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ICD-9-CM Codes

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  • 755.66 Other congenital anomalies of toes

  • 735.4 Other hammer toe (acquired)

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ICD-10-CM Codes

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  • M20.40 Other hammer toe(s) (acquired), unspecified foot

  • Q66.89 Other specified congenital deformities of feet

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Preferred Practice Pattern

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Key Features

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Description

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  • Toe bent into claw-like position

    • Distinguished from claw toe, which includes extension of metatarsophalangeal (MTP) joint

    • Distinguished from mallet toe, which includes flexion of only the distal interphalangeal joint (DIP)

  • Shortened flexor muscles, fascia, tendons

  • Flexion of proximal interphalangeal (PIP) and DIP joints

  • Most commonly affects 2nd toe, though may also affect 3rd or 4th

  • May alter mechanics during push-off phase of gait

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination or x-ray

  • May be independent diagnosis, not associated with disease process

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General Considerations

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  • Swelling

  • Inflammation around joint

  • Altered joint position

  • Evaluation of footwear

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Demographics

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  • Infants, congenital

  • Children who wear shoes they have outgrown and are too small

  • Adults

    • Poor footwear: improper fit, pointed toe, narrow forefoot, high heels

    • Dancers at higher risk

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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 toe

  • Decreased extension or dorsiflexion of toe

  • Pain, redness around joint

  • Callus under metatarsal head

  • Difficulty finding shoes with proper fit

  • Limited motion of MTP joint

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Functional Implications

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  • Pain with standing

  • Pain in affected toe with ambulation

  • Inability to wear stiff shoes

  • Need to wear shoes with large toe box to accommodate bunion, corn, flexion, and hypomobile PIP

  • Altered gait pattern and mechanical issues of the forefoot

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Possible Contributing Causes

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  • Improper footwear

  • Commonly in conjunction with bunions

  • Joint arthritis/injury

  • Muscle atrophy

  • Nerve damage

  • Friedrich's ataxia

  • Osteoarthritis

  • Rheumatoid arthritis

  • Stroke

  • Charcot-Marie-Tooth disease

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Differential Diagnosis

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  • Mallet toe: flexion of only the DIP

  • Claw toe

  • Hallux valgus

  • Gout

  • Osteochondrotic lesion of 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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  • Location and size of bone spur

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Treatment

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Medication

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  • NSAIDs

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Medical Procedure

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  • Surgery to straighten toe, involves cutting or lengthening tendons and ligaments, possible fusion of the joint

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Referrals/Admittance

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  • To hospital for imaging, x-ray

  • To physician for medication, anti-inflammatory, corticosteroid injection

  • To surgeon for surgical consult

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Impairments

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