The Clinical Syndrome

Mallet toe is a painful flexion deformity of the distal interphalangeal joint ( Fig. 136.1 ). The second toe is affected most commonly, although the deformity may occur in all toes ( Fig. 136.2 ). Mallet toe is usually the result of a jamming injury to the toe. However, as with bunion and hammer toe, the wearing of tight, narrow-toed shoes has also been implicated ( Fig. 136.3 ); also like bunion, mallet toe occurs more commonly in female patients than in male patients. An inflamed adventitious bursa may accompany mallet toe and contribute to the patient’s pain. A callus or ulcer overlying the tip of the affected toe may be present as well. High-heeled shoes may exacerbate the problem.

A, Clinical appearance of a mallet toe. There is a flexion deformity at the distal interphalangeal (DIP) joint. The proximal interphalangeal (PIP) and MTP joints are in a neutral position. B, Clinical appearance of a hammertoe. There is extension of the MTP joint, flexion at the PIP joint, and extension of the DIP joint. It is associated with a hallux valgus deformity. C, Clinical appearance of claw toes in a patient with diabetes mellitus. There is extension of the MTP joint and flexion at the PIP and DIP joints.

(From DiPreta JA. Metatarsalgia, lesser toe deformities, and associated disorders of the forefoot. Med Clin North Am. 2014;98(2):233–251.)

Foot of a diabetic patient with osteomyelitis of the distal phalanx of an insensate second mallet toe (distal interphalangeal [DIP] joint contracture). Disarticulation at the DIP joint removed the infective focus and shortened the prominent toe. Previous metatarsophalangeal joint disarticulation of the great toe had exposed the second toe to distal trauma from a shoe.

(From Bowker JH, Pfeifer MA, eds. Levin and O’Neal’s the diabetic foot. 7th ed. Philadelphia: Mosby; 2008:403–428.)

Mallet toe is usually the result of a jamming injury to the second toe. It is often seen in gymnasts, although the wearing of tight, narrow-toed shoes has also been implicated in its development.