What to do for a Drooping Fingertip / Mallet Finger?

Mallet Finger: What It Is, How to Spot It, and Why Early Treatment Matters

If you’ve ever caught your finger on a ball or jammed it awkwardly, you might have heard the term mallet finger. While it may seem minor at first, getting the right treatment early can ensure a smooth recovery and prevent long-term issues. Here’s what to look out for and what steps to take.

What Is Mallet Finger?

Mallet finger occurs when the extensor tendon—which straightens the tip of your finger is damaged. This typically happens when the fingertip is forcefully bent downward, such as when a ball strikes it or during a sudden impact. Mallet finger can also occur from benign activities such as tucking in bedsheets.

This force can:

• Tear the tendon from the bone (tendinous mallet)

• Or avulse a small piece of bone where the tendon attaches (bony mallet)

Both result in the same issue: you can’t actively straighten the tip of your finger.

How to Recognise a Mallet Finger Injury

Common signs include:

• Drooping of the fingertip (inability to straighten it without help)

• Mild swelling or bruising around the joint

• Sometimes minimal pain, which can lead to delayed treatment

It might look minor but the key sign, is the loss of active extension (ability to straighten or point) at the distal interphalangeal joint (DIPJ).

Tendon Tear vs. Fracture: What’s the Difference?

Both injuries look similar, but an X-ray is needed to confirm whether it’s tendinous or bony:

• Tendinous Mallet: The tendon is torn or stretched; no bone is involved.

• Bony Mallet: A small bone fragment has been pulled off along with the tendon.

This distinction matters. While treatment is generally similar, it helps guide the splinting

protocol and whether a surgical referral is needed—particularly in cases with joint subluxation.

• A bony mallet usually requires at least 6 weeks of full-time splinting.

• A tendinous mallet typically requires at least 8 weeks of full-time splinting.

How Is Mallet Finger Treated?

In most cases, non-surgical treatment with a custom-made splint is the preferred approach and typically achieves excellent results. When treating conservatively, the number of consultations may vary but usually follows this timeline for review consultations:

• Week 1

• Week 3

• Week 6/8

• Week 8/10

• Week 12

Key points of treatment:

• Continuous splinting of the DIP joint in full extension for 6–8 weeks

• No bending allowed during the healing period…even briefly

• Maintain mobility in surrounding joints to prevent stiffness. Gradual weaning off the splint after clinical clearance.

In more complex cases, especially with joint instability or displacement, surgical intervention may be recommended.

Custom Splint vs. Off-the-Shelf Splint

When it comes to treating mallet finger, splinting is the crucial part of treatment. While off-the-shelf splints can be convenient and cost-effective, a custom-made splint offers several advantages that can directly impact healing and comfort:

• More precise joint positioning: Custom splints are moulded to your individual finger and hold the DIP joint in optimal extension, which is crucial for tendon healing.

• Less bulk, better fit: Compared to pre-made options, custom splints are typically slimmer and less intrusive, making them easier to wear consistently throughout the day and night.

• Greater comfort and compliance: A well-fitted splint is less likely to cause skin irritation or pressure points, increasing your chances of sticking with the full-time splinting period.

Custom Splint:

Off-shelf splint:

Why Early Assessment Matters

Mallet fingers are often mistaken for “just a sprain,” but delaying treatment can lead to permanent deformity, such as a swan neck deformity, where the middle joint becomes hyperextended in conjunction with the fingertip drooping. To help prevent this, we may also choose to recommend and fabricate a night-time finger splint to support the finger in a particular way to reduce the risk of a biomechanical imbalance.

How a Hand Therapist Can Help

At SA Hand Therapy, we specialise in the assessment, splinting, and rehabilitation of hand injuries like mallet finger. Our experienced hand therapists will work with you to:

• Assess the injury and determine if it requires surgical opinion or conservative splinting

• Provide custom splinting to support tendon healing

• Educate you on injury care and what to avoid

• Guide your recovery and help you prevent complications like stiffness or deformity

In Summary

Mallet finger may seem like a small injury, but the impact on your hand function can be significant if not addressed promptly. Whether it’s a tendon tear or a small fracture, early diagnosis and proper splinting are the keys to avoiding long-term complications.

If you’ve noticed a drooping fingertip after a knock or strain, don’t brush it off—get it checked. At SA Hand Therapy, we’re here to guide you through a safe and effective recovery with personalised care and expert support every step of the way.