CLAW TOES

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    By: Christya Lorena G

    Tutor:

    Dr. Dewi / dr. Evan

    Supervisor:

    Dr. Jainal Arifin, Sp.OT

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    INTRODUCTION describes a hyperextension deformity of the MTP joint

    of the lesser toes with flexion deformity of the PIPjoint

    Increases with advancing age

    Occurs more frequently in females than males

    Patients with a hereditary motor sensory neuropathy

    as the cause of claw toes may have an autosomaldominant pattern of transmission.

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    PATOPHYSIOLOGY The most common cause is an imbalance between the

    intrinsic and extrinsic muscles of the foot.

    Concurrent contracture of the long flexors andextensors of the toes without any balancing force fromthe intrinsic muscles

    Typically occurs secondary to underlying neurogenicor inflammatory conditions that lead to imbalance ofthe toe musculature and attenuation of the passiveligament restraints of the joints

    Can be idiopathic

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    CLINICAL PICTURE

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    ETIOLOGI

    Tight shoe wear

    Hallux valgus

    Inflammatory arthropathy

    Neuropathy

    Diabetes mellitus

    Hereditary sensorimotor neuropathies

    Neuromuscular disease

    Spasticity disorders

    Compartment syndrome

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    DIAGNOSEANAMNESE.- Patients may complain of unacceptable cosmeticappearance, difficulty with shoe wear, or a painful

    bursa over the dorsum of the PIP joint.- With hyperextension of the MTP joint, the plantarfat pad subluxates distally and causes painful plantarcalluses and possible ulcerations in insensate feet.

    - Difficulty with shoe wear

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    TreatmentNON-OPERATIVE.A Budin splint may help correct flexible deformities.

    Silicone padding covering the toes may pad the

    symptomatic areas. Cushioned insoles can protect from painful

    metatarsalgia.

    Wide shoes with a high toe box can avoid painful

    rubbing of the claw toes.

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    OPERATIVE.

    For flexible deformities, a flexor-to-extensor tendon

    transfer can be performed to straighten the claw toe. Rigid deformities require release of the contracted

    MTP capsule and collateral ligaments, and extensortendon release or lengthening.

    Claw toes with dislocation of the MTP joint are treatedwith oblique distal metatarsal osteotomy to achievebony shortening and reduce the MTP joint (2,3).

    Rigid PIP joint contractures are corrected with partialphalangectomy or PIP joint fusion.