Introduction
Mallet toe primarily affects the longest toe, though any toe can be involved. This condition causes the joint nearest the toe tip to bend downwards. Structural issues or poorly fitting shoes often lead to mallet toe. Early diagnosis and treatment are crucial, as the condition can worsen over time, leading to rigidity in the joints. In severe cases, surgical intervention may be necessary to realign the bones.
Anatomy
Toes are part of the forefoot, playing vital roles in balance, walking, and movement. The big toe (hallux) consists of two bones (phalanges), while the second to fifth toes have three bones each. Mallet toe occurs when the distal interphalangeal (DIP) joint bends down or angles to the side.
Causes
Mallet toe is less common than other toe deformities and typically arises from gradual changes in the muscles and tendons that control toe movement. Individuals with conditions like diabetes, arthritis, or a history of stroke are at higher risk. Additionally, those with high arches may be more prone to developing mallet toe. Genetic factors, trauma, and wearing tight or high-heeled shoes can also contribute to the condition, with the longest toe usually being the most affected.
Symptoms
Symptoms of mallet toe tend to worsen over time. Initially, the joint may still move, but it can eventually become rigid. Affected individuals may experience pain or irritation, especially when wearing shoes, and may develop corns on the toes. People with diabetes are particularly susceptible to skin ulcers on the toe tip. Calluses might form on the toe's underside or the foot's ball, making it difficult to find comfortable footwear, which can interfere with walking.
Diagnosis
Diagnosis typically involves a review of your medical history and a physical examination of your foot. X-rays may be taken to confirm the diagnosis, and in some cases, nerve studies might be necessary.
Treatment
Non-surgical treatment options are available to alleviate symptoms of mallet toe. The first step for many is ensuring proper footwear—low-heeled shoes with a wide toe box can be beneficial. Cushioned insoles and orthopedic inserts may provide additional comfort. Your doctor may also recommend toe stretches and exercises.
Removal of corns and calluses should be performed by a healthcare professional.
Surgery
Surgery is considered when conservative treatments do not alleviate symptoms or if the toes become rigid or overlap. Surgical options include tendon lengthening or removal of a small bone segment (arthroplasty). In some cases, surgical hardware like pins may be used to stabilize the bones during healing. Amputation of the toe is a last resort.
Post-surgery, you may need crutches or a walker temporarily, with your doctor advising you on gradually increasing weight-bearing activities.
Recovery
Recovery from both surgical and non-surgical treatments for mallet toe varies. Factors influencing recovery include the underlying cause, severity of the condition, and type of treatment received. Some surgical procedures may require 6 to 12 weeks for full recovery, and your healthcare provider will provide guidance on what to expect.
Prevention
Consulting a foot specialist upon noticing signs of mallet toe is essential. Early intervention can help prevent further deformities. If left untreated, mallet toe can worsen, potentially necessitating surgical correction.
