Mallet Toe


 

Introduction

Mallet toe most commonly affects the longest toe on the foot, although any toe can be affected. It causes the joint closest to the tip of the toe to bend downward. Mallet toe is most frequently caused by structural problems in the toe or from wearing poor fitting shoes. It is important to diagnose and treat mallet toe early when the joints are still flexible, because the condition tends to become worse over time. Joints that become rigid or fixed can require surgery to place the bones in proper position.

Anatomy

Your toes are part of your forefoot. They help you balance, walk, and move. Your big toe (hallux) contains two bones (phalanges). Your second through fifth toes contain three bones. Mallet toe results when the joint nearest the tip of the toe (DIP joint) is bent (flexed) downward or angled to the right or left side.

Causes

Overall, mallet toe occurs less frequently than other types of toe deformities. Mallet toe commonly develops because of structural changes that take place over time in the muscles and tendons that bend the toes. People with certain medical conditions, such as diabetes, arthritis, or stroke, are at risk for developing mallet toe. People with high arches in their foot may be more susceptible to mallet toe. It can be an inherited condition. Other causes include trauma and wearing shoes that are tight or have high heels. The longest toe on the foot is most frequently affected by mallet toe.

Symptoms

The symptoms of mallet toe are progressive, meaning that they get worse over time. Mallet toe causes the end joint on the toe to bend downward. At first, the joint may be moveable, but overtime, the joint can become fixed or rigid.

The affected toe may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. People with diabetes are especially vulnerable for developing a sore (skin ulcer) on the tip of the toe. Thickened skin (calluses) may appear on the bottom of your toe or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear. A mallet toe can eventually interfere with walking.

Diagnosis

Your doctor can diagnose mallet toe by reviewing your medical history and examining your foot. X-rays will be taken. In some cases, nerve studies may be conducted.

Treatment

There are many non-surgical treatments to help relieve symptoms of mallet toe. The first step for many people is wearing the right size and type of shoe. Low-heeled shoes with a boxy or roomy toe area are helpful. Cushioned insoles, customized orthopedic inserts, and pads can provide relief as well. Your doctor may show you toe stretches and exercises to perform. 

Your doctor can safely remove corns and calluses. You should not try to remove them at home.

Surgery

Surgery is indicated when other types of treatment fail to relieve symptoms or the toes have become rigid or cross over each other. There are several types of surgery to treat mallet toe. A tendon may be lengthened or a small piece of bone may be removed from the joint (arthroplasty). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. In extreme cases, a toe may need to be surgically removed (amputated). 

You may need to use crutches or a walker for a short time following surgery. Your doctor will direct you to gradually increase the amount of weight that you put on your foot.

Recovery

Recovery from non-surgical and surgical treatment for mallet toe is individualized. Recovery depends on several factors, including the cause and extent of your condition and the type of treatment you received. Some surgeries can take between 6 and 12 weeks for a full recovery. Your doctor will let you know what to expect.

Prevention

It is important to visit a foot specialist if you develop mallet toe. Early treatment can help prevent future deformities. Mallet toe that is not treated can become worse over time, leading to a fixed joint and possible surgery.

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