If your hammertoe is still flexible and a tight tendon is pulling the toe into a bent position, a tenotomy is often enough to correct it. If the toe has become rigid and the joint itself is stiff or misshapen, traditional hammertoe surgery is usually the better fit. The deciding factor is how much the toe can still move, and that is something our podiatrists confirm with a hands-on exam and imaging.
This guide explains how each option works, who tends to benefit from each, and what to weigh as you decide.
A hammertoe is a toe that bends downward at the middle joint, so the toe takes on a shape that resembles a hammer. It most often affects the second, third, or fourth toe. The bend happens when the muscles and tendons that normally keep the toe straight fall out of balance.
Several things can cause that imbalance. Tight or narrow shoes push the toes into a cramped position. Some people inherit a foot shape that makes hammertoes more likely. Conditions such as arthritis and a bunion deformity can crowd the smaller toes and speed up the problem.
Over time, the top of the bent toe rubs against the shoe. That friction often leads to painful corns and calluses, which is one of the most common reasons patients come to see us.
Hammertoes are grouped by how much movement the toe still has:
Flexible hammertoe: The toe is bent, but you can still straighten it with your hand. The joint is not yet stiff. This is the earliest stage.
Semi-rigid hammertoe: The toe has started to stiffen. It moves some, but not fully.
Rigid hammertoe: The toe is locked in a bent position and cannot be straightened by hand. The tendons have tightened and the joint may have changed shape.
This difference matters more than anything else when choosing between a tenotomy and traditional surgery. A flexible toe has more treatment options. A rigid toe usually needs a procedure that addresses the joint.
Not every hammertoe needs a procedure. Treatment depends on the stage of the deformity, how much pain you have, and how the toe affects your daily life. Our doctors start with the least invasive approach that makes sense for your foot.
For mild or flexible hammertoes, conservative care can ease pain and slow progression. Options we offer include:
Shoe changes: Shoes with a deep, roomy toe box reduce pressure on the top of the bent toe.
Custom orthotics: Orthotics made for your foot can improve balance and take stress off the toes and the ball of the foot.
Corn and callus care: Trimming painful buildup in the office can bring quick relief when friction is the main complaint.
Cortisone injections: In some cases, an injection can calm inflammation around a painful joint.
These steps manage symptoms well for many patients. They do not straighten a toe that has already become rigid, though. When pain keeps returning or the toe keeps getting worse, a procedure becomes the next conversation.
Hammertoe surgery is a broad term. It covers several procedures that correct the bend and relieve pressure.
Traditional hammertoe surgery focuses on the joint as well as the soft tissue around it. The goal is to straighten the toe and keep it straight. Depending on the toe, this may mean reshaping the joint, fusing it so it stays in a corrected position, or adjusting the tendons that pull it out of line.
This type of surgery is most often recommended for rigid hammertoes. Once a joint is fixed in a bent position, releasing a tendon alone usually will not correct it. The structure of the joint itself needs attention.
Many patients with rigid hammertoes also have other problems in the same foot, such as a bunion. In those cases, our doctors may plan the procedures together so the whole forefoot is addressed. Before recommending surgery, our podiatrists review your medical history, circulation, and any conditions that affect healing. Patients with diabetic foot concerns or peripheral neuropathy need extra planning.
Your doctor will walk you through what to expect for your specific situation. That conversation is personal because the right plan depends on your health, your foot, and your goals.
Tenotomy is listed among the procedures our team performs. It is a smaller, more targeted option than traditional hammertoe surgery.
A tenotomy is a procedure that releases a tight tendon. In a hammertoe, a tendon on the underside or top of the toe can become too tight and pull the toe into a bent shape. Releasing that tendon lets the toe relax back toward a straighter position.
Because it only addresses the tendon, tenotomy works when the joint is still flexible. If you can push your toe straight with your finger, the joint is likely healthy enough that the tendon is the main problem. That makes you a possible tenotomy candidate.
Tenotomy is also used for toes that curl under and press their tips into the ground. That pressure can cause painful corns on the tip of the toe. Releasing the tendon can take pressure off that spot.
The two procedures solve different problems:
What is treated: Tenotomy releases a tendon. Traditional surgery addresses the joint and may adjust tendons too.
Who it fits: Tenotomy suits flexible toes. Traditional surgery suits rigid toes or toes where the joint has changed shape.
Scope: Tenotomy is a smaller procedure performed through a very small opening. Traditional surgery is more involved.
