A normal toe has all its joints – the proximal (PIP) and distal (DIP) interphalangeal joints – lined up in a straight line. In hammer toes, the PIP joint – the joint closest to where the toe joins the foot – is not lined up perfectly in a 180-degree line. The joint juts out at a 30 or 45 degree angle or sometimes more. This makes the toe appear as if it were a hammer. Hence the name “hammer toes” refers to this condition. A hammer toe curls downward; however, one part of it extends upward above the level of the other toes. This part rubs against the shoe that a person wears and the friction begins to wear down the toe. The toe afflicted with hammer toe then can develop a callus. Cause Muscle imbalance, arthritis, and improperly-fitting shoes cause hammer toes. The hammer toe curls downward because the tendons and ligaments of that toe pull it in a downward direction. This occurs because the muscles are contracting, but not relaxing. The joints of the hammer toe may be flexible or rigid. When the condition started to develop, the joint is still moveable and the hammer toe is considered flexible. The longer the condition exists, the more the joint progresses towards immovability, and is called a rigid hammer toe. Treatment & Prevention Because of the part of the hammer toe that juts upward surpassing the level of the top of the other toes, it’s important to wear shoes that have a high toe box. Hammer toe crests and splints may also be used. The best treatment for your hammer toes is to see a podiatrist who can determine the best treatment. Prevention is based on evaluating each pair of shoes in the closet that are worn or those which may be purchased. If the shoes rub against the hammer toe in any way, they must be replaced by ones that won’t cause any friction.