rehabilitation progress.	Gradual return to higher-impact activities may be considered, depending on healing, rehabilitation progress, and your surgeon’s advice.
Full healing	Complete bone and soft tissue healing typically takes 3–6 months.	Healing time varies according to the procedure performed and individual factors. Our surgeon will advise you during follow-up.

Recovery experiences vary between individuals. The timelines above are intended as general guidance only and should not be interpreted as a guarantee of outcome. Always follow the advice provided by the treating surgeon regarding activity progression and return to work or sport.

Risks of Leaving Hammer Toe Untreated

Hammer toe, mallet toe, and claw toe are generally progressive conditions. Without appropriate management, the deformity may worsen over time.

Flexible deformity becomes rigid: As the tendons shorten and the joint stiffens, the toe may become fixed in position. When this occurs, conservative treatment may become less effective, and surgical treatment may be considered.
Calluses and skin breakdown: Ongoing pressure from footwear can cause corns, calluses, or skin breakdown over bony prominences, which may increase the risk of infection. This is of particular concern in people with diabetes or poor circulation.
Changes in walking pattern: Altering the way you walk to avoid toe pain may place additional stress on the ball of the foot, ankle, knee, or hip, potentially contributing to discomfort in these areas over time.
Increasing difficulty with footwear: As the deformity progresses, it may become more difficult to find comfortable footwear, which can affect everyday activities.
Metatarsalgia: Changes in weight distribution across the forefoot may lead to pain and inflammation beneath the ball of the foot.

Medisave and Insurance

Certain surgical procedures for toe deformities may be claimable under Medisave, depending on the procedure performed and your eligibility. Hammer toe surgery involving procedures such as arthroplasty, arthrodesis, or tendon transfer may be claimable, subject to CPF Board guidelines and your individual clinical circumstances.

If you have questions about Medisave or insurance coverage, our clinic team can provide information on the claims process and advise on the documents required before your procedure. Please bring your insurance card and relevant policy documents to your appointment.

A doctor in blue gloves examining a patient's foot in a hospital setting.

Reducing Your Risk

Not all cases of hammer toe can be prevented, particularly those associated with genetics or underlying medical conditions. However, the following measures may help reduce mechanical stress on the toes and lower the risk of progression.

Choose shoes with a wide, deep toe box: Your toes should be able to rest comfortably without being compressed against the front or top of the shoe.
Limit high heels and pointed-toe shoes: These styles place increased pressure on the forefoot and smaller toe joints.
Seek assessment for early symptoms: If you notice mild discomfort or a developing toe deformity, early assessment may allow a wider range of treatment options.
Manage underlying health conditions: If you have diabetes, arthritis, or a neurological condition, regular foot checks may help identify early changes before they progress.
Maintain a healthy body weight: Maintaining a healthy weight may help reduce mechanical loading across the feet.
Address persistent foot pain: Ongoing foot pain may indicate an underlying biomechanical problem and should be assessed if symptoms persist.

Not Sure Which Treatment Is Right for You?

Our orthopaedic surgeon will assess your condition, explain the available treatment options, and recommend an approach based on your symptoms, examination findings, and individual needs.

Book Appointment

Hammer Toe

Frequently Asked Questions

Can hammer toe be corrected without surgery?

In many cases, yes — particularly when the deformity is still flexible. Footwear changes, padding, custom orthotics, and targeted exercises can relieve symptoms and slow progression. However, once the joint becomes rigid, non-surgical measures are unlikely to correct the underlying deformity, and surgery is typically the most appropriate option. An orthopaedic assessment will clarify which pathway suits your situation.

How long does recovery take after hammer toe surgery?

This depends on the surgical technique. With conventional procedures, patients typically wear a post-operative shoe for 2 to 4 weeks and may return to comfortable footwear around 6 to 8 weeks. Return to sport and higher-impact activities is generally possible from two to three months. Recovery varies depending on the procedure performed and individual healing. Our surgeon will provide personalised guidance based on your treatment plan.

Will hammer toe come back after surgery?

Recurrence is possible, particularly if the factors that originally caused the deformity — such as footwear habits or an underlying muscle imbalance — are not addressed. Your surgeon will discuss the most appropriate technique for your case and advise on footwear and activity modifications that can help protect the long-term result.

Can I prevent hammer toe from developing in my family?

There is a genetic component to certain foot structures that predispose people to hammer toe. While you cannot change your underlying anatomy, choosing appropriate footwear, managing underlying conditions, and promptly assessing any early bending can reduce the likelihood that the condition will progress. Regular foot checks are worthwhile if other family members have experienced similar problems.

What is the difference between hammer toe, mallet toe, and claw toe?