Recovery: Tenotomy recovery is generally shorter and simpler. Traditional surgery often needs a longer healing period, especially when a joint is fused.
When patients ask us “Hammertoe Surgery vs. Tenotomy: Which One Do You Need?”, our answer always comes back to the flexibility of the toe. A tenotomy cannot fix a joint that has already locked in place. Traditional surgery may be more than a flexible toe needs.
Patients often hear the term “minimally invasive” and want to know whether it applies to them. Tenotomy falls on the minimally invasive end of hammertoe care because it uses a very small opening and treats only the tendon.
Our team uses small-incision approaches where they fit the problem.
A smaller procedure is appealing, but it is only the right choice when it can actually correct the deformity. Here is how the two approaches generally compare:
Minimally invasive options such as tenotomy suit flexible deformities where the joint is healthy. They often allow a quicker return to normal shoes and activity.
Traditional procedures suit rigid deformities, toes that have dislocated at the base, or feet with more than one problem. They allow the surgeon to correct the joint directly.
Choosing the smaller option for a rigid toe can leave the deformity uncorrected. Choosing a larger procedure for a flexible toe can mean more recovery time than necessary. Matching the procedure to the toe is what gives a lasting result.
Hammertoe Surgery vs. Tenotomy: Which One Do You Need? The honest answer is that it depends on your toe, your health, and what you want to get back to doing. Our doctors make this recommendation after examining the foot, checking how far the toe moves, and reviewing imaging.
Our podiatrists weigh several points when recommending a treatment:
Flexibility of the toe: This is the biggest factor. Flexible toes often respond to tenotomy. Rigid toes usually need traditional surgery.
Location of the pain: Pain on the top of the toe, the tip of the toe, or the ball of the foot points to different causes.
Other foot conditions: Bunions, arthritis, or problems in the ball of the foot such as metatarsalgia may change the plan.
Overall health: Diabetes, circulation, and nerve health all affect which procedure is safest.
Activity level and goals: Someone training for a race may have different priorities than someone who wants to walk comfortably at work.
Response to conservative care: If orthotics, shoe changes, and corn care no longer control your pain, a procedure may be the next step.
Every doctor in our group can access your chart notes. If you see one podiatrist at our Livonia office and another in Novi, your history and past discussions stay connected.
For many patients, yes. A hammertoe that rubs, burns, or keeps forming corns can make shoes uncomfortable and limit how far you walk. Correcting the toe removes the source of that friction rather than treating the symptoms over and over.
The value comes from choosing the correct procedure. A flexible toe treated early with a tenotomy may never progress to a rigid deformity. A rigid toe corrected with traditional surgery can finally fit comfortably in a shoe. In both cases, the goal is a straighter toe and less pain during daily life.
Waiting too long can narrow your options. A toe that is flexible today may become rigid over time. That is one reason we encourage patients not to put off an evaluation.
You should see a podiatrist if:
A toe has started to bend and stay bent.
You have corns or calluses on the top or tip of a toe that keep coming back.
Shoes have become painful, or you have trouble finding shoes that fit.
The toe is getting stiffer or harder to straighten by hand.
You have diabetes or neuropathy and notice any change in the shape of your toes.
Earlier visits usually mean more choices. A flexible hammertoe may respond to conservative care or a tenotomy. A toe that has already locked in place often needs a larger correction.
Our Doctors see patients at offices in Livonia, Novi, and Howell. Each of our doctors is a board-certified podiatrist, and Bruce Kallou is also a dual-board certified podiatric surgeon. Kaitlyn Sharpe focuses on reconstructive surgery, and Matthew German focuses on all aspects of foot and ankle medicine and surgery.
Tenotomy is usually the right fit for a flexible hammertoe caused by a tight tendon. Traditional hammertoe surgery is usually the right fit for a rigid toe where the joint itself has changed. Conservative care can manage early symptoms, but it does not straighten a rigid toe. An exam with one of our podiatrists will show which stage your toe is in and which option will give you a lasting correction.
Dr. Neal A. Mozen is a renowned Hour Detroit “Top Doc” with over 25 years of experience in the Detroit area. He is known for his expertise in relieving foot and ankle pain using advanced techniques like the Sklar and Kissloc Bunionectomies, small-incision arthroscopic procedures, and custom orthotic therapy.
Don’t let foot and ankle pain keep you from living your best life.
October 11, 2026
