Mallet toe is a condition where the end of the toe is bent and does not straighten. It occurs when the extensor tendon on the back of the finger is damaged. The interphalangeal joints are hinge-joints that allows bending and straightening of the toes. Each toe is composed of 3 phalanges bones, joined by 2 interphalangeal joints (IP joints), except for the great toe that has 1 interphalangeal joint. The joint near the base of the toe is called the proximal IP joint or PIP joint, and the joint near the tip of the finger is called the distal IP joint or DIP joint.
Mallet toes occurs from tight shoes or sports activities causing a “jammed” toe or from excessive stress on the toe such as with a crushing injury. The injury causes either rupture of the extensor tendon without a bone fracture or rupture with a small or large bone fracture.
Generally, Mallet toes can be observed if not painful in shoes. Acute injuries may be reduced and pinned,
Causes
Mallet toes occurs due to tight shoes or sports activities that jam the toes.
Signs and Symptoms
The main symptoms of mallet toe are drooping of the tip of the toe that may cause callous formation at the tip.
Diagnosis
The diagnosis of mallet toes involves a physical examination and obtaining an X-ray of the injured finger. In some cases, other imaging techniques such as MRI scan may be recommended.
Treatment
Mallet toes can be observed if not painful in shoes. Acute injuries may be reduced and pinned, Chronic deformities are usually corrected with fusion of the distal interphalangeal joint, and this usually involves placement of a small screw between the distal 2 bones in the toe.
Post-operative Care
Patients usually wear a stiff soles closed back shoe or sandal for 4-6 weeks after surgery. The toe may be swollen for months, but most are glad they had the surgery performed by 4 weeks post-op.
Risks and Complications
The common risks and complications associated with mallet finger surgery, include:
- Avascular necrosis (bone death from lack of blood supply)
- Infection
- Stiffness
- Nail-bed damage
- Chronic tenderness
