Flexor Tenotomy - A Solution for Hammertoes & Clawed Toes

Written by Erica Halpern on April 2, 2026

Medically reviewed by Sadat Sharif, D. Ch.

Toe deformities like hammertoes and clawed toes are more than just cosmetic concerns—they can significantly impact your comfort, mobility, and quality of life. Whether it’s difficulty finding shoes that fit, pain while walking, or the development of corns and calluses, these conditions can become increasingly problematic over time. Fortunately, modern foot care offers effective solutions. One such solution is the flexor tenotomy, a procedure designed to correct toe deformities and restore normal function with minimal downtime.

Understanding Hammertoes and Clawed Toes

Hammertoes and clawed toes are common deformities of the toes caused by imbalances in the muscles, tendons, or ligaments that normally keep the toes straight.

Hammertoe: The middle joint of the toe bends downward, creating a hammer-like appearance. It often affects the second, third, or fourth toes.
Clawed Toe: The toe bends at both the middle and end joints, giving it a claw-like appearance. This deformity can be more rigid and uncomfortable.

These conditions can lead to pain, corns, calluses, difficulty walking, and challenges finding comfortable footwear. Risk factors include wearing tight shoes, high heels, muscle imbalance, arthritis, and genetics.

Conservative Treatments

Before surgery, mild hammertoes and clawed toes can sometimes be managed with:

Footwear modifications: Wide-toe box shoes and avoiding high heels.
Toe splints or orthotics: Help realign the toes and reduce pressure.
Exercises: Stretching and strengthening exercises for toe muscles.

However, if the toe becomes rigid or painful, surgical options like flexor tenotomies may be the most effective solution.

What is a Flexor Tenotomy?

A flexor tenotomy is a minimally invasive surgical procedure that releases the flexor tendon causing the toe to bend. It is usually performed under local anesthesia and involves only a tiny incision, allowing the toe to straighten naturally.

This procedure can correct flexible and semi-rigid hammertoes and clawed toes (meaning that the toe can be manually straightened) without the need for more invasive surgery. It is not suitable for hammertoes or clawed toes that cannot be manually straightened (rigid hammertoes).

Benefits of Flexor Tenotomies

Minimally invasive: It involves a tiny incision with low risk of complications.
Fast recovery: Most patients walk immediately and resume daily activities quickly.
Pain relief: Reduces pressure on joints, corns, and calluses.
Prevention of future complications: Especially important for diabetic patients at risk for foot ulcers.

Who is a Candidate?

Flexor tenotomies are best suited for patients with:

Flexible or semi-rigid hammertoes and clawed toes
Pain, discomfort, or skin irritation caused by toe deformities
No severe arthritis or joint damage in the affected toes

A chiropodist or foot specialist can evaluate the severity of the deformity and recommend the most appropriate treatment.

The Procedure

During the procedure:

A tiny incision is made at the base of the affected toe.
The flexor tendon is carefully released.
The toe is gently straightened and bandaged.

Post-procedure, most patients are allowed to walk immediately, sometimes using protective padding or special footwear.

Recovery and Aftercare

While a flexor tenotomy will help loosen the affected tendon and straighten the toe, it will not correct the underlying cause of the deformity. Flexor tenotomies are thus best used in conjunction with custom orthotics to correct any biomechanical issues, as well as proper fitting, supportive shoes.

Conclusion

If you have hammertoes or clawed toes, a flexor tenotomy offers a safe, minimally invasive solution that can relieve pain, restore toe alignment, and improve your ability to walk comfortably. Early intervention can prevent corns, calluses, and other complications, especially in patients with diabetes or mobility issues.

Do You Have Hammertoes?

If you have hammertoes, book a foot assessment to see if a flexor tenotomy is right for you. Don’t wait – book today!

About Author: Erica Halpern

Erica is the operations manager at Feet First Clinic. Since 2021, she has been writing, researching and editing website and social media content. She also oversees Feet First Clinic’s daily and strategic operations to ensure the best possible experience for our clients. Her goal is to ensure patients are equipped with the knowledge and solutions they need to help with their pain.

Learn more about Erica Halpern

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April 16, 2026

Do Toe Spacers Work?

