Mallet Toes

What are mallet toes?

A mallet toe occurs when the tip of the toe functions in a non-straightened manner. The tip of the toe is pointed down toward the sole of the shoe causing pain, discomfort and sometimes an infection. These infections are of major importance to the diabetic foot which is at a higher risk for abscess ulcerations, osteomyelitis (bone infection) and digital amputations.

It is very common to have a corn on the tip or top of a mallet toe due to rubbing against the sole and/or top of the shoe. The corn (hyperkeratotic lesion) is hard lifeless tissue which is discolored and looks bad.
This deformity alone has caused embarrassment when others see it sticking out like a "sore thumb". Sometimes a circular, light, hypo pigmented spot appears from the toe and shoe friction while other times a circular, dark, hyper pigmented spot discolors the skin on the toe. Changes in skin color can be permanent with a mallet toe deformity when left untreated.

Several other factors can lead to a good mallet toe going bad. Poor circulation, diabetes, edema (swelling) and non-leather shoes are examples of conditions that endanger the well being of a mallet toe. Complicating factors will produce sores on a mallet toe with puss, infection and drainage. Sometimes this scenario makes the toe begin to swell to almost twice its normal size, putting pressure on the surrounding toes causing those toes to be affected with lesions, sores, abscessed ulcerations and swelling too. Aching toes will alter ones walking pattern (gait cycle) and a cane or crutch could possibly be needed. Sometimes a lot of pain is present while other times absolutely no pain or discomfort is noticed because of nerve damage, decreased sensations in the feet from possibly a stroke or diabetes.

Most recently, sensory disorders in a patient's foot were caused by a closed head injury incurred during a snowmobile accident. Hemi paralysis of his right side required physical therapy to help regain function of his entire right side. Hard work and determination resulted favorable results for use and function of his right arm and lower extremity but the nerve damage is taking a long time to return to normal.

He decided to join some friends on a week long ski trip where he took beginner ski lessons and was able to manage this task quite well. The trip was uneventful, safe and he had a lot of fun on the slopes. Upon return he noticed some drainage from his second toe right foot coming from the side of his toenail. The toe was red and slightly swollen at the tip and around the eponychium (cuticle). The nail was partially detached and loose. His mallet toe deformity was exacerbated from the friction of his ski boot and he was unable to feel the pain secondary to the nerve damage existing in his foot and leg.

Without anesthesia, I removed the offending portion of his nail and had him soak his foot twice a day. No antibiotics were given and a week later the redness and infection were gone.

What causes a mallet toe?

Often times the bones and muscles in the toes are imbalanced causing mallet toes. You are more likely to develop mallet toes if you:

  • Are on your feet for the majority of the day
  • Participate in sporting activities on a regular basis
  • Already suffer from arthritis
  • Have nerve damage to your back, leg or foot
  • Have too high of an arch or very flat feet
  • Wear shoes that "just fit" or are too small
  • Have a toe deformity from birth

Some conservative treatments you could try are:

  • Wearing shoes with a large toe box
  • Toe crest or buttress pad
  • Gel toe shields and /or caps

Some surgical treatments your Podiatrist could try are:

  • Arthroplasty or partial bone/joint removal
  • Joint fusions in the toe
  • Flexor tenotomy or lengthening (spelling)
  • Amputation of the tip of the toe

For more information on this subject, or to schedule an appointment with a footDrHorsley Podiatrist, please call (877) 372-6048