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Ankle Exam

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


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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