The ball came in fast, the finger was pointing straight at it, and now the very tip of that finger is drooping. You can push it straight with your other hand, but the moment you let go, it drops again. It may not even hurt much. That is mallet finger, and it is one of the most common injuries of the netball, touch, cricket and basketball season on Brisbane's southside.
The good news is that most mallet fingers heal without surgery. The catch is that the treatment is unforgiving about one thing: the splint stays on, with the fingertip held straight, every minute of the day and night, for six to eight weeks. This article explains why, what happens if it comes off, and when the injury needs more than a splint.
In this article
What is mallet finger?
The tendon that straightens the last joint of your finger attaches to the top of the fingertip bone. When a ball, a hard tuck of a bed sheet or a jammed finger forces the tip to bend sharply while the tendon is pulling it straight, the tendon tears away from the bone, sometimes taking a small flake of bone with it. Without that attachment, nothing can lift the fingertip, so it hangs down like the head of a mallet. You can still bend it, and you can push it straight passively, but you cannot straighten it yourself.
It is easy to underestimate because the pain is often mild and the finger still works for most things. That is exactly why it gets ignored, and why a fingertip that is left drooping for weeks becomes harder to fix.
If a fingertip in your household is drooping, our physio in Mount Gravatt team can fit the right splint and set the plan the same week.
How common is it?
The most common closed tendon injury in sport
StatPearls describes mallet finger as the most common closed tendon injury seen in athletes, typically from a ball striking the tip of an outstretched finger. In the randomised trials reviewed in the Journal of Hand Therapy, fingers were splinted continuously for six weeks for acute injuries and eight weeks for chronic ones.
Those numbers tell you two things: it is common, and it usually responds to a simple treatment done properly. The remaining cases are mostly the ones where the splint came off too early or too often, and the ones with a larger bone fragment that shifted the joint.
Drooping fingertip? A hand assessment at ACE Sports Medicine in Upper Mount Gravatt gets the splint fitted correctly, which is where most of the outcome is decided.
Why does the splint have to stay on?
Because the tendon heals by scarring back onto the bone, and that scar is fragile for weeks. Every time the fingertip bends, even once, even "just to wash it", the healing tissue is pulled apart and the clock resets. In the trials reviewed, fingers were held continuously straight for six weeks after an acute injury and eight weeks when the injury was old. Continuous means in the shower, in bed, and when you change the splint to check the skin, which is done with the fingertip supported flat on a table so it never drops. After the continuous phase, most programmes use night splinting for a further period while the joint is gradually allowed to move again.
No single splint design came out ahead in the review. What mattered was the fit, the skin care and the discipline. Skin maceration and pressure sores were the main complications, which is why the fit is checked and adjusted rather than left alone.
Tendon or bone: does it matter?
Sometimes. If the tendon has pulled off a small flake of bone, the treatment is usually the same: splint it. If the fragment is large, or the joint has slipped out of line because of it, surgery may be recommended to fix the fragment in place. An open wound over the joint also needs medical assessment. That is why a mallet finger deserves an X-ray early on, so the plan is made on the right information. Your physiotherapist will arrange that with your GP if it has not already been done.
What actually helps?
Getting the splint on today, fitted properly, with a clear routine for skin checks. Then keeping it on. It sounds too simple to need a professional, but the fit is the difference between a splint that holds the tip straight and one that lets it sag a few degrees, and the skin routine is the difference between finishing the six weeks and pulling the splint off because of a sore. After the continuous phase, a physiotherapist guides the transition out of the splint, restores the movement of the joint, which is usually stiff after six to eight weeks straight, and plans the return to sport, often with the finger buddy-taped or splinted for games at first.
Many mallet fingers treated this way regain a straight or near-straight fingertip. A small residual droop is common and rarely affects function. A fingertip left untreated, on the other hand, can develop a permanent droop and, over time, a swan-neck shape in the finger, which is a much bigger job to sort out.
When should you seek help?
The same day, ideally. The earlier a mallet finger is splinted correctly, the better it tends to do.
Consider getting assessed if
The tip of a finger droops and cannot be straightened on its own after a ball strike, a jam or a hard tuck; the fingertip is swollen or bruised at the last joint; a finger has been drooping for weeks and you were waiting for it to sort itself out; or a splint you were given keeps slipping or has caused a sore. Seek prompt medical care for an open wound over the joint, a fingertip that looks out of line, or numbness in the finger.
The Quick Guide
A one-page summary you can save or print. Tap the image or the button to download the free PDF.
Helping You Perform at Your Best
Our physiotherapy team at ACE Sports Medicine in Upper Mount Gravatt sees mallet fingers from netball courts, cricket nets and school ovals across Brisbane's southside every season. Fitted early and worn faithfully, the splint does most of the work. We make sure it fits, the skin holds up, and the finger comes back to full function afterwards.