All three are toe deformities, but they involve different joints. Hammer toe involves the middle joint of the toe (PIP joint). Mallet toe affects the joint closest to the toenail (the DIP joint). Claw toe involves abnormal bending at multiple joints and often affects all four smaller toes simultaneously — it is more frequently associated with neurological conditions. Each may require a slightly different treatment approach, which is why an accurate diagnosis matters.

Is hammer toe surgery painful?

Discomfort after surgery is normal and is managed with appropriate pain relief. Some discomfort after surgery is expected and is usually managed with appropriate pain relief. The surgical team will provide guidance on pain management before and after your procedure. Where appropriate, minimally invasive techniques use smaller incisions than conventional open surgery and may be associated with reduced soft tissue disruption. Recovery varies depending on the individual and the procedure performed. Our surgical team will provide clear guidance on pain management before and after your procedure.

Can I use Medisave for hammer toe surgery in Singapore?

Certain surgical procedures for toe deformities may be claimable under Medisave, subject to CPF Board guidelines and your individual eligibility. If you have questions about Medisave or insurance coverage, our clinic team can provide information on the claims process and the documents required.

When should I see a doctor about a bent or painful toe?

It is worth arranging a consultation if your toe is no longer straightening on its own, if a corn or callus keeps returning despite padding, if toe pain is changing the way you walk, or if you have diabetes and notice any skin changes on your feet. The earlier you seek advice, the more treatment options are likely to be available to you.

What happens at a first consultation for a hammer toe at ACME Orthopaedics?

Your surgeon will take a detailed history of your symptoms and examine the foot, assessing the type and flexibility of the deformity and checking for any contributing factors. Weight-bearing X-rays are usually taken. At the end of your consultation, your surgeon will explain the findings and discuss appropriate next steps — whether that is conservative management, further investigation, or a surgical plan. Our surgeon will explain the findings and discuss the treatment options that may be appropriate for your condition.

What is minimally invasive hammer toe surgery, and am I a suitable candidate?

Minimally invasive surgery (MIS) uses very small incisions and specialised instruments under X-ray guidance to correct the bony and soft-tissue components of the deformity, using smaller incisions than conventional open surgery. In appropriately selected patients, this approach may be associated with reduced soft tissue disruption. Our surgeon will advise whether it is suitable for your specific deformity.

Why Patients Choose ACME Orthopaedics for Foot and Ankle Care

Dual subspecialty training in adult and paediatric foot and ankle surgery

Adults and children with foot and ankle conditions are seen by the same surgeon who has specific fellowship training in both areas. Parents do not need to seek a separate specialist for their child.
Fellowship-trained orthopaedic surgeon (FRCSEd, Orth)

Additional post-specialist training provides depth of experience in managing complex and surgical foot and ankle cases beyond general orthopaedics.
Full range of surgical and non-surgical options

Treatment recommendations are based on your condition, clinical assessment, and preferences. Both non-surgical and surgical treatment options are discussed where appropriate.
Named, verifiable surgeon with published credentials

Dr Chua’s qualifications, recognitions, and institutional affiliations are verifiable. E-E-A-T-transparent: no anonymous or ambiguous authorship of clinical content.
Two accessible clinic locations in Singapore

Mount Elizabeth Novena Specialist Centre and Parkway East Medical Centre offer patients a choice across different parts of the island.
Broad insurance and Medisave coverage

Major ISPs and corporate insurers panels are accepted. Our clinic team can assist with pre-authorisation and explain your insurance and MediSave eligibility before your procedure.
Structured, continuous care

From diagnosis through rehabilitation and follow-up, the same specialist oversees your care, ensuring continuity at every stage.
Active in research and professional development

Dr Chua contributes to mentoring, research supervision, and professional forums locally and internationally.

Concerned About a Painful or Bent Toe?

Our orthopaedic team is here to help you understand your options. Book a consultation today.

Book Your Consultation Today

Dr Zackary Chua (蔡克祥医生)

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (AUS)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A senior consultant orthopaedic surgeon with dual specialisations in Foot & Ankle Surgery and Paediatric Orthopaedics. Backed by his extensive years of training and experience, Dr Chua brings the necessary knowledge and skills to ensure a smooth recovery journey.

Rooted firmly by two fundamental philosophies: “When one’s feet hurt, one hurts all over” and “Children are not little adults”, Dr Chua’s approach to patient care reflects his compassionate care for adults and children.

Singhealth Quality Excellence Award – Silver (2011)
Service From the Heart Award (2021)
Singapore Health Quality Service Award – Gold (2023)
NUS Medicine Dean’s Award for Teaching Excellence (2023)

His active participation in the medical community extends to mentoring, research supervision, and contributions to key professional forums and symposiums, both locally and internationally.