Toe spacers are everywhere right now—from physiotherapy clinics to fitness influencers promoting “natural foot alignment.” But do toe spacers actually work, or are they just another trend? The short answer: yes, but with the right expectations. Let’s break down what toe spacers do, who they help, and how to use them effectively. What Are Toe Spacers? https://youtu.be/mK4pz6Pmjzo?si=1CWQoSiUZu7xhEpN Toe spacers (also called toe separators or toe aligners) are small devices placed between your toes to gently spread them apart. Most are made from silicone or gel and come in various sizes and designs, from simple separators to full forefoot alignment tools. They’re designed to reverse the effects of: Tight, narrow footwear Prolonged standing or walking Muscle imbalances in the feet Progressive toe deformities Over time, these factors can cause your toes to crowd, overlap, or shift out of their natural position. Do Toe Spacers Actually Work? Yes—but with realistic expectations. Toe spacers work by gradually encouraging your toes back toward their natural alignment. This can reduce pressure, improve muscle activation, and enhance overall foot function. Benefits of Toe Spacers When used consistently, toe spacers can: Relieve pressure and painSeparating the toes reduces friction and pressure points, especially between overlapping toes. Improve toe alignment (to a degree)They can help slow progression and mildly correct early deformities. Support bunion managementBy spacing the big toe away from the second toe, they reduce stress on the joint. Enhance foot muscle engagementToe spacers allow intrinsic foot muscles to activate more naturally during movement. Improve balance and stabilityA wider toe splay increases your base of support. What Toe Spacers Cannot Do This is where expectations matter most. Toe spacers cannot: Permanently reverse advanced bunions or rigid hammertoes Replace custom orthotics when biomechanical issues are present Deliver instant or dramatic structural changes Think of them as a supportive tool, not a cure. Conditions That Benefit Most from Toe Spacers Toe spacers are most effective in early or mild cases of: Bunions (hallux valgus) Hammertoes and claw toes Overlapping or crowded toes Forefoot pain (metatarsalgia) Corns and calluses caused by friction They’re also popular among runners and gym-goers looking to improve foot strength and alignment. How to Use Toe Spacers for Best Results Using toe spacers properly makes a big difference in outcomes. 1. Start Gradually Begin with 10–15 minutes per day, especially if your toes are stiff or sensitive. Increase wear time slowly as your feet adapt. 2. Wear Them in the Right Setting Barefoot at home With wide, foot-shaped shoes Avoid tight footwear, which cancels out the benefit 3. Be Consistent Like stretching, results come with daily, long-term use—not occasional wear. 4. Combine with Foot Exercises Toe spacers work best alongside strengthening and mobility work, such as: Toe splaying exercises Towel scrunches Calf and plantar fascia stretches 5. Listen to Your Body Mild discomfort is normal at first, but pain is not. If something feels off, reduce wear time or reassess fit. Are Toe Spacers Safe? For most people, yes. However, there are a few precautions. Use caution if you have: Diabetes Poor circulation Nerve damage (neuropathy) Open wounds or skin irritation In these cases, it’s best to consult a foot specialist before use. How Long Does It Take to See Results? Results vary depending on the individual and condition severity. Short-term (days to weeks): Pain relief and reduced pressure Medium-term (weeks to months): Improved flexibility and toe mobility Long-term (months+): Subtle alignment improvements and better foot function Consistency is everything—think of it as retraining your feet over time. Are Toe Spacers Worth It? If you’re dealing with mild toe misalignment or foot discomfort, toe spacers are a low-risk, affordable, and effective tool. However, if your condition is more advanced or painful, they should be part of a broader treatment plan that may include: Custom orthotics Footwear changes Professional foot care In some cases, minor procedures The Bottom Line Toe spacers do work—but they work best as part of a consistent foot care routine. They can relieve pain, improve toe positioning, and support healthier foot mechanics over time. The key is using them properly, staying consistent, and understanding their limitations.

