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CONDITION/DISORDER SYNONYM

  • Contracted toe

ICD-9-CM CODES

  • 735.4 Other hammer toe (acquired)

  • 755.66 Other congenital anomalies of toes

ICD-10-CM CODES

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

  • Q66.89 Other specified congenital deformities of feet

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion (ROM) Associated with Localized Inflammation1

PATIENT PRESENTATION

Patient is a 25-year-old soccer player. For fun he was kicking the ball around barefoot and stubbed his toes into the ground when trying to kick the ball. The patient had immediate pain and x-rays were negative for fractures. He presents to the clinic with the third toe bent with flexion of proximal interphalangeal (PIP) and DIP joints. The patient has swelling and cannot wear a closed toe shoe.

KEY FEATURES

Description

  • Toe bent with flexion of PIP

  • Shortened flexor muscles, fascia, tendons

  • Most commonly affects second toe, though may also affect third or fourth

  • May alter mechanics during push-off phase of gait

Essentials of Diagnosis

  • Diagnosis usually made by clinical examination or X-ray

  • May be independent diagnosis, not associated with disease process

General Considerations

  • Chronic condition developed over time with callus on top of the joint

  • Inflammation around joint

  • Altered joint position2

  • Evaluation of footwear

  • Distinguished from claw toe, which includes hyperextension (dorsiflexed) of the MTP joint with flexion (plantarflexed) of the PIP joint, DIP is plantarflexed

  • Distinguished from mallet toe, which includes neutral MTP and PIP joint with flexion (plantarflexion) of only the DIP

Demographics

  • 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

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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

FIGURE 210-1

Multiple hammertoes, hallux flexus, onychauxis, residual of rheumatoid arthritis, and degenerative changes. (From Halter JB et al: Hazzardís Geriatric Medicine and Gerontology, 6th edition. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.

Functional Implications

  • 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

Possible Contributing Causes

  • Improper footwear

  • Commonly in conjunction with bunions

    ...

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