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Ankle Exam

Toe Inspection


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


  • 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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