A mallet toe is part of a group of toe deformities called digital contractures. The most well known of these deformities is the hammertoe. A mallet toe is somewhat different than a hammertoe, whose main area of prominence is on the top of the toe, at the joint closest to the toe base. In a mallet toe, this joint is straight, while the second joint in the toe closer to the nail is bent downward (except in the big toe, where there is only one joint and all big toe contractures are technically mallet toes). What results is a toe that bent downward at its tip. This condition is seen in a variety of conditions, including nerve and muscle disease. However, it is just a commonly seen as a result of muscle imbalance in the toe due to one's specific foot structure. These conditions are generally not caused by tight shoes, contrary to popular belief, but the deformity can be aggravated further by a tight shoe.
As the toe end contracts downward, the tip of the toe bears most of its weight against the ground. Unlike the soft padded toe bottom that was designed to absorb pressure, the toe tip skin is thin and bony, and excessive pressure causes a reactive corn to form, which is nothing more than thickened skin tissue compacted together. As the corn thickens, it can become painful. In some people, such as diabetics and others with poor foot sensation or poor circulation, the resulting pressure can cause the soft skin underneath to die, forming a wound or ulcer. The tip of the superficial bone underneath the skin can become quickly exposed, leading to a deep toe infection.
Treatment of mallet toes involves either padding or corrective surgery. The padding is accomplished through either the use of a crescent-shaped pad that sits under the toes to lift them up, or a soft specialty pad inserted into the shoe that reduces the pressure from underneath. Surgery to correct the toe deformity can likewise have two options. Sometimes, simply releasing the tendon under the joint through a minimal incision can bring the toe back up. This procedure can often be performed under a local anesthetic in the office setting. If the toe deformity is rigid, some bone at the joint may need to be removed to allow the toe to reduce back into a normal straight position. Either way, the surgery to correct a mallet toe deformity heals relatively quickly and with few potential complications.