EpistemisClaw or hammer toe deformity
Specialty: Musculoskeletal.
Why it occurs
- Imbalance of the intrinsic and extrinsic muscles of the foot (common secondary to hallux valgus or bunion)
- Diabetic motor neuropathy (denervation of the interosseous and lumbrical muscles)
- Advanced rheumatoid arthritis (subluxation of the metatarsophalangeal joints)
- Chronic use of narrow or high-heeled footwear with reduced toe caps
- Charcot-Marie-Tooth disease (hereditary neuropathy with pes cavus)
- Previous or compartmental trauma of the foot
Initial workup
AP and lateral weight-bearing standing radiography (evaluates the degree of interphalangeal and metatarsophalangeal joint subluxation) | Electromyography and conduction velocities if underlying neuropathy is suspected | Microbiological culture of the ulcer fund if present.
red flags
Rigid deformity of the toes associated with a dorsal or plantar skin ulcer over the deformed joints that shows signs of perilesional erythema, purulent discharge or direct bone exposure (high risk of osteomyelitis and toe amputation in diabetic patients).
Standard management
- There are no drugs that correct bone structural deformity — requires the use of protective silicones or reconstructive surgery); in case of infected diabetic or arthritic foot ulcer: Piperacillin/Tazobactam (4 g/0.5 g IV every 6 hours
- Ciprofloxacin (500 mg every 12 hours orally to cover Pseudomonas if applicable).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 2