Hammer toe
| Classification according to ICD-10 | |
|---|---|
| M20.4 | Other hammer toe (acquired) |
| Q66.8 | Other congenital deformities of the feet - hammer toe, congenital |
| ICD-10 online (WHO version 2019) | |
The shape of a hammer toe ( digitus malleus ) results from the permanent claw-like flexion of a toe . A distinction is made between flexible and fixed hammer toes. It has to be differentiated from camptodactyly in the differential diagnosis and is mostly mechanical due to the use of unsuitable footwear . Also neurological disorders can cause this symptom.
definition
The Hammer is the most common deformation toes. There is a flexion contracture in the middle joint (PIP = p roximales I nter p halangealgelenk), rare (also) in the distal interphalangeal joint (DIP = d istales I nter p halangealgelenk). In contrast to the hammer toe, the claw toe is characterized by a dislocation or subluxation in the metatarsophalangeal joint (MTP = M eta t arso p halangeal joint) in the sense of hyper- extension .
etiology
The hammer toe is rarely congenital. Acquired it can occur with neuromuscular diseases , arches foot , splayfoot , after compartment syndrome , poliomyelitis , rheumatic diseases or with incorrect footwear and with dancers.
Clinic and diagnostics
Pressure problems with corns , calluses, pain under the metatarsal heads, shoe conflicts, aesthetic disorders. Determining the range of motion, toe length and the distance between the toes is important for the selection of the surgical procedure.
Conservative therapy
The indication for this is when the toe position can be corrected passively.
- Walking barefoot and choosing footwear with adequate toe space, especially for children who are still growing
- Physiotherapy in the early stages with exercise and stretching to prevent progression.
- Podiatry - foot care, protective bandages.
- The orthopedic technology offers the most opportunities: Deposits with support behind the metatarsal heads (retro capital), dilated toe, splints and bandages for position correction, orthotics
Operative therapy
- In the case of flexible, correctable misalignments: change in the course of the tendons or surgery according to Weil
- For contractures: Hohmann surgery or resection arthroplasty
The contraindication for surgical rehabilitation is poor blood circulation ( PAD ). Postoperatively, full weight bearing in a stiff sole is usually allowed; the sutures can be removed after two weeks. Wound healing disorders, circulatory disorders or necrosis can occur as complications .
X-rays
Hammer toe before surgical correction
Hammer toes after surgical correction; the shortened third links of the three inner toes are clearly recognizable (Hohmann's operation). The hallux valgus was also corrected during this operation .
Hammer toe on middle toe
literature
- A. Imhoff, R. Baumgartner, R. Linke: Orthopedic checklist . 2nd Edition. Thieme Verlag, Stuttgart et al. 2005, ISBN 3-13-142281-5 .
- Carl Joachim Wirth: Practice of orthopedics . Georg Thieme Verlag, Stuttgart et al. 2001, ISBN 3-13-125683-4 .
