Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 755.66 Other congenital anomalies of toes735.4 Other hammer toe (acquired) ++ M20.40 Other hammer toe(s) (acquired), unspecified footQ66.89 Other specified congenital deformities of feet ++ 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1 +++ Description ++ Toe bent into claw-like positionDistinguished from claw toe, which includes extension of metatarsophalangeal (MTP) jointDistinguished from mallet toe, which includes flexion of only the distal interphalangeal joint (DIP)Shortened flexor muscles, fascia, tendons Flexion of proximal interphalangeal (PIP) and DIP jointsMost commonly affects 2nd toe, though may also affect 3rd or 4thMay alter mechanics during push-off phase of gait +++ Essentials of Diagnosis ++ Diagnosis usually made by clinical examination or x-rayMay be independent diagnosis, not associated with disease process +++ General Considerations ++ SwellingInflammation around jointAltered joint positionEvaluation of footwear +++ Demographics ++ Infants, congenitalChildren who wear shoes they have outgrown and are too smallAdultsPoor footwear: improper fit, pointed toe, narrow forefoot, high heelsDancers at higher risk +++ Signs and Symptoms ++ Pain in metatarsal with walkingCorn on top of toeDecreased extension or dorsiflexion of toePain, redness around jointCallus under metatarsal headDifficulty finding shoes with proper fitLimited motion of MTP joint +++ Functional Implications ++ Pain with standingPain in affected toe with ambulationInability to wear stiff shoesNeed to wear shoes with large toe box to accommodate bunion, corn, flexion, and hypomobile PIPAltered gait pattern and mechanical issues of the forefoot +++ Possible Contributing Causes ++ Improper footwearCommonly in conjunction with bunionsJoint arthritis/injuryMuscle atrophyNerve damageFriedrich's ataxiaOsteoarthritisRheumatoid arthritisStrokeCharcot-Marie-Tooth disease +++ Differential Diagnosis ++ Mallet toe: flexion of only the DIPClaw toeHallux valgusGoutOsteochondrotic lesion of first metatarsal headSesamoiditis, turf toeOsteochondritis dissecansMetatarsalgiaMetatarsal stress fracture +++ Imaging ++ X-ray ++ Location and size of bone spur +++ Medication ++ NSAIDs +++ Medical Procedure ++ Surgery to straighten toe, involves cutting or lengthening tendons and ligaments, possible fusion of the joint ++ To hospital for imaging, x-rayTo physician for medication, anti-inflammatory, corticosteroid injectionTo surgeon for surgical consult ++ Antalgic gait secondary to pain in toe with push-offHypomobility of MTP joint: dorsally in toe, plantar direction in PIP Inability to ambulate 1 mile secondary to pain ++ Rest: weight off feet will allow inflammation reductionOrthotics with ray cut outMetatarsal pad for MTP support ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process 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 Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.