Mallet Finger Info
Last reviewed
Mallet finger causes fingertip drooping after extensor tendon injury; splinting is key, surgery occasionally needed.
What you're feeling
Mallet finger usually shows up right after an injury — often when a ball strikes the tip of your finger during sport, or your fingertip catches on a sheet, sleeve, or piece of furniture. The tip of your finger droops downward and you can no longer straighten it on your own, even though you can still bend it normally. You may have pain, swelling, and bruising over the back of the last joint, but the most striking finding is the drooping tip.
Day-to-day, this means you might struggle to type, button a shirt, or pick up small flat objects because the fingertip cannot extend. Many people delay seeing anyone because the pain is mild and the finger still works for most things — but early treatment matters.
What's actually happening
The extensor tendon is a thin band on the back of your finger that pulls the tip straight. In a mallet finger, that tendon has either torn at its attachment near the nail or pulled a small piece of bone off with it (a "bony mallet"). With the tendon disconnected, no muscle force reaches the tip joint, so the fingertip droops.
Mallet finger usually heals well if treated early, but the tendon needs to be held in the correct position for several weeks for the ends to knit together. If the fingertip is allowed to bend even briefly during this period, the partly-healed tendon stretches out and the droop becomes permanent.
For a related extensor-tendon injury one joint further back, see Boutonnière deformity.
What we can do about it
Most mallet fingers are treated without surgery using a small plastic splint that holds the tip joint straight 24 hours a day for six to eight weeks. The crucial rule is the splint must NOT come off — even to wash — because letting the fingertip bend even briefly resets the healing clock. Many patients wear the splint for a further few weeks at night only after the continuous phase ends.
Surgery is sometimes recommended when a large piece of bone has pulled off the tip and is sitting out of place, or when the injury is open. The bone fragment may be pinned back in position. Long-standing mallet fingers (more than several weeks since injury) are still worth treating, but recovery is less complete.
After splinting ends, the finger is often stiff and slightly droopy at first. Gentle hand-therapy exercises gradually restore movement. Most people end up with a finger that functions normally, sometimes with a few degrees of permanent droop.
When to see someone
Show your droopy fingertip to a clinician within a few days of the injury — the sooner you start splinting, the better the result. You should seek same-day attention if there is an open wound near the joint (infection risk), if you have numbness, tingling, or coldness in the finger, or if the fingertip looks dusky. If you have been splinting at home and the droop hasn't improved at the end of the recommended period, you also need a professional review.
