Mallet Toes
Daily wear and tear on our feet can cause occasional toe pain. But developing mallet toe is different. You may have trouble wearing shoes, walking without discomfort, or doing normal activities. Persistent toe pain caused by a bent toe should get evaluated by a healthcare provider.
Mallet Toe
A mallet toe refers to an upward bend at the toe joint. It may cause the toe to look curled instead of flat. Mallet toe happens most often in the second toe (next to the big toe) since this is the longest of the four smaller toes. However mallet toe can also affect the third and fourth toes.
Mallet toe involves the distal interphalangeal joint (DIPJ) and the flexor digitorum longus (FDL). The DIPJ is the joint in the toe, closest to the toenail. The FDL is a muscle that starts near the shin and runs down to the four smaller toes. It helps the toes curl. When the muscle becomes too tight, it can bend a toe joint upward.
Mallet toes are usually described as flexible or rigid:
- Flexible mallet toes: The muscle and toe joint are still flexible and movable.
- Rigid mallet toes: The muscle and nearby tendons (tissues that attach muscle to bone) tighten. This change freezes the toe joint in a bent position.
Mallet toes are often confused with hammertoes and clawtoes. Although all three conditions affect joints in the toes, they have important differences:
- Mallet toes: Bend in the third toe joint, closest to the toenail.
- Hammertoes: Bend in the second, or middle, toe joint.
- Claw toes: Bend in the first toe joint, and possibly the second and third joints.
Causes
Mallet toes develop when a toe is repeatedly forced upward. The most common causes of mallet toes include:
- Arthritis
- Injury to the toe
- Shoes that are too tight
- Bone (foot bones too short)
- muscle imbalances (weak muscles)
Symptom
- toe pain when wearing shoes or walking
- curling or bending at the toe joint nearest the toenail
- Redness and swelling of the affected toe.
- Corns or calluses on the bent part of the toe.
- Toenail thickening or changes
- Toe sores or ulcers (especially in diabetics)
Diagnosis
Mallet toes usually are diagnosed with a thorough physical exam.
The doctormay look at footwear, check the toe flexibility, order an x-ray of the toe to rule out facture and perform a thorough foot and ankle examination. The physical exam may help determine if added pressure or stress on the affected toe is a cause.
Treatment
Fortunately, most people with flexible mallet toe find relief with conservative treatments which may include:
- exfoliating, or smoothing, calluses.
- Toe pads for corns or calluses.
- Reducing inflammation with a steroid injection.
- Stretching the toes frequently.
- Using orthotics (special shoe inserts) to take pressure off the affected toe.
- Wearing shoes with extra room in the toes.
For people with diabetes, proper foot care is essential. Tips for foot health include:
- Checking your feet for sores or injuries each day.
- Keeping your feet clean and dry.
- Trimming your toenails regularly.
Severe or rigid mallet toes may not respond to conservative therapies. Some people will need toe surgery to restore proper alignment in the joint. Surgical options include:
- Arthroplasty: Removing part of the bent toe bone and realigning it.
- Tendon release: Cutting a tight toe tendon to allow the toe to lay flat.
- Tendon transfer: Moving the tendon in the mallet toe to another part of the foot, to force the toe to straighten.
Prevention
To prevent the development of mallet toes:
- Avoid shoes that pinch or crowd your toes.
- Choose footwear with a low heel to take pressure off your toes.
- Stretch your feet and toes regularly.
- Have your shoes sized by a sales professional.