Mallet Toe

What is mallet toe?

A mallet toe has an abnormal bend or buckle in the top toe joint, nearest to the toenail. This causes the tip of the toe to curl or point down instead of lying flat. Mallet toe most often affects your second toe, next to your big toe, because this toe is often the longest. But it can also affect your third or fourth toe.

Are there different types of mallet toes?

Your healthcare provider may describe your mallet toe as either flexible or rigid.

Flexible mallet toes are bent, but they can still bend back toward their normal shapes.

Rigid mallet toes are frozen in their bent positions. This type is trickier to treat.

What symptoms does mallet toe cause?

Mallet toe is most recognizable by its appearance, with the downward-pointing tip of the toe forming the shape of a mallet. But it’s also uncomfortable to walk on. And by changing the way you walk, it can create secondary problems that also cause discomfort. Some of the symptoms it might cause include:

• Joint pain in the bent toe joint.
• Toe pain on the bent tip.
• Discoloration and swelling.
• Toe corns and calluses.
• Toe ulcers or sores.
• Walking gait abnormalities.

What causes mallet toe?

Mallet toe usually develops gradually, when forces — like the shoes you wear or the way you walk — cause a tendon in your toe to tighten and contract. The contracture is usually somewhat flexible in the early stages, but after a while, it becomes rigid and “fixed.” Contributing causes may include:

• Poor-fitting shoes.
• High heels.
• Congenital (present at birth) foot differences.
• Previous injury.
• Neuromuscular disorders.
• Foot and ankle arthritis.

What are the risk factors for developing mallet toe?

You may be more likely to develop mallet toe if you have a condition that affects the nerves in your feet and your ability to feel sensations in your toes. This might make it easier for you to injure your toe or walk with your toes in an awkward position without realizing it. Some of these conditions include:

• Diabetes.
• Peripheral neuropathy.
• Peripheral artery disease.

How is mallet toe diagnosed?

A podiatrist can diagnose mallet toe with a thorough physical exam and X-rays. They’ll look at your shoes, how you walk and where your calluses are, then confirm with images of the joint. If they suspect you have an underlying condition, like arthritis or neuropathy, they might want to run additional tests.

How is mallet toe treated?

In the earlier stages, when it’s still flexible, you might be able to treat and even reverse mallet toe with home remedies. Your provider might recommend changing your shoes, wearing orthotics or taping your toe. They might suggest exercises or physical therapy to stretch out your toe and improve its flexibility.

Even if your toe is rigid and inflexible, most healthcare providers will offer nonsurgical treatments first, focusing on your symptoms. Specialized footwear can help take pressure off your toe. Steroid injections can help relieve swelling and pain. If these don’t help enough, your provider might suggest surgery.

What is mallet toe surgery?

Surgeons use a variety of procedures to fix mallet toe. When possible, they use minimally invasive surgery techniques. For example, they might use ultrasound to guide a needle through your skin (percutaneous surgery). Or they might operate through a small hole with a scope (arthroscopy).

Mallet toe procedures include:

• Tenotomy. Tenotomy means surgery on a tendon. Sometimes, it’s also called a tendon release. With mallet toe, your flexor tendon has become too tight and contracted, pulling your toe under. Tenotomy releases the tension by puncturing it, dividing it or removing damaged pieces.
• Tendon transfer. An alternative method is to detach the tight flexor tendon from the underside of your toe and reattach it to the top side. This way, the contracted tendon works to pull the toe back into a normal position, working against the forces that created mallet toe in the first place.
• Joint fusion. Arthrodesis (joint fusion) is surgery to permanently fuse two bones in a joint. Arthrodesis straightens a mallet toe by realigning the bones and fusing them so the joint can’t bend anymore. They use pins or wires to hold the bones together until they heal and fuse.

What can I do to prevent mallet toe?

Since mallet toe usually happens gradually, taking care of your feet can help prevent it. If you notice symptoms like foot pain after walking or wearing certain shoes, consult a podiatrist. If you have a condition that makes your feet less sensitive, it’s important to check them regularly for signs of harm.

What’s the prognosis for mallet toe?

Most of the time, mallet toe can improve with conservative treatments, although these treatments may take time and persistence to work. Mallet toe becomes harder to treat if it goes untreated for too long and becomes rigid. If this happens, you might need surgery. But surgery usually succeeds in fixing it.

A note from Cleveland Clinic

It’s easy to take foot pain for granted; but if it’s frequent, there’s a risk of real damage being done. Foot deformities like mallet toe can have a snowball effect on your ability to walk and your quality of life. If you notice physical changes, see your provider. Seek care sooner than later to prevent worse outcomes.