March 5, 2026

Ultrasound-Guided Injections for Foot and Ankle Pain: What You Need to Know

What Are Ultrasound-Guided Steroid Injections? Ultrasound-guided cortisone injections are a precise, minimally invasive way to treat chronic foot and ankle pain. They combine corticosteroid medication—commonly called cortisone—with ultrasound imaging to target the exact area of inflammation. Unlike “blind” injections, which rely on anatomical landmarks and the clinician’s feel, ultrasound guidance allows a podiatrist or chiropodist to see the tissues in real time. This ensures the cortisone reaches the injured tendon, ligament, joint, or nerve exactly where it’s needed. This combination of precision and anti-inflammatory medication makes the treatment highly effective for conditions like: Plantar fasciitis Achilles tendonitis Ankle arthritis Neuromas (i.e.: Morton's Neuroma) or nerve irritation How Cortisone Works Cortisone is a synthetic steroid that mimics hormones naturally produced by your adrenal glands. Its main job in foot and ankle injections is to reduce inflammation. Here’s what happens on a cellular level: Cortisone suppresses inflammatory chemicals called cytokines that cause swelling and pain. It stabilizes cell membranes in the injured tissue, preventing further irritation. Cortisone can also reduce nerve sensitivity in the area, which helps decrease pain perception. By directly targeting the source of inflammation, cortisone helps speed up healing and relieve chronic pain without the need for surgery. The Role of Ultrasound in the Injection Ultrasound guidance takes steroid injections to the next level. Using high-frequency sound waves, the clinician can see: Tendons and ligaments Inflamed soft tissue Nerves Joint spaces This allows the injection to be delivered exactly where it’s needed, which: Improves the effectiveness of the medication Minimizes risk of hitting nerves, blood vessels, or healthy tissue Reduces discomfort during the procedure For example: In plantar fasciitis, the cortisone is placed at the point where the plantar fascia attaches to the heel bone. In Achilles tendonitis, the cortisone is delivered around the tendon sheath rather than the tendon itself, preventing damage to healthy tissue. In neuromas, it targets the inflamed nerve sheath precisely, reducing pain without affecting surrounding nerves. Why It Works: The Science The combination of corticosteroids and its precise placement is what makes this treatment so effective. Targeted anti-inflammatory action – By delivering cortisone directly to the inflamed tissue, the body’s natural healing process can work more efficiently. Reduced tissue trauma – Ultrasound guidance avoids unnecessary needle trauma to surrounding tissue, allowing faster recovery. Pain modulation – Cortisone temporarily decreases nerve irritation, which lowers pain signals sent to the brain. Support for chronic injuries – Chronic tendon or ligament injuries often involve persistent inflammation and microtears. Cortisone helps calm inflammation so the tissue can repair itself. In short, the science is all about precision + anti-inflammatory power: delivering cortisone exactly where it’s needed to calm inflammation, reduce pain, and support healing. Who Can Benefit from Ultrasound-Guided Cortisone Injections? This treatment is ideal for people with chronic foot or ankle pain that hasn’t improved with other treatments like: Rest and activity modification Custom orthotics or supportive shoes Physical therapy Anti-inflammatory medications It’s especially helpful for plantar fasciitis, Achilles tendonitis, ankle arthritis, or nerve-related foot pain. Ultrasound guided injections alone won't address any underlying biomechanical issues that caused the pain in the first place. Therefore, it's most effective when combined with other treatments, like custom orthotics, supportive shoes that match your foot type and gait pattern, and physiotherapy. Bottom Line Ultrasound-guided steroid injections are a safe, precise, and scientifically backed way to treat chronic foot and ankle pain. By combining the anti-inflammatory power of cortisone with the accuracy of real-time imaging, patients often experience faster relief and better outcomes than with traditional injections. Feature image by nts01 from Pixabay

November 27, 2025

Top 5 Ways to Take Care of Your Feet

Your feet are essential to your mobility and independence, yet they’re commonly overlooked in everyday health routines. Proper foot care is about more than aesthetics; it helps prevent discomfort, reduce the risk of injury, and support your overall well-being. At Feet First Clinic in Toronto, our chiropodists treat everything from nail and skin concerns to pain and mobility issues. Here are the top five ways to take care of your feet to keep them healthy and strong all year round. 1. Keep Your Feet Clean and Dry Healthy feet start with good hygiene. Wash your feet daily with warm water and mild soap, and don’t forget to clean between the toes. After washing, dry your feet thoroughly (especially between the toes) to help prevent fungal infections like athlete’s foot. If your feet tend to sweat a lot, moisture-wicking socks or antibacterial foot deodorant powder can help keep them dry and fresh. 2. Moisturize to Prevent Cracked Heels and Dry Skin Dry, flaky, or cracked skin on the feet can be uncomfortable and, if left untreated, may lead to infection. Applying a foot cream or urea-based moisturizer daily helps lock in moisture and keeps the skin soft and supple. Focus on the heels and soles, but avoid putting lotion between the toes as excess moisture there can increase the risk of fungal infections. If you have thick, rough skin or painful calluses, a chiropodist at Feet First Clinic can safely debride (shave down) the skin and recommend medical-grade moisturizers to help prevent recurrence. 3. Trim Your Toenails Properly Toenail care is more important than it might seem. Cutting nails too short or rounding the corners can cause ingrown toenails, which are painful and can become infected. Trim your nails straight across and gently file any sharp edges. If your nails are thick, discoloured, or difficult to trim, don’t force it. Our chiropodists have specialized tools to safely and comfortably trim thick toenails, and we can check for signs of fungal infections or other nail concerns. Feet First Tip: The best time to trim your toenails is after a shower when they’re softer and easier to cut. 4. Choose Proper Footwear Your shoes play a huge role in your foot health. Wearing shoes that are too tight, narrow, or unsupportive can lead to corns, calluses, bunions, or heel pain. When buying new shoes, make sure: There’s about a finger’s width of space between your longest toe and the front of the shoe. The heel fits snugly without rubbing or pressure. You can wiggle your toes freely. If you have foot pain, flat feet, or high arches, custom orthotics may be a game-changer. At Feet First Clinic, our chiropodists assess your gait and foot structure to design orthotics that support your body from the ground up. 5. Schedule Regular Foot Checkups Even if your feet feel fine, regular checkups can help prevent problems before they start. Chiropodists are trained to detect and treat a wide range of foot and nail conditions, including: Ingrown and fungal toenails Corns, calluses, and cracked heels Plantar fasciitis and heel pain Diabetic foot complications At Feet First Clinic, we believe prevention is the best medicine. Routine foot care helps maintain comfort, mobility, and confidence — especially as we age or if we spend long hours on our feet. Feet First Tip: If you notice pain, swelling, or changes in your toenails or skin that don’t go away, it’s time to book an appointment. Small issues can quickly become big problems if ignored.

