Updated: 6/7/2021

Mallet Toe

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  • summary
    • Mallet Toe is a lesser toe deformity characterized by hyperflexion of the DIP joint. 
    • Diagnosis is made clinically with DIP joint hyperflexion with neutral PIP and MTP joints in a lesser toe.
    • Treatment is a trial of nonoperative management with shoe modification and toe sleeves. Surgical management is indicated for progressive deformity, fixed contractures, and dorsal toe ulcerations.
  • Etiology
    • Pathoanatomy
      • contracture (or spasm) of FDL because of pressure of toe against the end of shoe
        • > 70% of patients have a longer digit
      • rupture of EDL at DIP joint
      • Deformity may be
        • flexible or fixed
    • Congenital mallet toe
      • associated with flexion and lateral deviation of the DIP joint
  • Anatomy
    • Claw toe vs. Hammer toe vs. Mallet toe
      Claw toe
      Hammer toe 
      Mallet toe
      DIP
      Flexion
      Normal
      Flexion
      PIP
      Flexion
      Flexion
      Normal
      MTP
      Hyperextension
      Slight extension
      Normal
  • Presentation
    • Physical exam
      • callositieson toe
        • dorsum of the DIP
        • tip of toe; pain results from impacting the ground with gait
  • Treatment
    • Nonoperative
      • shoes with high toe boxes, Silicone/foam toe sleeves
        • indications
          • first line of treatment
    • Operative
      • percutaneous/open FDL tenotomy
        • indications
          • flexible deformities that have failed nonoperative management
      • FDL transfer to dorsum of phalanx
        • indications
          • to prevent unopposed extensor with FDL tenotomy and cock-up deformity
      • DIPJ fusion or middle phalangeal distal condylectomy (excisional arthroplasty of DIP)
        • indications
          • rigid deformities that have failed nonoperative management
        • technique
          • repair attenuated extensor tendons
          • K wire placement used to hold affected digit in extension

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