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  • 755.66 Other congenital anomalies of toes
  • 735.4 Other hammer toe (acquired)

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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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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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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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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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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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Imaging

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  • Location and size of bone spur

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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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  • To hospital for imaging, x-ray
  • To physician for medication, anti-inflammatory, corticosteroid injection
  • To surgeon for surgical consult

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  • Antalgic gait secondary to pain in toe with push-off
  • Hypomobility of MTP joint: dorsally in toe, plantar direction in PIP
  • Inability to ambulate 1 mile secondary to pain

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  • Rest: weight off feet will allow inflammation reduction
  • Orthotics with ray cut out
  • Metatarsal pad for MTP support and alignment
  • Address swelling
  • Address pain
    • Ice
    • Massage
    • Joint mobilization
    • ...

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