Mallet finger is a drooping fingertip. A knock on the end of a straight finger, usually from a ball, forces the last joint to bend and tears the thin tendon that straightens it, sometimes taking a sliver of bone with it. The tip then hangs down and you cannot lift it, although it can still be pushed straight. It is common, it is rarely painful for long, and most mallet fingers heal without an operation by wearing a small splint continuously for at least six weeks. Where a large piece of bone has come away and the joint has slipped out of position, we pin or fix the fragment. What decides the result is starting early and never letting the tip drop until the tendon has healed.
What is mallet finger?
The tendon that straightens the end of your finger, the terminal extensor tendon, is thin and flat, and it attaches to the top of the last bone of the finger just behind the nail, crossing the joint nearest the fingernail, the DIP joint.
When a straight finger is suddenly forced to bend, the tendon is pulled beyond what it can take. In a tendinous mallet the tendon tears where it meets the bone. In a bony mallet the tendon holds but pulls off the piece of bone it is attached to. Both have the same effect: nothing is holding the tip up, so it droops. An open mallet, where a cut on the back of the finger divides the tendon, is less common and is treated differently because a wound is involved.
Symptoms
Most people describe:
- A fingertip that droops and cannot be lifted, although it can be pushed straight with the other hand
- Swelling and bruising over the back of the last joint
- Surprisingly little pain after the first day or two, which is why many people wait before seeking help
- In longstanding cases, the middle joint bending backwards into a swan neck shape
Causes and risk factors
Ball sports are the classic cause: cricket, basketball, netball, football and volleyball. Mallet finger is just as common from ordinary household moments, tucking in a bed sheet, pulling off a sock, catching a finger in a pocket. In older people the tendon is thinner and less force is needed, so it can follow a trivial knock. The ring and little fingers are affected most often. It is an accident, not a weakness.
How it is diagnosed
By examination and an X-ray. The drooping tip that you cannot lift, with a joint that straightens passively, is characteristic.
The X-ray matters for two reasons. It shows whether a piece of bone has been pulled off and how large it is. And it shows whether the last bone of the finger has slipped out of the joint, which is the single finding that most changes treatment: a bony mallet with the joint still in place heals in a splint, while a large fragment with the joint slipping usually needs fixing.
Non-surgical treatment
Splinting is the treatment for most mallet fingers, tendinous and bony, and done properly it gives a good result in the majority of cases.
Splinting
The splint holds the end joint straight, or a few degrees beyond straight, so the torn ends sit together while they heal. The middle joint is left free and should be moved normally.
The splint is worn continuously for at least six weeks, and usually six to eight weeks. Continuously means day and night, in the shower and in bed. The tendon heals as scar, and scar that is stretched even once in the early weeks lengthens and leaves a droop. If the tip drops when you change the splint, the clock starts again. After that comes a further two to four weeks of wearing the splint at night and for sport.
Hand therapy
Our hand therapists mould a custom thermoplastic splint to your finger, teach you how to change it with the finger flat on a table so the tip never drops, check the skin and run the weaning programme at the end. Having therapy on site means the splint is fitted the same week.
When surgery is needed
Most mallet fingers do not need an operation. We advise surgery where:
- A large piece of bone has come away, roughly a third or more of the joint surface, and the joint has slipped out of position
- The tendon has been cut by a wound, which needs the skin and tendon repaired together
- A mallet finger has been left for months and the droop or a swan neck deformity is causing real problems
The operation
For a bony mallet with a displaced joint, the usual procedure is pinning. A fine wire is passed across the joint to hold it straight, and a second wire pushes the bone fragment back into position, through small punctures rather than an incision. The wires stay in for six weeks and are removed in the rooms. Where the fragment is large enough, it can instead be fixed with a small screw through a short incision, which is the open fixation on our treatment list.
These are day surgery procedures using sedation with a local anaesthetic, taking approximately 20 to 40 minutes. A splint protects the finger afterwards.
For a longstanding mallet finger with a stiff, painful or badly drooping joint, fusing the end joint straight is a reliable option, described on our DIP arthritis page.
Recovery, week by week
Indicative, for the splinted mallet finger. After pinning the stages are similar, with the wire doing the job of the splint for the first six weeks.
Week 1. Splint fitted and worn continuously. Swelling and bruising over the joint are normal. Move the middle joint and the rest of the hand freely.
Weeks 1 to 6. Splint on day and night. Change it only with the finger flat on a table. Your therapist checks the skin. You can type, write and do most work with the splint on.
Week 6. Review, and an X-ray for a bony mallet. If the tip holds straight, weaning begins. If not, continuous splinting continues for another two weeks.
Weeks 6 to 10. Splint at night and for sport, off during the day. Gentle bending exercises start. The tip feels stiff and may look swollen for months.
Weeks 10 to 12. Splint discarded. Ball sports and heavy gripping resume from twelve weeks, taped for sport at first.
Driving and work. Driving and office work within days, with the splint on. Manual work that risks knocking the finger waits until the splint comes off.
Risks and complications
Splinting is safe. Its problems are mostly about the skin and about the final degree of straightness.
- Skin irritation or a pressure sore under the splint. Prevented by a well fitted splint, keeping it dry and regular checks.
- Residual droop. A small lag of 5 to 10 degrees is common and usually of no functional consequence. A larger lag follows if the splint comes off too early or the tip drops during a change.
- A permanent bump over the back of the joint, and some stiffness of the end joint, which usually improves over months.
- Swan neck deformity of the middle joint, more likely where a droop persists.
After pinning there are additional risks: infection around the wire, treated with antibiotics and early removal of the wire, nail deformity from injury to the nail bed, and arthritis of the joint in later years, which relates to the original damage to the joint surface more than to the surgery.
When to be seen sooner
Contact us, or see your GP, if you have:
- A fingertip that droops after a knock and has not been X-rayed
- A wound over the back of the finger near the nail with loss of straightening
- Whitening, pain or a sore under a splint
- A droop that is no better after eight weeks of continuous splinting
- Redness, discharge or increasing pain around a wire after pinning
If you have had treatment with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Can I just leave it?
You can, and some people do. A drooping tip that is left usually stays dropped, and over time it can pull the middle joint into a swan neck. Function is often acceptable but the finger catches on things. A splint for a few weeks early on is a small price for a straight finger.
It does not hurt, so is it serious?
Pain is a poor guide here. Mallet finger often stops hurting within days while the tendon is still completely detached. The droop is the problem, not the pain, and the sooner it is splinted the better the result.
Why does the splint need to stay on for so long?
The tendon heals by forming scar, and scar takes six to eight weeks to become strong enough to hold the tip up against the pull of the tendon that bends it. Stretching it even once early on lengthens the scar and leaves a droop. There is no way to speed this up.
Will my finger be completely straight again?
Most people end up with a straight or almost straight finger. A few degrees of droop and a small bump over the joint are common and rarely matter. Where a larger droop persists after splinting, there are surgical options.
It happened three weeks ago. Is it too late to splint?
No. Splinting still works for most people within the first twelve weeks of injury, although we would keep the splint on for longer. If it has been months, come and see us anyway. The options are different but not absent.
Do I need a referral?
Yes for a consultation with one of our surgeons: a referral from your GP or another specialist. No referral is needed to see our hand therapists for splinting, and many mallet fingers are managed entirely by the therapy team.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 8 November 2026