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  • 735.5 Claw toe (acquired)
  • 755.66 Other anomalies of toes

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

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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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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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Imaging

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  • Bone spur, location and size

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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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  • For imaging, x-ray
  • For medication, anti-inflammatory or corticosteroid injection
  • For surgical consult1

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  • Antalgic gait secondary to pain at the toe with push-off
  • Hypomobility of the MTP joint
  • Inability to ambulate distances of one mile secondary to pain

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  • Rest, weight off feet will allow for reduction of inflammation
  • Orthotics with ray cut out
  • Swelling
  • Pain
  • Weakness, ...

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