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Introduction
  • Mallet deformity is characterized by
    • hyperflexion of the DIP joint
  • Deformity may be
    • flexible or fixed 
  • 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
  • Congenital mallet toe
    • associated with flexion and lateral deviation of the DIP joint
Anatomy

 
Claw Toe
Hammer Toe
Mallet Toe
 
DIP
flexion
normal
flexion
PIP
flexion
flexion
normal
MTP
hyperextension
normal (slight extension)
normal

Presentation
  • Physical exam
    • callosities on 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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