Mallet Toe Deformity


  • A flexion deformity of the distal interphalangeal joint
  • Either flexible or fixed
  • Often the 2nd digit due to excessive length in comparison to other toes

Symptoms & Signs:

  • Pain over dorsal aspect of distal interphalangeal joint (DIP)
  • Pain at tip of toe from striking ground
  • Callus formation
  • Ulceration
  • Nail deformity

Physical Exam:

  • Standing observation to evaluate severity
  • Passive range of motion to determine if fixed or flexible deformity

(If flexible, plantar flexion allows DIP to straighten)

Conservative Treatment:

  • Wide toe-box shoes
  • Pad tip of toe

Surgical Treatment:

  • Flexible deformity – release of flexor digitorum longus tendon
  • Fixed deformity – condylectomy, or resection of the distal middle phalanx

Mallet Deformity of 3rd and 4th  Hammer deformity of 2nd

Following flexor tenotomy of distal interphalangeal flexion crease for correction of mallet toe deformity (4th toe)

Hammer Toe Deformity


  • Plantar flexion deformity of the proximal interphalangeal joint (PIP)
  • Flexible of fixed
  • Associated with hyperextension of metatarsophalangeal (MTP) joint
  • Typically one or two involved toes

Symptoms & Signs:

  • Either fixed or flexible
  • Callus formation over PIP extensor surface
  • Associated hallux valgus deformity


  • Correct shoe wear = wide toe box
  • Flexible deformity = Transfer of long flexor tendon to extensor mechanism
  • Fixed deformity- Condylectomy of PIP joint – distal head of proximal phalanx
  • Both – Correction of Hallux Valgus deformity

Hammer toe of second toe, with adjacent hallux valgus deformity

Clawtoe Deformity


  • Always involves both the MTP and interphalangeal joints.
  • Flexible or Fixed
  • Can be disabling
  • Marked dorsiflexion of MTP joints
  • Forced plantarflexion of the metatarsal heads
  • **Usually involves all of lesser toes, even great toe


  • Cavus foot deformity
  • Neuromuscular diseases
    • Cerebral Palsy
    • Charcot-Marie-Tooth Disease
  • Trauma

Symptoms & Signs:

  • Pain and chafing over dorsum of PIP and DIP joints
  • Pain beneath metatarsal heads
  • Calluses over PIP joints and under metatarsal heads


  • Extra-depth shoes
  • Pad metatarsal heads
  • Flexible: Combination of tendon transfers and lengthening
  • Fixed: Release of MTP extensor tendons, dorsal capsule, and collateral ligaments +/- PIP condylectomy

Post-traumatic clawtoe deformity of all digits on right foot