- 735.4 Other hammer toe (acquired)
- M20.40 Other hammer toe(s) (acquired), unspecified foot
- 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
- Diagnosis is usually made by clinical examination or x-ray
- Can be an independent diagnosis and not associated with a disease process
- Results from wearing shoes that are too small
- Poor footwear: too small or narrow, toe comes to a point, high heels
- Trauma from impact on tip of the toe
- 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
- 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
Possible Contributing Causes
- Muscle imbalance
- Pes planus (flat foot)
- Improper show wear
- Commonly seen in conjunction of bunions
- Joint arthritis/injury
- Muscle atrophy
- Nerve damage
- Friedrich’s ataxia
- Rheumatoid arthritis
- Charcot-Marie-Tooth disease
- Hammer toe: different in that it is flexion of the PIP (generally extension/depression of the MTP and DF of PIP)
- Hallux valgus
- Osteochondrotic lesion of the first metatarsal head
- Sesamoiditis; turf toe
- Osteochondritis dissecans
- Metatarsal stress fracture
- Bone spur, location and size
- Surgery to straighten out the toe and lengthen ligaments/tendons.
- 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
- Antalgic gait secondary to pain at the toe with push-off
- Inability to ambulate distances of one mile secondary to pain
- Rest, keep weight off feet to reduce inflammation
- Orthotics with ray cut out
- Taping techniques
- Address swelling and pain
- Address pain
- Address weakness and joint ...
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