October 30, 2025

All About Extensor Tendonitis: Causes, Symptoms, and Treatment

Extensor tendonitis is a common foot condition that affects the tendons running along the top of your foot. These tendons connect your muscles to your toes and help lift your toes and foot during walking and other activities. When these tendons become inflamed or irritated, it can lead to pain and difficulty moving your foot comfortably. What Is Extensor Tendonitis? Extensor tendonitis refers to inflammation or irritation of the extensor tendons on the top of the foot. This condition often results from overuse, repetitive strain, or injury. People who are active in sports, wear tight footwear, or have certain foot structures may be more prone to developing extensor tendonitis. Causes of Extensor Tendonitis Overuse: Repetitive activities such as running, jumping, or walking long distances. Improper Footwear: Shoes that are too tight or have insufficient space on the top can compress the tendons. Foot Mechanics: Flat feet, high arches, or gait abnormalities can put extra strain on the tendons. Injury: Trauma or sudden impact to the foot. Underlying Conditions: Arthritis or inflammatory diseases may contribute to tendon irritation. Symptoms of Extensor Tendonitis Pain and tenderness on the top of the foot, especially over the affected tendon. Swelling or redness along the top of the foot. Difficulty lifting the toes or foot. Pain worsens with activity and improves with rest. Occasionally, a burning or tingling sensation. Treatment Options Rest and Activity Modification Avoid activities that aggravate the pain and allow the tendon to heal. Proper Footwear Wear shoes with adequate space in the toe box and good support to reduce pressure on the top of the foot. Ice Therapy Apply ice packs to reduce inflammation and pain. Physical Therapy Stretching and strengthening exercises can improve tendon flexibility and foot mechanics. Orthotics Custom orthotics may help correct biomechanical issues that are causing excess strain on the extensor tendon and muscles on top of the foot. Medication Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation. When to See a Specialist If pain persists beyond a few weeks or worsens, consult a chiropodist or foot specialist for a biomechanical assessment and personalized treatment plan.

October 2, 2025

Achilles Tendonitis vs Achilles Tendinosis: Understanding Differences, Symptoms, and Treatments

