ConditionBones, joints & muscles
Mallet Toe
Mallet toe is a deformity in which the toe bends downward at the joint closest to the toenail, so the tip of the toe points down toward the floor. It most often affects the second toe and is linked to tight or narrow shoes, a long second toe and muscle imbalance. The tip can press on the ground or shoe, causing a painful corn, nail damage or sores. Early on the toe is flexible and responds to roomy shoes and padding; a rigid toe may need a minor operation.
Also called: Mallet toe deformity, distal interphalangeal joint flexion deformity
At a glance
- What it is
- A toe bent down at the last joint (the distal interphalangeal joint).
- Most affected
- The second toe, especially when it is longer than the big toe.
- Causes
- Tight, short or high-heeled shoes, toe length, injury, arthritis and nerve or muscle conditions.
- Symptoms
- A painful corn on the tip, nail thickening or damage, and difficulty with shoes.
- Treatment
- Roomy shoes, padding, splints and stretching; surgery for rigid or painful toes.
When to get help
See a doctor within a day or two
- A sore, ulcer, redness, swelling or drainage on the tip of the toe, especially with diabetes or poor circulation
- A toe that suddenly becomes bent after an injury
Book a routine appointment
- A toe that is becoming stiffer or more bent
- A painful corn on the tip of a toe that keeps returning
- A toe deformity with diabetes, numbness in the feet or poor circulation (needs regular foot care)
- Several toes curling, especially with weakness or high arches (possible nerve condition)
Usually safe to manage at home
- A flexible mallet toe that only hurts in tight shoes and can be straightened with your fingers
What happens in mallet toe
Each smaller toe has three bones and two joints. In mallet toe, the joint nearest the nail stays bent downward. The flexor tendon under the toe pulls harder than the extensor tendon above, often because the toe has been cramped in a shoe for years. Over time, the soft tissues tighten and the bend can become fixed.
Mallet toe vs hammer toe vs claw toe
| Deformity | Where the toe bends | Typical appearance |
|---|---|---|
| Mallet toe | Last joint (near the nail) bends down | Tip of the toe points to the floor |
| Hammer toe | Middle joint bends down | Middle of the toe raised like a hammer |
| Claw toe | Base joint bends up, the middle and last joints bend down | Toe curls like a claw, often affecting several toes |
Claw toes in several toes, especially with high arches, can point to a nerve or muscle condition and should be checked.
Causes and risk factors
- Footwear: narrow, short or high-heeled shoes that push the toes forward and cramp them
- Toe length: a second toe longer than the big toe
- Bunion: the big toe drifts toward the second toe and crowds it
- Injury: stubbing or jamming the toe
- Arthritis: rheumatoid arthritis and osteoarthritis
- Nerve and muscle conditions: diabetes, Charcot-Marie-Tooth disease and stroke
- Age and sex: more common with age and in women, likely related to footwear
Symptoms
- the tip of the toe bends down and may touch or press into the ground
- a painful corn on the tip of the toe, or on top of the joint
- a thickened, damaged or ingrown toenail from pressure
- pain when walking or wearing shoes
- reduced ability to straighten the toe
Diagnosis
A podiatrist or orthopedic foot specialist diagnoses mallet toe by examination, checking whether the toe can be straightened (flexible) or not (rigid), and looking for corns, calluses and circulation or sensation problems. X-rays show joint alignment and arthritis, mainly when surgery is being considered.
Treatment
Non-surgical treatment
- Shoes: a deep, wide toe box, low heels, and at least 1 cm (about half an inch) of space beyond the longest toe
- Padding: gel toe caps, crest pads or silicone sleeves to protect the tip
- Toe splints or straps to hold the toe straighter
- Stretching and strengthening: gently straightening the toe by hand, picking up marbles or a towel with the toes
- Corn care: a podiatrist can safely pare corns; avoid medicated corn plasters if you have diabetes or poor circulation
- Orthotic insoles to rebalance pressure
Surgery
For a rigid, painful toe or recurring ulcers, outpatient surgery may involve:
- Tendon release: cutting the tight flexor tendon, for flexible deformities
- Joint resection or fusion: removing a small part of the bone at the joint and straightening the toe, sometimes held with a temporary wire
- Partial toe bone shortening in some cases
Recovery usually involves a stiff-soled post-operative shoe for a few weeks, with swelling lasting several months.
Complications
- painful corns and calluses
- toenail damage
- skin breakdown and ulcers, which can become infected, especially with diabetes (diabetic foot problems)
- pain limiting walking and activity
Prevention
- wear shoes that fit both length and width, especially in children as their feet grow
- avoid high heels and pointed shoes for long periods
- treat bunions early
- check your feet regularly if you have diabetes
Frequently asked questions
What is mallet toe?
Mallet toe is a toe deformity where the joint nearest the toenail bends downward, so the tip points to the floor. It usually affects the second toe and can cause painful corns on the toe tip.
What causes mallet toe?
The most common causes are tight, narrow or high-heeled shoes, a second toe longer than the big toe, injury and arthritis. Nerve and muscle conditions such as diabetes can also contribute.
Can mallet toe be fixed without surgery?
A flexible mallet toe often improves or stops progressing with roomy shoes, padding, splints and toe exercises. These relieve pain but rarely fully straighten a long-standing toe. Rigid or very painful toes may need surgery.
What is the difference between mallet toe and hammer toe?
Mallet toe bends at the joint nearest the toenail. Hammer toe bends at the middle joint of the toe, raising the middle of the toe. Both are caused by similar factors and treated in similar ways.
How long does recovery take after mallet toe surgery?
Most people walk in a special shoe right after surgery. Any pin is usually removed after about 3 to 6 weeks. Regular shoes are often possible after 4 to 6 weeks, but swelling can last several months.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons: Hammer toe and mallet toe
- American College of Foot and Ankle Surgeons: Hammertoes and toe deformities
- American Podiatric Medical Association: Hammertoes
- NHS: Hammer toes, claw toes and mallet toes
- MedlinePlus: Toe deformities