Mallet Finger — Non-Operative — Zone I Mallet Finger — Conservative

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Weight-Bearing

No surgical restrictions; no WB involved UE; DIP extension orthosis full time

Key Restrictions

No aggressive gripping/pinching with involved digit; no lifting >5 lbs involved UE; no PROM of DIPJ

Timeline & Phases

Phase I (initial to 6–8 wks): full-time DIP immobilization in extension/slight hyperext (no skin blanching); AROM/PROM PIP and MP of involved finger; daily skin checks; if swan-neck deformity develops splint PIP 30–45° flexion via dorsal block | Phase II (6–8 wks): AROM all joints of involved finger; DIP blocking AROM; wean daytime orthosis over 2 wks (1 hr/day increments); continue night orthosis 2 wks; no PROM DIPJ | Phase III (10–12 wks): return to all activities; strengthening as needed; D/C orthosis

Notes

Indication: acute/recent onset (<4–5 wks) tendinous mallet, bony mallet (if non-reduceable bony mallet, requires surgical intervention); orthosis time frames from initiation of full-time use, NOT injury date; extension lag >15° = continue full-time orthosis; expected outcome: 10–15° extension lag acceptable; >20° lag = additional 2 wks full-time orthosis; consider taping DIP in extension within orthosis for hygiene changes; PIP hyperextension: consider including PIP at 30° flex x 2–3 wks; shared URL with Post-Operative (K-wire pinning) protocol; developed collaboratively by UW Health and UnityPoint Health - Meriter Rehabilitation