Mallet Toes

Question 1

What is this?

Answer 1

Mallet toe

Question 2

Which toes are most commony affected in mallet toe

Answer 2

The lesser toes

Commonly the second toe

Question 3

What is mallet toe

Answer 3

A flexion deformity at the distal interphalangeal joint of the involved toe

There is no PIP or MTP joint involvement

Question 4

How would you complete the examination of a patient with mallet toe

Answer 4

Watch the patient walk

Examine her shoes

Ask her questions to assess the effect of the condition on her life

Question 5

What is the cause of mallet toes

Answer 5

Imbalance between intrinsic and extrinsic muscles of the lesser toes

Question 6

What are the intrinsic muscles of the lesser toes

Answer 6

Lumbricals

Interossei

Question 7

What are the extrinsic muscles of the lesser toes

Answer 7

Long flexors and extensors

Question 8

Who is more likely to get mallet toes

Answer 8

More common in females than males

Elderly

Patients with RA

Diabetics with peripheral neruopathy

Question 9

How would you treat mallet toes

Answer 9

Non-surgical

• Appropriate footwear - usually unhelpful

Surgical:-

• Mobile deformity - consider flexor digitorum longus tenotomy
• Fixed deformity
  
  • Flexor tenotomy with resection of the middle phalangeal head and neck
  • Fusion of the DIPJ
  • Amputation of distal half of distal phalanx to include nail and matrix

Question 10

What is a tenotomy

Answer 10

Surgical cutting of a tendon