← Patient Resources
EN ES Kreyòl

Treatment plan

Mallet Finger Splint Protocol

The standard non-surgical treatment for most mallet finger injuries. Simple in concept, but strict in execution — the splint must stay on continuously.

The goal

A mallet finger is an injury to the small extensor tendon that straightens the fingertip. It causes the tip of the finger to droop down. The tendon heals well if the tip of the finger is held fully straight — or even slightly hyperextended — continuously for 6 to 8 weeks, so that the torn ends can scar back together. The challenge is simply keeping it straight, all the time, without exception.

The splint

You have been given a small splint (either a custom thermoplastic splint from a hand therapist or a stock "Stack" splint). The splint covers the last joint of the finger (the DIP joint) and holds it fully straight. The middle joint (PIP) is left free to bend.

The most important rule

The fingertip must not be allowed to bend — even once — for the entire 6 to 8 weeks. Every time the tip of the finger is allowed to drop, the healing tendon tears apart and the clock starts over. This means the splint comes off only for brief, careful skin care, and the finger is always supported during that time.

Daily splint schedule

Weeks 1 to 6: full-time splinting

  • Wear the splint 24 hours a day, every day, including sleep and showering.
  • The finger must never be allowed to droop, even for a second.

Skin care and splint changes

  • Once a day, you can remove the splint briefly to wash the skin and check for pressure sores.
  • When you remove the splint, keep the fingertip pressed firmly against a flat surface (a table or a book) so that it stays fully straight the whole time.
  • Wash the finger with soap and water, pat it dry, and put the splint back on. The entire process should take less than a minute.
  • Do not bend the finger at the tip, even to test it, during these skin checks.

Showering

  • Wear the splint in the shower, or have a second splint on standby so you can keep the finger supported while switching.
  • If you use a single splint in the shower, dry it thoroughly afterward and wear a finger cot over it if needed.

Week 6: starting to wean

  • At 6 weeks, Dr. Barrera will examine the finger. If there is no droop when the splint is removed with active extension, you begin a 2-week wean:
  • Weeks 6 to 7: remove the splint for short periods (an hour at a time) during the day, progressing to several hours. Continue to wear the splint at night.
  • Week 8: splint at night only.
  • If at any point during the wean the finger starts to droop, go back to full-time splinting and call the office.

Common problems during the protocol

  • Red, irritated skin under the splint. Usually from moisture or pressure. Keep the skin dry, make sure the splint is the right size, and ask a hand therapist to adjust or re-mold it.
  • The splint feels loose. The finger is less swollen than it was at first. Call the office or a hand therapist for a refit — a loose splint lets the fingertip bend.
  • A skin blister forms. Often a sign the splint is poorly fitted. See a hand therapist to remold it.
  • You forgot and let the finger bend. Put the splint back on, keep the finger fully straight, and call the office. In most cases the clock restarts from that day, but the overall treatment still works.

Expected results

  • Most patients recover excellent extension at the fingertip, though a small residual droop (called an "extensor lag") of 5 to 10 degrees is common and does not affect function.
  • The DIP joint can be permanently stiff after the protocol — this usually loosens up over the months after the splint comes off.
  • A small firm bump on the back of the DIP joint (where the tendon scarred back together) is normal.
  • Full use of the finger returns gradually over 2 to 3 months after the splint comes off.

When surgery is considered instead

Most mallet fingers are treated with the splint protocol above. Surgery (pinning of the joint or repair of a large bony fragment) is reserved for specific injuries — a large, displaced piece of bone, a joint that will not stay reduced, or a chronic mallet that has not responded to splinting. Dr. Barrera will discuss whether the splint protocol or surgery is the right choice for your specific injury.

Follow-up

Check-in at 2 weeks to make sure the splint is comfortable and the skin is healthy. At 6 weeks, the finger is examined and the wean is planned. Final follow-up at 10 to 12 weeks.

Call the office sooner if
  • The skin under the splint becomes very painful, breaks open, or develops pus
  • The finger becomes numb, pale, or cold
  • A splint cannot be kept in position (it keeps sliding off, or the fingertip keeps slipping into flexion)
  • You accidentally let the finger bend and are not sure what to do

Related

About mallet finger · Swan neck deformity

Questions?

Call your office location for non-urgent questions:

See our office contact information for addresses and fax numbers.