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8/12/2019 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.