Toe Inspection
January 1st, 2017
Lesser Toe Deformities
Look For
- Valgus or varus deformities
- Overlapping or underlapping of toes
- Mallet toe: flexion deformity at the DIP joint with PIP and MTP in neutral position.
- Hammer toe: flexion deformity at PIP joint with DIP extension.
- Claw toe: flexion deformity of PIP and DIP joints with MTP extension.
Causes of Lesser Toe Deformities
- Congenital deformity
- Poor footwear
- Trauma
- Inflammatory arthritis
- Neuromuscular disorders
- Metabolic disease
Hallux Valgus
Look For
- Lateral deviation of the great toe (hallux) at the MTP joint. Note the angle of deviation.
Significance
- A very common disorder of the forefoot which may require orthotics or surgery.
Risk Factors for Hallux Valgus
- Genetic predisposition
- Poor footwear
- Pes planus
Nail Discolouration
Look For
- Discolouration of the nail or nail bed.
Interpretation
- Brown / black nail - may indicate subungal haematoma, fungal infection or subungal melanoma.
- Yellow nail - may be indicative of bronchiectasis, chronic bronchitis, lymphoedema
- Leukonychia (white nail) - associated with low serum albumin
Onycholysis
Look For Separation of the nail plate from the nail bed or nail fold.
Causes of Onycholysis
- Trauma
- Dermatoses - onychomycosis (fungal infection), lichen planus, psoriasis
- Systemic disease - thyroid disease, multiple myeloma, scleroderma, anaemia, peripheral vascular disease, diabetes mellitus.
- Drugs
Ingrown Toenails
Look For
- Ingrowth of the nail into the medial or lateral nail fold, which may be associated with erythema, tenderness and / or purulent exudate.
Risk Factors for Ingrown Toenails
- External pressure - poor footwear, poor foot posture, poor nail trimming
- Internal pressure - subungal tumour, phalangeal deformities, inflammation, arthropathy
- Systemic disease - obesity, thyroid disease, oedema
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