Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 735.4 Other hammer toe (acquired) ++ M20.40 Other hammer toe(s) (acquired), unspecified foot ++ 4E: Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation +++ Description ++ Distal joint of the toe is bent into a claw like positionUsually due to trauma from impact on tip of the toeFlexor muscles, fascia, tendons shortenFlexion of the distal interphalangeal joint (DIP)Most commonly affects the 2nd toe; can also be 3rd to 5thMay alter mechanics during the push-off phase of gait +++ Essentials of Diagnosis ++ Diagnosis is usually made by clinical examination or x-rayCan be an independent diagnosis and not associated with a disease process +++ General Considerations ++ SwellingInflammation around the jointAltered joint position +++ Demographics ++ InfantsCongenitalChildrenResults from wearing shoes that are too smallAdultsPoor footwear: too small or narrow, toe comes to a point, high heelsDancersTrauma from impact on tip of the toe +++ Signs and Symptoms ++ Pain in metatarsal with walkingCorn on top of the toe above the DIP jointDecreased extension or dorsiflexion of the toeJoint redness and painCallus formation under the metatarsal head +++ Functional Implications ++ Pain with standingPain with ambulation at the toeInability to wear stiff shoesNeed to wear larger shoes to accommodate bunion, large toe boxAlteration of gait pattern (such as no toe off, forefoot abduction, decreased arch height) and mechanical issues of the forefootDifficulty finding shoes +++ Possible Contributing Causes ++ Muscle imbalanceTraumaPes planus (flat foot)Improper show wearCommonly seen in conjunction of bunionsJoint arthritis/injuryMuscle atrophyNerve damageFriedrich’s ataxiaOsteoarthritisRheumatoid arthritisStrokeCharcot-Marie-Tooth diseaseDiabetes +++ Differential Diagnosis ++ Hammer toe: different in that it is flexion of the PIP (generally extension/depression of the MTP and DF of PIP)Hallux valgusGoutOsteochondrotic lesion of the first metatarsal headSesamoiditis; turf toeOsteochondritis dissecansMetatarsalgiaMetatarsal stress fracture ++ ImagingX-ray ++ Bone spur, location and size ++ MedicationAnti-inflammatorySurgery to straighten out the toe and lengthen ligaments/tendons. ++ For Imaging, x-rayFor corticosteroid injectionFor 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-offInability to ambulate distances of one mile secondary to pain ++ Rest, keep weight off feet to reduce inflammationOrthotics with ray cut outTaping techniquesAddress swelling and painIceAddress painIceMassageJoint mobilization... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth