summary Mallet Toe is a lesser toe deformity characterized by hyperflexion of the DIP joint. Diagnosis is made clinically with DIP joint hyperflexion with neutral PIP and MTP joints in a lesser toe. Treatment is a trial of nonoperative management with shoe modification and toe sleeves. Surgical management is indicated for progressive deformity, fixed contractures, and dorsal toe ulcerations. Etiology Pathoanatomy contracture (or spasm) of FDL because of pressure of toe against the end of shoe > 70% of patients have a longer digit rupture of EDL at DIP joint Deformity may be flexible or fixed Congenital mallet toe associated with flexion and lateral deviation of the DIP joint Anatomy Claw toe vs. Hammer toe vs. Mallet toe Claw toe Hammer toe Mallet toe DIP Flexion Normal Flexion PIP Flexion Flexion Normal MTP Hyperextension Slight extension Normal Presentation Physical exam callositieson toe dorsum of the DIP tip of toe; pain results from impacting the ground with gait Treatment Nonoperative shoes with high toe boxes, Silicone/foam toe sleeves indications first line of treatment Operative percutaneous/open FDL tenotomy indications flexible deformities that have failed nonoperative management FDL transfer to dorsum of phalanx indications to prevent unopposed extensor with FDL tenotomy and cock-up deformity DIPJ fusion or middle phalangeal distal condylectomy (excisional arthroplasty of DIP) indications rigid deformities that have failed nonoperative management technique repair attenuated extensor tendons K wire placement used to hold affected digit in extension