Mallet Toes

Overview

What are mallet toes?

A mallet toe refers to an upward bend at the toe joint. It may cause the toe to look curled instead of flat. Mallet toe happens mostly in the second toe, next to the big toe. That’s because it’s often the longest of the four smaller toes. But mallet toe can also affect the third and fourth toes.

Mallet toe involves two parts of the body. They’re called the distal interphalangeal joint (DIPJ) and the flexor digitorum longus (FDL). The DIPJ is the last joint in the toe, closest to the toenail. The FDL is a muscle that starts near the shin and runs down to the four smaller toes. It helps the toes curl. When the muscle becomes too tight, it can bend a toe joint upward.

Are there different types of mallet toes?

Mallet toes are usually described as flexible or rigid:

  • Flexible mallet toes: The muscle and toe joint are still flexible and movable.
  • Rigid mallet toes: The muscle and nearby tendons (tissues that attach muscle to bone) tighten. This change freezes the toe joint in a bent position.

What is the difference between mallet toes, hammertoes and clawtoes?

Mallet toes are often confused with hammertoes and clawtoes. Although all three conditions affect joints in the toes, they have important differences:

  • Mallet toes: Bend in the third toe joint, closest to the toenail.
  • Hammertoes: Bend in the second, or middle, toe joint.
  • Clawtoes: Bend in the first toe joint, and possibly the second and third joints.

Symptoms and Causes

What causes mallet toes?

Mallet toes develop when a toe is repeatedly forced upward. The most common causes of mallet toes include:

  • Arthritis.
  • Bone and muscle imbalances, such as foot bones that are too short or muscles that are especially weak.
  • Injury to the toe.
  • Shoes that are too tight.

What are the symptoms of mallet toes?

The most obvious symptom of a mallet toe is curling or bending at the toe joint nearest the toenail. Other symptoms can include:

  • Redness and swelling of the affected toe.
  • Corns or calluses on the bent part of the toe.
  • Toe pain when wearing shoes or walking.
  • Toe sores or ulcers, especially in people with diabetes.
  • Toenail thickening or changes.

What do I need to know about toe deformities and diabetes?

If you have diabetes, you’re at a higher risk of developing complications from foot conditions like mallet toe. Diabetes can cause nerve damage and circulation (blood flow) problems in your feet and toes. That means corns or calluses can lead to blisters or sores. And those sores, or ulcers, can develop into dangerous open wounds that are prone to infections. You’re then more likely to get infection or even gangrene (dead tissue).

Diagnosis and Tests

How are mallet toes diagnosed?

Mallet toes should get diagnosed by a healthcare provider. You can start with your primary care physician (PCP) or visit a podiatrist (foot and ankle doctor). Mallet toes usually just need a thorough physical exam. Your provider will:

  • Look at your footwear.
  • Likely check the toe’s flexibility.
  • Possibly do a gait analysis, to assess the way you walk.
  • Take an X-ray of your foot.
  • Perform a foot and ankle exam.
  • Debride (remove) any painful skin or nail.

The physical exam can help determine if you’re putting added pressure or stress on the affected toe. In some cases, your healthcare provider may also order imaging tests. An X-ray will rule out any toe fractures (broken bones).

Management and Treatment

How are mallet toes treated?

Mallet toe treatment can take many forms. Fortunately, most people find relief with conservative treatments. That means they don’t need surgery. If the mallet toe is still flexible, your healthcare provider may recommend:

  • Gently exfoliating, or smoothing, calluses.
  • Putting toe pads on corns or calluses.
  • Reducing inflammation with a steroid injection.
  • Stretching your toes frequently.
  • Using orthotics (special shoe inserts) to take pressure off the affected toe.
  • Wearing shoes with extra room in the toes.

For people with diabetes, proper foot care is essential. Tips for foot health include:

  • Checking your feet for sores or injuries each day.
  • Keeping your feet clean and dry.
  • Trimming your toenails regularly.

Never try to cut off corns or calluses yourself. Always allow a healthcare provider to assess diabetic foot issues. The provider will recommend the best treatment.

Will I need toe surgery?

Severe or rigid mallet toes may not respond to conservative therapies. Some people will need toe surgery to restore proper alignment in the joint. Surgical options include:

  • Arthroplasty: Removing part of the bent toe bone and realigning it.
  • Tendon release: Cutting a tight toe tendon to allow the toe to lay flat.
  • Tendon transfer: Moving the tendon in the mallet toe to another part of the foot, to force the toe to straighten.

What are the risks of toe surgery?

All surgeries come with risks. Possible complications of mallet toe surgery include:

  • Infection.
  • Nerve damage.
  • Recurrence (return) of the bent toe.
  • Stiffness.
  • Swelling.

Prevention

How can I prevent mallet toe?

Taking good care of your feet can help prevent the development of mallet toes. Be sure to:

  • Avoid shoes that pinch or crowd your toes.
  • Choose footwear with a low heel to take pressure off your toes.
  • Stretch your feet and toes regularly.
  • Have your shoes sized by a sales professional.

Outlook / Prognosis

Is a mallet toe permanent?

Some rigid mallet toes will remain bent permanently. But there are many ways to relieve toe joint pain and prevent further problems, such as corns and calluses.

Living With

When should I contact the doctor about mallet toe?

A mallet toe on its own is usually not an urgent medical condition. But make sure to contact a healthcare provider right away if you:

  • Have diabetes and see an open sore or wound forming on your toe.
  • Notice signs of infection around your toenail.
  • Suspect your bent toe could come from a fracture or soft tissue injury.

A note from Cleveland Clinic

Your feet and toes help you do all the activities you enjoy. A condition like mallet toe can make it painful to wear shoes, walk or exercise. If you’re dealing with persistent foot pain, get help from a healthcare provider. There are a wide range of treatment options available for most foot and toe issues. Some involve surgery, but many don’t.

Reviewed by a Cleveland Clinic medical professional.

References

  • American Diabetes Association. Accessed 1/21/2021. Foot Complications. (https://www.diabetes.org/diabetes/complications/foot-complications)
  • Centers for Disease Control and Prevention. Accessed 1/21/2021.Diabetes and Your Feet. (https://www.cdc.gov/diabetes/library/features/healthy-feet.html)
  • Davda K, Malhotra K, Singh D. . Efort Open Reviews. 2017;1:409-419. Accessed 1/21/2021.The pathology and management of lesser toe deformities (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367573/)
  • Davis DD, Kane SM. In: StatPearls [Internet]. Treasure Island, Florida: StatPearls Publishing; 2020. Accessed 1/21/2021.Fifth-Toe Deformities. (https://www.ncbi.nlm.nih.gov/books/NBK557461/)

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