A mallet toe is a deformity of the second, third or fourth toes. In this condition, the toe is abnormally curled due to a bend in the end joint of a toe.
People with mallet toe may develop painful corns or calluses on the top of the end joint of the toe or on the tip of the toe. Finding comfortable shoes may become very difficult, and walking may become painful.
Mallet toe is commonly caused by wearing poorly fitting shoes – shoes that are too short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a mallet-like appearance.
A simple measure of relieving the pain and pressure of mallet toe is changing your footwear. However, in more severe cases of mallet toe, surgery may be needed.
Symptoms
- The toe is bent downwards at the joint nearest the nail, while the rest of the toe stays straight
- Pain at the tip of the toe, worst inside shoes
- A corn or callus on the tip of the toe, or over the top of the bent joint
- The toenail may thicken, lift or become damaged from pressure against the shoe
- Redness and swelling around the joint
- Difficulty finding shoes that do not press on the toe
Early on the toe can usually still be straightened by hand. Over time the joint stiffens and the bend becomes fixed, which changes what treatment can achieve.
Causes
A mallet toe develops when the tendon that bends the toe becomes tighter than the one that straightens it, holding the end joint bent. Common reasons include:
- Shoes that are too short or too narrow, or high heels that push the toes against the front of the shoe
- A second toe that is longer than the big toe, which takes more pressure inside a shoe
- Previous injury to the toe
- Conditions that affect the nerves or muscles of the foot, including diabetes with nerve damage and rheumatoid arthritis
Risk factors
- Age — mallet toes become more common as you get older
- Wearing narrow, short or high-heeled shoes regularly
- Having a second toe longer than the big toe
- Diabetes, particularly where there is nerve damage in the feet
- Rheumatoid arthritis and other inflammatory joint conditions
- A previous fracture or injury to the toe
Investigations
A mallet toe is usually diagnosed by looking at and examining the foot. Your doctor will check whether the joint can still be straightened by hand or has become fixed, because this determines the treatment options.
An X-ray may be taken to look at the joint and the alignment of the bones, particularly if surgery is being considered.
If you have diabetes or poor circulation, sensation and blood flow in the foot will also be checked, since these affect how well skin problems on the toe will heal.
Complications
- Painful corns and calluses that keep returning
- Skin breakdown at the tip of the toe, which can develop into an ulcer — a particular risk if you have diabetes or poor circulation
- Infection, if the skin over the toe breaks down
- Damage to the toenail
- The joint becoming permanently fixed, after which padding and footwear changes no longer straighten it
- Changes to the way you walk, which can cause pain elsewhere in the foot
Treatment
Non-surgical treatment helps most people, and is more effective the earlier it is started.
- Footwear — shoes with a deep, wide toe box and a low heel. This is the single most useful change.
- Padding — a silicone sleeve or cap over the tip of the toe takes the pressure off a painful corn
- Toe props — a small pad under the toe can support it in a straighter position while it is still flexible
- Corn and callus care — have these trimmed by a podiatrist rather than using over-the-counter corn removers, which contain acid and can cause ulcers. This matters especially if you have diabetes.
- Stretching — gently straightening the toe by hand can help keep the joint mobile while it is still flexible
- Insoles — may help if the way you load the foot is contributing
Surgery is considered when the toe stays painful despite these measures, or a sore over the toe keeps coming back.
- If the joint is still flexible, the tight tendon under the toe can be released or lengthened
- If the joint is fixed, the end joint is usually fused straight, sometimes held with a temporary wire for a few weeks
This is normally day surgery. Swelling in the toe can take several months to settle, and most people are back in normal shoes within six weeks to three months.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
- Choose shoes with a deep, rounded toe box and about a centimetre of space beyond your longest toe
- Avoid regularly wearing high heels or pointed shoes
- Buy shoes late in the day, when your feet are at their largest
- Deal with a developing mallet toe early, while the joint is still flexible and footwear changes can still work
- If you have diabetes, check your feet daily for corns, redness or skin breakdown
F.A.Q. | Frequently Asked Questions
Will a mallet toe straighten out on its own?
No. Mallet toes do not correct themselves and tend to become gradually more bent over time. While the joint is still flexible, treatment is aimed at relieving pressure and pain. Once the joint is fixed, only surgery will straighten it.
What is the difference between a mallet toe, a hammer toe and a claw toe?
They are named for where the toe bends. A mallet toe bends at the end joint, nearest the nail. A hammer toe bends at the middle joint. A claw toe bends up at the joint with the foot and down at the joints beyond it.
Do I need surgery?
Most people do not. Surgery is usually reserved for a toe that stays painful despite roomier shoes and padding, or where a corn or ulcer over the toe keeps returning.
Can I cut the corn off myself?
It is safer to have corns trimmed by a podiatrist. Over-the-counter corn removers contain acid and can damage healthy skin, which is dangerous if you have diabetes or poor circulation.
How long does recovery take after surgery?
The toe stays swollen for several months, which is normal. Most people return to ordinary shoes somewhere between six weeks and three months.