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CONDITION/DISORDER SYNONYM

  • Claw toe

ICD-9-CM CODES

  • 735.4 Other hammer toe (acquired)

  • 755.66 Other anomalies of toes

ICD-10-CM CODES

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

  • Q66.89 Other specified congenital deformities of the feet

PREFERRED PRACTICE PATTERN

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

PATIENT PRESENTATION

A 26-year-old female states she was walking at night in her apartment barefoot to go to the kitchen when she kicked the leg of the sofa which she did not see. Patient states she had severe pain and ecchymosis. She had X-rays which were negative on her second toe. She presents with flexion at the distal interphalangeal (DIP) joint with pain during ambulation. The distal joint of the second toe is bent into a claw like position.

KEY FEATURES

Description

  • 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 DIP joint

  • Most commonly affects the second toe as it is the longest; can also be third to fifth

  • May alter mechanics during the push-off phase of gait

Essentials of Diagnosis

  • Diagnosis is usually made by clinical examination or X-ray

  • Can be an independent diagnosis and not associated with a disease process

  • Can be flexible in the developmental stage

  • Rigid toes will have tight tendons and joint capsules

General Considerations

  • Swelling

  • Inflammation around the joint

  • Altered joint position

  • Tip of the toe can develop a painful corn or ulcer

FIGURE 211-1

Structure of the ankle joint and foot. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Evaluation. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Demographics

  • 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

FIGURE 211-2

Toe fractures. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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

Functional Implications

  • Pain with standing

  • Pain with ambulation at ...

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