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What is Mallet Toe?

Mallet toe is a deformity where the toe abnormally bends downward, resembling a hammer or mallet. The bones at the tip of the toe are connected by the distal interphalangeal joint (DIP). Muscle imbalance or damage to the tendons or ligaments of the DIP causes contraction and deformity. Mallet toe can be either flexible, where the joint is still movable, or rigid, where the deformity is fixed.

Symptoms of Mallet Toe

The bent portion may rub against the shoe causing pain and irritation, and corns can develop. In severe cases, your balance may be affected, which makes it difficult to walk.

Causes

Wearing tight-fitting shoes can force your toes to stay in a bent position. Prolonged bending causes tightening of the muscles and contraction of tendons. Over time, the toe cannot straighten, causing mallet toe. Wearing high heels can increase pressure on the toes, causing them to bend., therefore women are more likely to develop mallet toe.

Other causes can include arthritis, certain neuromuscular disorders, toe injury, aging, and a family history of toe deformities.

Diagnosis

Your doctor will physically examine the toe and ask about any family history of toe deformities. An X-ray will be ordered to examine the tendons and ligaments more closely.

Treatment

Your treatment plan includes non-surgical treatment options such as:

  • Taking prescription pain medications to manage pain
  • Wearing a gel pad over the toe to prevent rubbing against the shoe
  • Wearing a mallet toe splint to keep the toe straight
  • Wearing loose-fitting shoes and avoiding high heels
  • Using a pumice stone to rub calluses
  • Performing stretching and strengthening exercises of your toe that involve activities such as picking up marbles or towel-curling with your toe

Surgery is recommended if you do not respond to conservative treatment options. Talk to your doctor if you are diabetic, or have any vascular disorders. The surgery is performed under local anesthesia and may involve:

  • Surgical release of the tendons or supporting tissue in the toe joint
  • Arthroplasty or phalangeal head resection (removing a part of your toe bone)
  • Arthrodesis or joint fusion (removing part of the joint and allowing the toe bones to grow together)
  • Amputation or removal of the affected toe (in rare cases)

Following surgery, you may experience some pain for which medications will be given to keep you comfortable. RICE treatment (resting, ice packs, compression, and elevation) may be suggested by your surgeon to also ease pain and inflammation. Follow-up X-rays may be ordered to monitor the healing process and complete healing which may take about 12 weeks.

Some risks and complications that can occur following surgery include bleeding, infection, and nerve injury. Your doctor will review all the risks with you prior to the procedure.

  • American Orthopaedic Society for Sports Medicine
  • American Association for Hand Surgery
  • American Academy Of Orthopaedic Surgeons
  • The American Board of Pediatrics
  • North American Spine Society
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