Mallet Toes

Mallet Toes

A sagittal plane deformity of the toe where the DIPJ is in a flexed position, the PIPJ is in a neutral or extended position and the MTPJ is neutral or dorsiflexed. Usually only one toe – maybe bilateral.

Aetiology:
Inappropriate footwear – narrow toe box, inadequate dept of toe box, too short, too small; Familial predisposition/inherited factors; Neuromuscular disorders; Long digit (plantarflexion occurs at IPJ due to shoe pressure); Ineffective flexor digitorum brevis (when flexor digitorum longus contract, the distal phalanx will plantarflex).

Clinical Features:
Many are asymptomatic; pressure from footwear may cause bursal development over the DIPJ- maybe a fistula and sinus; may be hyperkeratotic lesions associated with the pressure on DIPJ and apex of joint; nail dystrophy is common; may be pain secondary to arthritic changes; early, range of motion is normal, but later  limited dorsiflexion at DIPJ.

Management:
Treat inflammatory states and reduce hyperatotic lesions.
Protective padding if fixed.
Corrective padding or splints if flexible
Surgery (flexor tenotomy; resection of head of middle phalanx; partial amputation; arthrodesis of IPJ)
Footwear advice.

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