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Anatomy and Cause of a Hammertoe

A hammertoe is an unnatural upward or sideways bending in the toe. This abnormal position of the toe can cause pain, loss of movement, or skin sores from rubbing. A hammertoe can be caused by either certain imbalances within the leg/foot or overactive muscles due to a flexible foot. Hammertoe symptoms may be made worse with tight fitting shoes, narrow shoes or serenous activity. The risk of developing a hammertoe increases with age and the development of certain diseases such as diabetes and arthritis.

In the beginning stages, a hammertoe may still be flexible. However, as time goes on the tendons in the toe may begin to tighten and contract, leading to adaptive changes in the toe’s joint structure. These changes can cause the toe to lose movement and become permanently stiff or rigid.

Schedule an appointment today with Dr. Bryant Castelein, DPM – Podiatry Specialist

Advanced stages of hammertoes may result in a toe moving to the right or left at an angle. The hammertoe may cross over an adjacent toe and will occasionally rest on top of another toe. This can make it difficult or painful to wear socks and shoes. Sores and even open wounds can develop from this unnatural position. During this advanced stage of a hammertoe, an additional structure within the toe called the plantar plate becomes damaged. In a typical toe the plantar plate helps keep the toe in a straight position. When the plantar plate becomes torn, the toe is allowed to float upwards and is unable to touch the ground. Many times the joint at the base of the toe is also painful and swollen. Dr. Castelein always evaluates the hammertoe for possible plantar plate tear and addresses this injury as needed.

Conservative Treatment for Hammertoes

Depending on the severity, Dr. Castelein may recommend conservative treatment methods for hammertoes. These methods typically focus on reducing stress on the hammertoe and correcting the muscle imbalance. Another key component is wearing accommodating shoes to adapt to the changes in toe structure.


Foot orthotics can prevent your hammertoe from worsening as they aid in reducing the muscle imbalance causing the hammertoe. The orthotics keep your foot in its neutral position to ensure the best mechanical pull of the tendons.

Shoe Fit:

Ensure that the shoes you wear and purchase have these key qualities:

These shoe buying tips may help you avoid excess hammertoe pain!

Advanced Treatment Options for Hammertoe

In-Office Tenotomy

For patients with mild deformity and best served in-office, Dr. Castelein may recommend a tenotomy. This is a low-risk, minimally invasive office procedure that aids in correcting the hammertoe deformity and associated pain. Dr. Castelein numbs the affected toe and releases the contracted tendon and joint to better straighten the toe. After a tenotomy, you can walk out of the office in your normal shoes, return to normal activity right away, and be fully recovered when the stitch is removed..

Depending on the severity of the deformity and amount of pain associated, Dr. Castelein may recommend outpatient surgery to correct your hammertoe. The type of procedure chosen will depend upon imaging results and will be discussed in detail with Dr. Castelein.

Medical School and Training

Arthroplasty: This surgical procedure is very commonly performed for correction of hammertoe deformities. Dr. Castelein increases the joint space of the affected toe. This allows for the toe to sit in a better position without rubbing or pain on the top of the toe.

Arthrodesis: Hammertoe arthrodesis is an established surgical procedure usually recommended when osteoarthritis is present or other methods have failed. Dr. Castelein will remove damaged bone before fusing the small joint within the toe. Arthrodesis ensures the toe joint remains in a fixed, solid position thereby removing the ability of the hammertoe to return. New implants reduce the need for surgical wire insertion in the toe allowing for a faster recovery period.

Plantar Plate Repair: Floating or cross-over hammertoes often have an additional injury to the plantar plate. The plantar plate is a thick band on the bottom of the toe. When these toes are corrected, Dr. Castelein will first correct the position of the toe with either an arthroplasty or arthrodesis procedure as discussed above. Dr. Castelein then has to correct the plantar plate through a small bone cut called a weil osteotomy which allows him to access the plantar plate.  He then repairs any tears in the plantar plate and tightens the plantar plate back to the bone restoring its function. This retightening is achieved through sutures and bone anchors very similar to procedures performed in ankles, knees, and shoulders.

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Client Testimonials

I'm so happy to have found Brighton Foot And Ankle in Brighton. The office staff and assistant are very pleasant. Dr. Bryant Castelein is a great knowledgeable Dr. Who has eased my worry over my medical condition. Plus he's handsome. I would highly recommend this practice for anyone needing podiatry help.
What great people to help you! From receptionist to doctor, they are top notch! You would not regret going here for any of your foot/ankle problems, they will fix you up with the utmost care and compassion.
Yo K
Dr. Castelein and staff were friendly, knowledgeable , efficient and took the time to get to know me and understand my medical needs. I would not hesitate to go to Brighton Foot & Ankle. They go out of their way to treat their patients like family.
Dr. Castelein is great; he is very nice, patient, and professional. His staff is also excellent and friendly. It's only been about three hours since having my big toenail removed and, with acetaminophen and ibuprofen, there is very little pain(sometimes I completely forget about it); he did an excellent job. Overall, I am very impressed with Dr. Casteleins Practice and I would highly recommend his office.
Doctor & staff were so professional, friendly & efficient. I had a high risk condition that they expertly guided me through 5 months of healing. Thankfully a full recovery. I give them my best recommendation.
Very friendly and accommodating front desk staff. Dr. Castelein and Jennifer always take their time and do an amazing job! Great variety of quick pick up over the counter products that are always affordable too. Best experience I have had at an office.
Dr. Castelein is very friendly and extremely knowledgeable in his field. During my visit he did a great job explaining my situation and was very encouraging of any questions. I never felt rushed and I believe to have received the best care possible. Highly recommend this doctor and this facility.
Nicole C
Excellent staff and exceptional doctor. I went in with Bunion issues. Dr. Castelein listened to my concerns and addressed my options. 4 days post-op bunion surgery I can say he did an amazing job. Best experience I have ever had. I would definitely recommend; I promise you won't look further.
The staff and Dr. Castelein are all amazing. They are polite and very respectful. I came to see them in 2019 for bunion and hammer toe issues among some others. Dr. Castelein and his assistant listened to my concerns and gave me my options. He explained everything to me in detail and all my questions were answered.. I have seen other podiatrists and he is beyond the best. I would recommend him to anyone.
Friendly staff and intelligent doctor! I went in for some ankle X-rays and was given a great strategy on the different ways to heal my ankle, and how to progress forward if less invasive treatment doesn't help. I would highly recommend them to anyone with foot or ankle problems!