Mallet Finger — Non-Operative — Extensor Tendon Mallet Finger — Zone I-II Non-Operative

University of Virginia Orthopaedic Surgery

Weight-Bearing

No surgical restrictions; light ADLs with DIP extension orthosis at all times

Key Restrictions

DIP orthosis in 0° to slight hyperextension worn without fail at ALL times including hygiene; if removed, DIP must be manually held in full extension; no composite or hook fisting uninvolved fingers; if extension lag noted, resume full-time immobilization 2 additional weeks; no PROM DIP flexion during Phase 2

Timeline & Phases

Phase 1 (day 1 to 6-8 wks): custom static DIP extension orthosis full time, active FDS straight fisting for uninvolved fingers, passive PIP flexion, light hand use without hook/tight fisting; Phase 2 (6-10 wks): orthosis weaning (wk 1: light AROM; wk 2: 2-3 hrs off:on with night wear; wk 3: wean day, discharge night), composite fisting, hook fisting, intrinsic extension

Notes

Non-surgical; if PIP hyperextension noted, add dorsal blocking component at 20-30° PIP flexion until resolved (typically first 3-4 weeks); monitor skin for irritation; monitor for extensor lag throughout weaning; weaning starts at 6-8 weeks per surgeon

Published

09/2024