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ICD-9-CM Code

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  • 735.5 Claw toe (acquired)

  • 755.66 Other anomalies of toes

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ICD-10-CM Code

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  • M20.5X9 Other deformities of toe(s) (acquired), unspecified foot

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Preferred Practice Pattern

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Key Features

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Description

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  • Toe is bent into a claw-like position

  • Flexor digitorum brevis contraction/shortening

  • Hyperxtension of the MTP joint with Flexion of the proximal interphalangeal joint (PIP)

  • Flexor muscles, fascia, tendons shorten

  • Most commonly affects the second toe; can also affect the third to fifth

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination or x-ray

  • Can be an independent diagnosis and not associated with a disease process

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General Considerations

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  • Swelling

  • Inflammation around the joint

  • Can be associated with medical conditions

  • Can be a flexible or fixed deformity

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Demographics

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  • Infants

    • Congenital

  • Children

    • Wearing footwear that is too small

  • Adults

    • Poor footwear: improper fit/toe comes to a point/narrow forefoot/high heels

    • Dancers

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Clinical Findings

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Signs and Symptoms

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  • Pain in metatarsal with walking

  • Corn on top of the toe

  • Altered joint position

  • Decreased extension or dorsiflexion of the toe

  • Joint redness and pain

  • Callus formation under the metatarsal head

  • Difficulty finding shoes that fit properly

  • Limited motion of the MTP joint

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Functional Implications

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  • Pain with standing

  • Pain with ambulation at the affected toe

  • Inability to wear stiff shoes

  • Need to wear larger shoes to accommodate bunion, large toe box

  • Alteration of gait pattern and mechanical issues of the forefoot

  • Altered mechanics during the push-off phase of gait

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Possible Contributing Causes

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Differential Diagnosis

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  • Mallet toe: different in that it is flexion of only the DIP

  • Hallux valgus

  • Gout

  • Osteochondrotic lesion of the first metatarsal head

  • Sesamoiditis, turf toe

  • Osteochondritis dissecans

  • Metatarsalgia

  • Metatarsal stress fracture

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray

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Findings and Interpretation

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  • Bone spur, location and size

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Treatment

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Surgical

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  • To straighten out the toe

    • Cut or lengthen tendons and ligaments

    • Fusion of the joint

    • Tendon transfer1,2

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Medication

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  • Anti-inflammatory

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Referrals/Admittance

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  • For imaging, x-ray

  • For medication, anti-inflammatory or corticosteroid injection

  • For surgical consult1

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