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Family Foot & Ankle

Mallet Toes

I’ve heard of hammertoes, but what is a mallet toe?

The main difference between the more common hammertoe and the somewhat less common mallet toe is the location of the affected joint. In the former, the middle joint of a toe (usually the second) is bent, while in the latter the final joint nearest the toenail is bent (usually the second toe as well, though it can be present in any of the five). Otherwise, they share similar causes, similar risk factors, and similar symptoms.

Bent Mallet Toes

How Did I Get this Bend in My Toe?

The problem is ultimately caused by a muscle imbalance. If a toe is regularly forced into a bent position for extended periods of time, muscles contract and weaken, tendons contract, and slowly you lose the ability to straighten out the toe again. Initially you’ll have a “flexible” mallet toe, which means that you can still put the joint back in its proper place temporarily using your fingers. As the condition progresses, however, the joint becomes rigid and won’t straighten even if you use outside force.

Tight shoes are the most typical catalyst, which is why women suffer from this condition much more commonly than men. Other causes are possible, though, including nerve damage or a separate injury such as a sprain or fracture. Additionally, extra-long second toes (especially those longer than the big toe) are at a greater risk since they’re less likely to fit into the average shoe.

Progressive Problems Lead to Long-Term Pain and Complications

In the early going, you may only notice that your toe looks a little odd and you might not be able to straighten it all the way. But mallet toes are a progressive condition, which means that without corrective treatment the symptoms will not get better. As the damage worsens, you may experience a greater amount of pain and find it harder and harder to find footwear that fits. Bent toes can easily rub against the inside of your shoes, leading to painful friction lesions such as blisters or corns. In the most severe cases, you may even wind up having difficulty walking or maintaining balance.

Mallet Toe Treatment

Here’s why you should never wait to hit that gong—if you take action before your toes get too bent out of shape, the only treatment you may need is a new pair of shoes. Low heels and deep toe boxes that don’t press the toe into an awkward position may permanently prevent the problem from getting worse, and if you aren’t experiencing any pain or complications, then you can consider the case closed.

If that’s not enough, we may suggest splints to keep the toes in a straightened position, pads to defend against corns and blisters, and/or stretches and exercises designed to strengthen your toe muscles so that they can resist future damage and degradation. Shoe inserts or custom orthotics might also be a good choice, depending on your condition.

Unfortunately, the only way to permanently correct the deformity is surgery, and if conservative methods don’t relieve your symptoms then it may be your only choice. In a typical procedure, the contracted tendon is “released” and, on occasion, the bone may also be shortened in order to allow your digit to lie flat and straight again.

If you notice your toes beginning to curl away from you, don’t wait until they get so stiff that surgery is your only choice. Visit Family Foot and Ankle Center at one of our six convenient Greater Cincinnati offices. You can set up an appointment online, or by calling us at (513) 728-4800 in Ohio, or (859) 282-1572 in Kentucky.

Dr. Cynthia Miller
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Dr. Cynthia Miller is a board certified podiatrist who has been established in the Cincinnati area since 2004.