Operative Repair of the Mallet Toe Deformity

Abstract

Over a 14-year period, 60 patients (86 toes) underwent resection arthroplasty of the proximal interphalangeal joint for a mallet toe deformity. During the same period, 788 hammertoe corrections were performed, for a ratio of 9:1 hammertoe to mallet toe corrections. Fifty patients (72 toes) were evaluated at an average 55-month follow-up. In 53 toes (73%), the involved toe was longer than the adjacent toes. The second, third, and fourth toes were almost equally involved with a mallet toe deformity.

With a resection arthroplasty technique, an arthrodesis of the PIP joint occurred in 52 toes (72%) and a fibrous union occurred in the remaining 20 toes (28%). Overall, 86% of the toes were rated as satisfactory by the patient (P < .001). A slightly lower satisfaction rate (75%) was noted in those toes with a fibrous union. A flexor tenotomy was performed in 22 toes along with the mallet toe repair. Acceptable alignment was noted in 96% of toes without a flexor tenotomy, and in 90% where a mallet toe repair was performed with a flexor tenotomy.

Pain was relieved (97%), correction was well maintained (91%), and patient subjective satisfaction was high (86%) with this procedure. Minor complications occurred in 14% of cases; however, one fourth of these patients still noted a satisfactory result.