The Achilles tendon is the strongest tendon in the body. It connects your calf muscles to your heel bone and enables activities like walking, running, and jumping. However, it is also prone to injury -particularly from overuse. Two common conditions affecting the Achilles tendon are Achilles tendonitis and Achilles tendinosis. Although their names sound similar, they differ in causes, symptoms, and treatment approaches. Understanding these differences is crucial for effective recovery and prevention. What Is Achilles Tendonitis? Achilles tendonitis is an acute inflammation of the Achilles tendon, typically caused by sudden increased activity or repetitive strain. It results in swelling, pain, and irritation along the tendon. Typical pain in a male jogger`s achilles tendon. XXL size image. Causes of Achilles Tendonitis: Sudden increase in physical activity or intensity Overuse during running or jumping sports Poor footwear Training on hard surfaces Tight calf muscles Poor biomechanics Symptoms of Achilles Tendonitis: Sharp or burning pain along the back of the heel or lower calf Swelling and tenderness over the tendon Stiffness, especially in the morning or after rest Pain worsens with activity What Is Achilles Tendinosis? Achilles tendinosis is a chronic condition characterized by degeneration of the tendon’s collagen fibers without significant inflammation. It often develops after untreated or recurrent Achilles tendonitis and results in thickening and weakening of the tendon. It's essentially what can happen if Achilles tendonitis goes untreated. Causes of Achilles Tendinosis: Repeated micro-tears and poor healing Chronic overuse without adequate rest Aging and reduced blood supply to the tendon Biomechanical abnormalities Symptoms of Achilles Tendinosis: Dull, persistent pain along the tendon Thickened or nodular tendon Decreased strength and flexibility in the calf and ankle Pain may improve with warm-up but worsen with prolonged activity Key Differences Between Tendonitis and Tendinosis FeatureAchilles TendonitisAchilles TendInosisNatureInflammatoryDegenerative (non-inflammatory)DurationAcute or subacuteChronic, long-termTissue ConditionInflamed tendon fibersDegenerated, disorganized fibersPainSharp, localizedDull, diffuseTreatment FocusReduce inflammation, restPromote tendon healing, strengthen Treatment Options For Achilles Tendonitis: Rest and activity modification Ice and anti-inflammatory medications Physical therapy focusing on stretching and strengthening Proper footwear and orthotics Gradual return to activity For Achilles Tendinosis: Eccentric strengthening exercises to stimulate tendon repair Physical therapy and stretching Shockwave therapy or ultrasound treatments Possible use of platelet-rich plasma (PRP) injections Surgery in severe, unresponsive cases Prevention Tips Warm up properly before exercise Gradually increase activity intensity and duration Wear supportive, well-fitting shoes Maintain calf flexibility and strength Avoid running on hard or uneven surfaces when possible

September 4, 2025

Clawed Toes vs Hammertoes vs Crossover Toes: Causes, Symptoms, and Treatment Options

Toe deformities can cause discomfort, affect your balance, and limit your footwear options. Among the most common conditions are clawed toes, hammertoes, and crossover toes. While they may sound similar, each has distinct characteristics, causes, and treatment approaches. Understanding the differences can help you identify symptoms early and seek appropriate care. What Are Clawed Toes? View this post on Instagram A post shared by Feet First Clinic (@feetfirstclinic_) Clawed toes are characterized by an abnormal bending of the toe joints, causing the toe to curl downward like a claw. Typically, the toes bend upward at the joint where they meet the foot (the metatarsophalangeal joint), and then downward at the middle (proximal interphalangeal) and end joints (distal interphalangeal). Causes of Clawed Toes Neurological conditions such as diabetes, stroke, or multiple sclerosis that affect muscle control. Muscle imbalances caused by arthritis or injury. Wearing poorly fitting shoes that crowd the toes. Symptoms of Clawed Toes Toes curl downward permanently. Pain or discomfort in toes or ball of the foot. Calluses or corns on the top or tip of the toes due to friction. Difficulty fitting into shoes comfortably. What Are Hammertoes? Hammertoes involve an abnormal bend in the middle joint of the toe, causing it to resemble a hammer. Unlike clawed toes, the bending mainly occurs at the proximal interphalangeal joint. Causes of Hammertoes Wearing tight or ill-fitting shoes that force toes into a bent position. Muscle imbalance or weakness. Injury or trauma to the toe. Arthritis or other joint conditions. Symptoms of Hammertoes Toe bent downward at the middle joint. Pain or irritation on the top of the bent toe. Corns or calluses forming on the affected toe. Limited toe movement. What Are Crossover Toes? Crossover toes occur when the second toe moves sideways, crossing over the big toe. This deformity often causes crowding and pressure between the toes. Causes of Crossover Toes Tight or narrow footwear. Muscle imbalances or ligament laxity. Structural foot issues like bunions. Arthritis or prior injuries. Symptoms of Crossover Toes Second toe overlapping or crossing the big toe. Pain between toes or on the side of the foot. Corns or calluses where toes rub together. Difficulty wearing certain shoes. Treatment Options for Toe Deformities Conservative Treatments Proper footwear: Shoes with a wide toe box and good support can relieve pressure. Orthotics: Custom shoe inserts can help correct foot mechanics. Padding and taping: To protect affected toes from friction. Physical therapy: Exercises to strengthen foot muscles and improve flexibility. When Surgery May Be Needed If conservative treatments don’t relieve symptoms or deformities worsen, surgical options may be considered. Procedures vary depending on the deformity but may include tendon release, joint fusion, or bone realignment. When to See a Specialist If you experience persistent toe pain, difficulty walking, or notice changes in toe shape, it’s important to consult a foot specialist. Early intervention can prevent complications and improve your foot health.

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Flexor Tenotomy – A Solution for Hammertoes & Clawed Toes