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  • 735.4 Other hammer toe (acquired)

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

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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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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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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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  • 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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  • Bone spur, location and size

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  • Medication
    • Anti-inflammatory
  • Surgery to straighten out the toe and lengthen ligaments/tendons.

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

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  • 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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