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Mallet Toe — Symptoms, Causes, and Treatment Options

Dr. Patrick DeHeer

Reviewed by
Dr. Patrick DeHeer

Mallet toe is a deformity of the toe that can cause pain and disability in the affected person. It is similar to hammertoe; in both conditions, the toe bends downward, causing it to resemble a mallet or hammer.

In a person with mallet toe, the distal (outer) interphalangeal joint is affected, whereas in hammertoe, the deformity is in the proximal (inner) interphalangeal joint (the interphalangeal joints are the joints between the toes).

The deformity can affect the great toe or the second, third, or fourth toe, and more than one toe may be involved.

The footwear you choose can sometimes cause mallet toe. Shoes that are too tight or that force the toes to bend unnaturally increase the risk of mallet toe.

Symptoms are typically progressive. Mallet toe is a common orthopedic condition that is treatable when addressed early. In severe cases, surgical treatment may be required. If not treated, the deformity can become permanent.

Mallet Toe

Mallet Toe Symptoms To Watch For

Symptoms of mallet toe may include:

  • Pain in the toe, often with movement of the foot
  • Stiffness
  • Corns and calluses
  • Toe stuck in a bent position, forming the shape of a mallet

The deformity may be fixed or flexible. If you have flexible mallet toe, you may be able to straighten your toe.

If you have fixed mallet toe, however, you may not be able to move the toe at all. Pressure on the bent surface of the toe joint can cause irritation. Over time, a corn may develop on the top of the toe, and callus can form on the bottom of the toe.

Corns and calluses can become painful and cause additional symptoms, such as redness, bleeding, and difficulty wearing socks and shoes.

What Causes Mallet Toe?

Mallet toe often occurs in people who wear certain types of shoes, such as high-heels that cramp the toes or do not allow the toes to lie flat. Other factors that can cause mallet toe include:

  • Genetics
  • Injury or trauma in which the toe is jammed or broken
  • Diseases that affect the nerves and muscles, such as arthritis
  • Abnormal foot mechanics due to nerve or muscle damage, causing an imbalance of the flexor and extensor tendons of the toe
  • Improperly fitted shoes or poor shoe choices

The older you are, the more you are at risk for mallet toe. The condition is more common in women than in men. Having a second toe that is longer than your big toe may also increase your risk of mallet toe.

How Is A Mallet Toe Diagnosed?

Your doctor can diagnose mallet toe after reviewing your medical history and examining your foot and your footwear. He or she will ask about your symptoms, your normal daily activities, and family history.

If your symptoms are severe, your doctor may order an x-ray or other tests to determine whether a systemic disease is causing your symptoms. The earlier a mallet toe is diagnosed, the better the prognosis and treatment options.

Mallet Toe Treatment Options For You

Nonsurgical treatment of mallet toe focuses on relieving the pressure under the tip of the toe. Special footwear that has extra depth around the toe can help alleviate this pressure. Soft orthoses or toe protectors are also helpful.

Toe crest pads, buddin splints, silicone toe protectors, and accommodative or custom orthotics can often help. Good results can also be obtained with physical therapy for flexible deformities.

Surgeries for mallet toe include flexor tenotomy and partial or complete amputation of the distal toe.

Flexor tenotomy is a minimally invasive procedure that involves making a small incision and cutting the tendon, which releases it and lets the toe straighten out. The type of surgery that will be performed will depend on the severity of the condition.

After surgery, your skin is closed with fine sutures. A dressing is used to help keep your toes in their new position. Pain relievers are prescribed. Most people heal completely within one month of surgery, with few complications.

What Are The Complications of Mallet Toe?

If a mallet toe deformity is not corrected, the toe may remain stiff permanently. Your shoes may rub against the raised portion of the toe and cause painful corns and calluses. This could also cause difficulty walking.

Complications associated with surgical correction of a mallet-toe deformity include:

  • Excessive bleeding
  • Infection of the surgical wound
  • Excessive swelling that may last several months
  • A fat short toe, which may be permanent
  • Loss of sensation in the toe
  • Floppy or deformed, maligned toe
  • Eventual recurrence
  • Nonunion or malunion of the toe

Can Mallet Toe Be Prevented?

The best thing you can do to prevent mallet toe is to wear shoes that fit well. Many foot problems can be prevented by simply practicing good foot hygiene. To keep your feet and toes healthy:

  • Wear comfortable shoes that fit properly, and avoid shoes that are too narrow
  • Wear shoes that are appropriate for your type of work and the sports you participate in
  • Examine your feet and toes regularly for any skin changes or deformities
  • See your podiatrist if you have foot or toe pain
  • Do stretching exercises daily to strengthen the muscles in your feet

Talking to Your Doctor About Mallet Toe

Here are some questions you may want to ask your doctor about mallet toe:

  • At what age should I begin looking for symptoms of mallet toe in my children?
  • What types of shoes are best for my feet?
  • What non-surgical treatment options would benefit me most?
  • How severe is my condition?
  • How long should I wait to contact you again for a follow-up visit?
  • Do you have a brochure about mallet toe that I can take home?
  • What measures can I take at home and at work to lessen symptoms?
  • What additional symptoms should I watch for after treatment begins that might indicate my condition is not improving?

Medical References:

    1. S. Maguire. Mallet toe. In WR Frontera et al, eds, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed. Philadelphia: Saunders Elsevier; 2008: 457-459. 2. Clinical Practice Guideline Forefoot Disorders Panel, J. L. Thomas, E. L. Blitch 4th, D. M. Chaney, K. A. Dinucci, K. Eickmeier, L. G. Rubin, M. D. Stapp, J. V. Vanore. Diagnosis and treatment of forefoot disorders. Section 1: Digital deformities. Journal of Foot and Ankle Surgery. 2009;48(2):230-238.

This page was last updated on January 1st, 2016



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