History
The patient with a mallet toe usually presents with pain, either from callosity or from pressure on the nail. Occasionally, a cosmetic deformity is noticed, often by anxious parents or family, without symptoms. The physician should obtain a thorough history, noting any family history or history of trauma, previous surgery, or associated infections. The severity of the presenting symptoms should be evaluated, as well as the presence of generalized conditions, such as diabetes, vascular disease, neuropathy, or arthropathic disease.
Physical Examination
The examination should address overall foot alignment, the presence of palpable pedal pulses, signs of other foot deformities, and any prior surgery. Specifically, with respect to the toe, it is important to assess the metatarsophalangeal (MTP) joint, the proximal interphalangeal (PIP) joint, and the locations of callosity and nail deformity. The flexibility of the distal interphalangeal (DIP) joint should be evaluated with the toe plantarflexed and dorsiflexed at the MTP joint and the PIP joint.
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Classic mallet toe. Note flexion when toe is dorsiflexed.
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Photo showing acute flexion deformity at the DIP joint of the second toe.
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Radiograph of the same patient with an implant in the PIP joint causing a mallet deformity in the DIP joint.
