X-ray of hammer toe

Author: Mikael Häggström ^{[notes 1]}
A hammer toe or contracted toe is a flexion deformity of the proximal interphalangeal (PIP) joint of the second, third, or fourth toe, causing it to be permanently bent.

Planning

Indications

Imaging is not necessary for clinical diagnosis.^[1] Its main uses are in detecting any alternative or synchronous diagnoses, as well as surgical planning.^[1]

Procedure

Weightbearing dorsoplantar and lateral projections.^[1]

Evaluation

• Look at joints for erosions, suggesting arthritis.^[1]
• Look at the metatarsophalangeal (MTP) joints for any varus angulation and/or dorsal subluxation or widening of the joint sace, suggesting MTP instability.^[1]
• Detect any bunion^[1] (see X-ray of bunion)

• 

  Also look at the metatarsal heads, particularly for enlargemet and osteophytes, suggesting Freiberg disease (pictured)

• 

  Measure the flexion angles of suspected involved toes only if requested by the referral. This case is a normal foot, with flexion angle of the second toe PIP joint.

Report

• Flexed PIP joints and in which toes.^{[notes 2]}

• Give angles in numbers only if the degree of deformity is requested by the referral, since it is not a reliable basis for diagnosis.

• Absence or presence of other deformities.

See also: General notes on reporting

Notes

References