Hammertoes, along with mallet, claw and curly, are all deformities of the toe that start out quite innocent-looking: a slight curve or contour along some part of the digit. But little known is that these seemingly harmless bends are actually progressive conditions — the toes gradually begin to tighten up even further, eventually becoming stiff, rigid and sometimes overlapping other toes.

In any case, whether slightly raised or severely stiffened, most hammertoes require surgery to rectify. Typically, the longer people wait, the more involved the fix is, according to Dr. Jason Ahuero, a foot and ankle surgeon at Houston Methodist.

"Tape, splints and toe correctors are all conservative options for the treatment of hammertoe but none of them will actually correct the problem," says Dr. Ahuero. "They can help hold the toe in a corrected position and prevent it from rubbing on the shoe, but when you stop wearing them, the toe is going to go back to the position it was in."

Moreover, the case for fixing hammertoes goes beyond aesthetics. They can also pose certain health risks, particularly among those with conditions such as diabetes and neuropathy.

The idea of surgery can make anyone's toes clench, but Dr. Ahuero shares important considerations when it comes to addressing this oft-overlooked condition.

What exactly are hammertoes?

Hammertoes are a relatively common type of toe deformity that causes a particular toe joint to lift upward and the remaining half to point downward, creating a hammer- or claw-like shape.

The main difference among hammertoe, claw toe and mallet toe is the joints in which the toes curve. Hammertoe typically involves a flexing of the middle toe joint, called the proximal interphalangeal (PIP). Mallet toe involves a curling downward of the furthermost toe joint, called the distal interphalangeal (DIP). Claw toes involve both the DIP and PIP toe joints, making them seem the most claw-like compared to the others.

Regardless, Dr. Ahuero says that while the differences between these conditions are important, in most cases he treats them all the same: with surgery.

What causes hammertoes?

"There are many causes of hammertoe, but ultimately they're caused by an imbalance in the muscles and tendons that control the flexion and extension of the toes," says Dr. Ahuero.

The main causes of hammertoe are genetics, age, injury and medical conditions, notes Dr. Ahuero.

Genetics

People with bunions, flat feet, high-arched feet and even those with long toes can be more susceptible to hammertoes than others.

As it turns out, bunion formation is largely determined by genetics rather than ill-fitting shoes, explains Dr. Ahuero. Hammertoes, on the other hand, can be caused by tight or narrow shoes — especially in people with longer-than-average toes. However, while the two conditions may have different causes, they are nonetheless related. They afflict more women than men.

High-arched and flat feet are also genetic and frequently result in over-recruitment of the tendons on the bottom of the foot. Since hammertoes are largely caused by an imbalance of tendons in the foot, these conditions are associated with an increased risk of hammertoe formation, according to Dr. Ahuero.

Age

While you can develop hammertoes at any age, it's more common to acquire the condition as you get older, says Dr. Ahuero. He says he occasionally sees younger people with more advanced hammertoes, but it's pretty unusual.

Typically, hammertoes in younger people without any underlying health conditions are a result of some sort of genetic predisposition along with outside factors such as poor-fitting shoes or an acute injury to the foot.

Injury

Runners and women who frequently wear high heels are more susceptible to injuries related to the formation of hammertoes, says Dr. Ahuero.

Both activities involve repeatedly bearing weight on the ball of the foot, which can cause recurrent trauma in the area and eventually stretch and tear the plantar plate, a thick ligament that runs along the ball of the foot to support the toe joints.

When the plantar plate tears, people can sometimes hear or feel a "pop" in their foot, followed by severe pain with their toe having lifted up. In rare cases, tape can sometimes mend these injuries, but in almost all cases, the injury will not heal correctly and will develop into a hammertoe, says Dr. Ahuero.

Also, repeated wear of narrow or ill-fitting shoes can force your toes into unnatural positions, causing the muscles and tendons to tighten and loosen where they shouldn't.

Medical conditions

Patients with conditions affecting the nerves or joints of the feet are especially susceptible to several toe deformities, including hammertoe.

"Anytime you have nerve damage or nerves that aren't working, if those muscles in the foot aren't getting innervated correctly, that can cause the toes to start clawing," Dr. Ahuero says. "Patients with conditions causing joint inflammation can also develop toe deformity due to inflammation and stretching out of the joint capsule connecting the toe to the foot."

Those conditions include:

• Diabetic peripheral neuropathy
• Idiopathic (i.e., unknown) neuropathy
• Rheumatoid arthritis
• Other joint inflammation disorders

(Related: What Are the Early Warning Signs of Neuropathy?)

How are hammertoes treated?

As Dr. Ahuero explains, surgery is the only true fix when it comes to hammertoes, but there are other more conservative options for patients who aren't surgical candidates or would simply rather wait.

Surgery

Hammertoe surgery involves removing a small segment of bone to straighten out the toe and reinforcing it with a screw, implant or wire while it heals. For most standard hammertoe surgeries, patients are placed in a walking sandal for about six weeks while the bone heals, then back into regular shoes after that. Swelling, Dr. Ahuero says, can sometimes persist for a few months but will go away.

Extra-depth shoes and orthotics

Since narrow and tight shoes are a known contributor to hammertoes, Dr. Ahuero says extra-depth shoes and cushioned orthotics can help reduce the pressure both on top of the foot where the toes are lifted and the bottom of the foot where the toes are often pointed. While not a "perfect fix," he says, it can help curb further callus and blister formation.

(Related: PODCAST: How to Avoid Common Shoe Mistakes)

Callus and blister care

As hammertoes form, increased pressure and rubbing from shoes can cause the joints and tips of your toes to blister. These blisters eventually lead to calluses, but Dr. Ahuero says patients should be keep an eye out for any signs of infection, which can be dangerous if left untreated.

"Any calluses that form may benefit from being trimmed and shaved by a professional," he says. "The worst thing you could do is attempt to trim these calluses at home, especially neuropathy patients with reduced feeling in their extremities."

"Both cuts and blisters can get infected," he adds. "People may end up creating a wound and not know it's infected until it's a more serious issue."

Can hammertoes ever come back?

"Surgical correction of hammertoe is usually a permanent fix," says Dr. Ahuero. "Years ago, in rare cases, joints that were once reinforced with wires sometimes never fused together, causing the hammertoe to come back."

However, he adds, many surgeons have since transitioned to a screw or other permanent implant to ensure that the cut ends of the bones fuse back together.

Other changes have occurred, too, like the introduction of minimally invasive surgeries, newer technology and a better understanding of the anatomy. Dr. Ahuero says those advances are helping to achieve good and lasting results for patients.