Effective Exercises to Treat and Prevent Hammertoes: A Comprehensive Guide
Learn How to Manage Hammertoes with Targeted Stretching, Strengthening, and Mobility Exercises to Improve Toe Alignment and Reduce Pain
How Muscle Imbalance Leads to Hammertoe
An imbalance between the overactive flexors (FDL and FDB) and weakened extensors (EDL and lumbricals) pulls the toe into a bent position at the proximal interphalangeal (PIP) joint. Over time, this imbalance can become fixed, making the deformity rigid and difficult to correct without intervention.
Muscle Imbalances in Hammertoe Development
Overactive Flexor Muscles in Hammertoe:
- Flexor Digitorum Longus (FDL): This muscle flexes the toes. When it becomes overactive, it pulls the toes down, causing them to bend at the middle joint and creating a hammer-like shape.
- Flexor Digitorum Brevis (FDB): Similar to the FDL, this muscle contributes to toe flexion. Its dominance exacerbates the downward pull, reinforcing the hammertoe position.
Weakened Extensor Muscles in Hammertoe:
- Extensor Digitorum Longus (EDL): This muscle helps lift and straighten the toes. When weakened, it cannot counteract the strong flexion force of the FDL, leading to abnormal toe bending.
- Lumbrical Muscles: These small intrinsic muscles balance the flexion and extension forces in the toes, they also work to spread out the toes (abduction). When they become weak or inhibited, they fail to oppose the flexors, contributing to the deformity.
Stages of Hammertoe and Potential for Reversal
Flexible Stage:
The toe can still be manually straightened. Targeted exercises and stretching can correct the imbalance and potentially reverse the deformity.Semi-Rigid Stage:
The toe begins to lose flexibility, and movement is more restricted. Conservative treatments like exercises and orthotics can still help, but progress may be slower.Rigid Stage:
The toe is fixed in a hammer position. Conservative treatments are less effective, and surgery may be necessary to release tight tendons and realign the toe.
Comprehensive Exercise Routine for Hammertoes
Toe Stretching and Extension Exercises for Hammertoes
Manual Toe Stretching:
Sit on a chair, cross the affected leg over the opposite knee, and use your hands to gently stretch your toes towards you, holding for 30-60 seconds. Alternatively, place the tops of your toes on the floor and roll the foot to stretch the top of the toes, similar to a ballerina pose, but then go further in to the stretch. This exercise helps stretch the Extensor Digitorum Longus.Toe Dorsiflexion Stretch:
Sit with the ball of your foot on the floor and bend the toes back to stretch the bottom of the foot, as if wearing a high heel. Hold for 60 seconds. This targets the plantar fascia and toe flexor muscles.
Strengthening Exercises for Hammertoes
Toe Lifts and Spreading:
Lift and spread your toes, holding for 5 seconds. Then, place the foot flat and spread the toes again. Repeat 10 times. This strengthens the EDL and lumbricals.Toe Curls:
Place a towel on the floor and use your toes to scrunch it up. Keep scrunching until you move the entire towel backward under your foot. This strengthens the intrinsic foot muscles like the Flexor Hallucis Brevis and lumbricals.
Dynamic Mobility and Balance Exercises for Hammertoes
Toe Walking:
Walk on your tiptoes for 1 minute daily. This strengthens the forefoot muscles and helps maintain toe alignment.Chair Pose Squats with Toe Engagement:
Stand on both feet, spread your toes, and press them into the floor. Lift your heels and perform a set of squats while maintaining toe position/heels lifted. This engages the toes and forefoot muscles during the movement.- Heel Rises Off a Step: With the balls of the feet on the edge of a step, push the toes in to the step. Lower your heels below the edge, then raise up as high as you can.
Trailing Limb Exercise:
Stand on your left leg, lift the heel, and place your right heel out in front as if taking a step. Ensure your weight is over the left toes before landing the right heel. Reverse directions, using the left toes to lower your weight back to the heel, and step back with the right foot. This mimics the toe-off phase in walking, strengthening the toe and foot muscles.Marble Pickup:
Use your toes to pick up small objects like marbles or pencils. Move them from one spot to another, using your toes to grip. This exercise improves dexterity and strengthens the Flexor Digitorum Brevis.Rowing Machine with Toe Engagement:
While rowing, engage the pads of all toes with each push-off. This adds toe strength training to your rowing workout.Incorporate Toe Engagement in Standing Exercises:
Press the pads of your toes into the floor and spread them out during any standing exercise. This engages the intrinsic foot muscles.Bosu or Balance Pad Exercises:
Stand on one or two feet on a flexible surface while doing leg, back, or arm exercises. This helps strengthen the feet and improve balance.Single Limb Stance Balance Exercises:
Stand on one foot with toes spread out and combine this with any arm exercise. Rotational and pulley type resistance works well.Planks:
Planks with toes supporting. Start with plank on elbows, move up to either longer holds or planks on hands. Later add alternating lifts of opposite arm and leg.
Daily Life Adjustments for Hammertoe Management
Pay attention to how your toes behave during activities. Are your toes lifted when you stand up from a chair or push with the ball of your foot while driving? Engage your toe muscles actively, and try walking barefoot whenever possible to build strength.
Footwear Recommendations for Hammertoe Management
Wear shoes with wide toe boxes to allow your foot muscles to work properly. Avoid narrow or pointed shoes or shoes that don’t let your toes reach full length. Recommended brands include:
Lems Shoes casual, barefoot, minimalist
Altra Running running
Baer Shoes hiking, flats, leisure
BIRKENSTOCK USA Online Shop sandals, boots, clogs
Chaco sandals, flip flops, hiking
Conker Shoes hand made leather
Duckfeet USA hand made boots, shoes, sandals
Hey Dude casual boat shoes
KEEN Footwear shoes and sandals
KURU Footwear boots, slip-ons, shoes, sneakers
Merrell hiking, running, clogs, casual
OESH Shoes women’s flats,, sneakers sandals
Taos Footwear boots, shoes, sandals
Collections – VIBAe leather and wool boots, kids, slides
Hammertoes progress from flexible to rigid stages. Early intervention with exercises and footwear adjustments can halt or reverse the condition. In the rigid stage, surgery may be necessary. By consistently performing these exercises and wearing appropriate footwear, you can manage hammertoes effectively and potentially avoid more invasive treatments.
Toe spacers or braces can help in the mid stage:
Toe Separators for Bunions – Page 2 – ZenToes