Mallet toe is a toe that is bent downward at the joint at the tip of the toe (distal joint). The deformity can occur on all of the toes including the big toe. When it is the big toe it is called hallux malleolus.
The deformity is caused when an imbalance occurs between the two sets of muscles that cause the toe to flex or extend. When one set over powers the other the deformity occurs. The deformity is flexible initially and over time becomes rigid or non-reducible.
- Hereditary – you inherited a tendency to develop a hammertoe because your foot is not stable. Common with people with flat feet but can occur in individuals with a high arched foot.
- Injury to the toe can also cause mallet toes. Repetitive injury due to poor fitting shoes or fracture of the toe can lead to the deformity.
- Diseases of the joints can result in the deformity such as osteoarthritis or rheumatoid arthritis.
- Diseases of the nerves and muscles such as diabetes and stroke can result in the deformity.
Mallet toes are typically painful at the tip of the toe due to excessive pressure. Often thickened skin can form at the tip of the toe resulting in pain. In patients with no feeling in their feet this can lead to ulcerations. Pain due to shoe pressure can also occur at the top of the joint. Pain can also occur at the joint which can become inflamed.
- Proper shoe gear.
- Adequate arch support.
- Deep and wide toe box.
- Avoid pointed toes.
- Length of the shoe should be 3/8” to 1/2″ from the LONGEST toe. In 15% of the population the 2nd toe is the longest. These are the people I commonly see a mallet toe because they have been fitted to the length of their big toe all their lives.
- Avoid high heels for any extended periods of time.
- For deformities that are still flexible or reducible stretching exercises may help.
Treatment is designed to limit irritation of the toe. This can be achieved by conservative and surgical options.
Conservative treatment options include:
- Changes in shoe gear
- Over the counter innersoles or orthotics with metatarsal pad.
- Topical pads made of foam, felt or silicone. I like the silicone toe caps.
- Buttress pads work well in preventing the tip of the toe to hit the shoe.
- If the deformity is still flexible you can tape the toe.
- Lubrication of the friction points can help slow down the development of thickened skin.
- Padded socks can also decrease pressure.
Avoid use of chemical corn removers or the cutting of corns especially if you are diabetic, have circulation or immunity problems.
Surgical treatment designed to straighten the toe:
Should conservative options fail to alleviate the condition there are surgical options available. If the deformity is still flexible tendon work alone may be an option. Once the deformity is rigid an arthroplasty would performed which involves removing a piece of bone from the joint and holding it in place with a pin.
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