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ICD-9-CM Code

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  • 735.4 Other hammer toe (acquired)

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ICD-10-CM Code

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  • M20.40 Other hammer 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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  • Distal joint of the toe is bent into a claw like position

  • Usually due to trauma from impact on tip of the toe

  • Flexor muscles, fascia, tendons shorten

  • Flexion of the distal interphalangeal joint (DIP)

  • Most commonly affects the 2nd toe; can also be 3rd to 5th

  • May alter mechanics during the push-off phase of gait

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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

  • Altered joint position

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Demographics

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  • Infants

    • Congenital

  • Children

    • Results from wearing shoes that are too small

  • Adults

    • Poor footwear: too small or narrow, toe comes to a point, high heels

  • Dancers

    • Trauma from impact on tip of the toe

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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 above the DIP joint

  • Decreased extension or dorsiflexion of the toe

  • Joint redness and pain

  • Callus formation under the metatarsal head

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Functional Implications

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  • Pain with standing

  • Pain with ambulation at the toe

  • Inability to wear stiff shoes

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

  • Alteration of gait pattern (such as no toe off, forefoot abduction, decreased arch height) and mechanical issues of the forefoot

  • Difficulty finding shoes

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Possible Contributing Causes

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  • Muscle imbalance

  • Trauma

  • Pes planus (flat foot)

  • Improper show wear

  • Commonly seen in conjunction of bunions

  • Joint arthritis/injury

  • Muscle atrophy

  • Nerve damage

  • Friedrich's ataxia

  • Osteoarthritis

  • Rheumatoid arthritis

  • Stroke

  • Charcot-Marie-Tooth disease

  • Diabetes

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Differential Diagnosis

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  • Hammer toe: different in that it is flexion of the PIP (generally extension/depression of the MTP and DF of PIP)

  • 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

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  • Imaging

    • 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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  • Medication

    • Anti-inflammatory

  • Surgery to straighten out the toe and lengthen ligaments/tendons.

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Referrals/Admittance

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  • For Imaging, x-ray

  • For corticosteroid injection

  • For surgical consult to straighten out the toe, which may involve cutting or lengthening tendons and ligaments and possible fusion of the joint

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Impairments

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