Our Clinic sees a fair amount of persons with this issue, who are unsure as to what exactly, is ailing them, and how to deal with it. For their part, they’re in pain and need help!
Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning as it should. A mallet toe occurs when the joint at the end of the toe cannot straighten, (it becomes bent). This can affect any of the three central toes. In some instances, the area can develop bursitis (become inflamed), and excessive rubbing of the mallet toe against the top of the shoe, can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe, causing pressure and discomfort.
What causes mallet toes?
Arthritis (particular rheumatoid), can lead to many forefoot deformities including mallet toes. Mallet toes can cause extreme discomfort, and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.
There are many different causes, but commonly it is due to shoes, or the way in which the foot works (functions) during walking. If the foot is too mobile, and / or the tendons that control toe movement are over active, this causes increased pull on the toes which may result in deformity.
In some instances trauma (either direct injury or overuse from walking or sport), can predispose to mallet toes. Patients who have other conditions such as diabetes and neuromuscular conditions are more likely to develop hammertoes.
Are women more likely to get the problem?
It is more common in women as they tend to wear tighter, narrower shoes (especially the pointy tips) with increased heel height. These shoes place a lot of pressure onto the joint and predispose to deformity.
- Deformity / prominence of toe
- Redness around the joints
- Swelling around the joints
- Corn / Calluses
- Difficulty with shoes
- Difficulty in walking
- Stiffness in the joints of the toe
There are several things that you can do to try and relieve your symptoms:
- Wear good fitting shoes with a deep toe box
- Avoid high heels
- Use a toe prop to straighten the toe if it is still mobile
- Wear a protective pad over the toe
- See a podiatrist/chiropodist/foot health practitioner is the earlier stages; in the more advanced stage see an orthopaedic surgeon.
Can the treatment/s cure the problem?
If the deformity is mobile, then the treatment/s may help prevent progression, although there have been no scientific studies to analyse the benefit. If the deformity is fixed, then these treatments will not cure the problem but may reduce the symptoms.
What will happen if I leave this alone?
Generally, the deformity becomes worse with time and slowly becomes fixed (stiff). This can then cause discomfort in shoes.
Can I correct the deformity?
The only effective way of correcting the deformity is to have an operation. But will there be a lot of complications?
There are risks and complications with all operations, and these should be discussed in detail with your specialist. However, with most foot surgery it is important to remember that you may be left with some pain and stiffness. This is why it is not advisable to have surgery if the deformity is not painful and does not limit your walking. A thorough examination of your foot and general health is important so that these complications can be minimised.
Although every effort is made to reduce complications, these can occur. In addition to the general complications that can occur with foot surgery, there are some specific risks with toe surgery:
- Persistent swelling which may be permanent
- Recurrence of deformity / corn
- Regrowth of removed bone
- Residual pain
- Stiffness or floppy toe
You may also get discomfort in other parts of your foot during the recovery period. This generally settles. As well, there is always a possibility that the deformity may return in later life.
Any forefoot problems that cause pain or discomfort should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possibly even infection. Conservative treatment of mallet toes begins with accommodating the deformity. The goal is to relieve pressure, reduce friction, and transfer forces from the sensitive areas. Shoes with a broad toe box are recommended for people suffering from forefoot deformities such as mallet toes. This prevents further irritation in the toe area from developing. Other conservative treatment includes forefoot supports such as gel toe caps, gel toe shields and toe crests. Supports/insoles can also provide immediate comfort and relief from common forefoot disorders.