eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Mallet Toe

Author: Christopher Brown, MBBS, FRCS(C), FRACS, FAOrthA, Clinical Lecturer, Department of Orthopaedics and Trauma, University of Adelaide, Australia
Coauthor(s): Nancy Cullen, MD, FRCSC, FRACS, Senior Visiting Medical Officer, Clinical Lecturer, Department of Orthopaedics and Trauma, University of Adelaide, Australia
Contributor Information and Disclosures

Updated: Jan 11, 2009

Introduction


Classic mallet toe. Note the flexion when the toe...

Classic mallet toe. Note the flexion when the toe is dorsiflexed.

[ CLOSE WINDOW ]
Classic mallet toe. Note the flexion when the toe...

Classic mallet toe. Note the flexion when the toe is dorsiflexed.


A mallet toe is a fixed or flexible deformity of the distal interphalangeal (DIP) joint of the toe.

Related eMedicine topics:

Claw Toe

Hammertoe Deformity

Problem

Pain or callosity may be the presenting complaints when the distal interphalangeal joint of the toe has abnormal flexion, either fixed or flexible.

Frequency

In the United States, mallet toe deformity is much less common than hammertoe deformity, with a 1:9 ratio. It occurs most often in the longest toe (75%) but can occur in the second, third, or fourth toe, as well. Twelve percent of cases may have associated lateral or medial deviation.

International incidence of mallet toe is unknown.

Etiology

Mallet toe of a long toe is usually idiopathic. Inappropriate shoe wear, iatrogenic causes (eg, following proximal interphalangeal [PIP] joint fusion), congenital abnormalities, trauma, neuromuscular disorders, and pes cavus can lead to the deformity.

Pathophysiology



Classic mallet toe. Note the flexion when the toe...

Classic mallet toe. Note the flexion when the toe is dorsiflexed.

[ CLOSE WINDOW ]
Classic mallet toe. Note the flexion when the toe...

Classic mallet toe. Note the flexion when the toe is dorsiflexed.


The principal pathophysiology is flexion of the DIP joint with pressure on the tip of the toe, often with associated attenuation of the extensor tendon (see Image above and Image 1 in Multimedia). This may lead to callosities or nail deformity on the tip of the toe. The deformity may be flexible in cases in which the principal problem is an overtight flexor digitorum longus. However, it is not associated with contracture of the joint capsule or with fixed deformities in cases in which the plantar joint structures are contracted or alteration of the joint surfaces restricting joint range of motion has occurred.1,2,3,4

Presentation

Presentation is usually with pain, either from callosity or pressure on the nail. Occasionally, a cosmetic deformity is noticed, often by anxious parents or family, without symptomatology. The physician should obtain a thorough history, noting any family history or history of trauma, prior surgery, or associated infections. Note the severity of the presenting symptoms, as well as the presence of generalized conditions, such as diabetes, vascular disease, neuropathy, or arthropathic disease.

The examination should reveal the overall foot alignment, presence of palpable pedal pulses, signs of other foot deformities, and prior surgery. Specifically with respect to the toe, assess the metatarsophalangeal (MTP) joint, the proximal interphalangeal (PIP) joint, and the location of callosities and nail deformity. Assess the flexibility of the distal interphalangeal (DIP) joint with the toe plantarflexed and dorsiflexed at the MTP joint and PIP joint.

Indications

The usual indication for surgery is the presence of painful deformity. Occasionally, cosmesis may be raised as a presenting complaint.

Relevant Anatomy

The distal interphalangeal (DIP) joint is a hinge joint with collateral and accessory collateral ligaments and a plantar plate. The flexor sheath extends to the DIP joint.

Contraindications

Contraindications to surgery include vascular compromise, active infection, lack of symptoms, and significant psychiatric disorders. Patients also should have had a trial of simple nonoperative treatment prior to considering surgery.

More on Mallet Toe

Overview: Mallet Toe
Workup: Mallet Toe
Treatment: Mallet Toe
Follow-up: Mallet Toe
Multimedia: Mallet Toe
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Cooper PS. Disorders and Deformities of the Lesser Toes. In: Myerson MS, ed. Foot and Ankle Disorders. Philadelphia, Pa: WB Saunders; 2000:321-322.

  2. Coughlin MJ. Mallet toes, hammer toes, claw toes, and corns. Causes and treatment of lesser-toe deformities. Postgrad Med. Apr 1984;75(5):191-8. [Medline].

  3. Lancaster SC, Sizensky JA, Young CC. Acute mallet toe. Clin J Sport Med. May 2008;18(3):298-9. [Medline].

  4. Schuh A, Hönle W. [Deformities of the smaller toes]. MMW Fortschr Med. Feb 21 2008;150(8):37, 39. [Medline].

  5. Coughlin MJ. Operative repair of the mallet toe deformity. Foot Ankle Int. Mar 1995;16(3):109-16. [Medline].

  6. Nakamura S. Temporary Kirschner wire fixation for a mallet toe of the hallux. J Orthop Sci. Mar 2007;12(2):190-2. [Medline].

[ CLOSE WINDOW ]

Further Reading

A mallet toe is a fixed or flexible deformity of the distal interphalangeal (DIP) joint of the toe.

Related eMedicine topics:

Claw Toe

Hammertoe Deformity

[ CLOSE WINDOW ]

Keywords

mallet toe, toe pain, toe callus, mallet toe deformity, hammertoe deformity, claw toe, toe deformity, diabetic foot, diabetic foot, clavus

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Christopher Brown, MBBS, FRCS(C), FRACS, FAOrthA, Clinical Lecturer, Department of Orthopaedics and Trauma, University of Adelaide, Australia
Christopher Brown, MBBS, FRCS(C), FRACS, FAOrthA is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

Coauthor(s)

Nancy Cullen, MD, FRCSC, FRACS, Senior Visiting Medical Officer, Clinical Lecturer, Department of Orthopaedics and Trauma, University of Adelaide, Australia
Nancy Cullen, MD, FRCSC, FRACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

Medical Editor

Heidi M Stephens, MD, Associate Professor, Department of Surgery, Division of Orthopedic Surgery, Director of Diabetic Foot Clinic, Assistant Dean for Clinical Outreach, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health
Heidi M Stephens, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Florida Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

N Ake Nystrom, MD, PhD, Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FAAOS, Chairman, J Vernon Luck Distinguished Professor, Department of Orthopedic Surgery, University of Missouri
Jason H Calhoun, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

RELATED EMEDICINE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.