210: HAMMER TOE

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

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

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