What are the key components to describe when assessing hammertoes on physical examination?

Key Components for Describing Hammertoes on Physical Assessment

When assessing hammertoes during physical examination, clinicians should document the specific deformity characteristics, associated findings, and functional impact to guide appropriate management and prevent complications.

Anatomical Description Components

• Joint Position and Deformity Pattern:

  • Document hyperextension of the metatarsophalangeal (MTP) joint 1
  • Note flexion deformity of the proximal interphalangeal (PIP) joint 1, 2
  • Assess if the deformity is fixed (rigid) or flexible 3

• Skin Changes and Pre-ulcerative Signs:

  • Document presence, location, and characteristics of calluses over bony prominences 4, 5
  • Note any corns, particularly on the dorsal aspect of the PIP joint 1
  • Assess for erythema, warmth, or signs of skin breakdown 4
  • Document any open wounds, ulcerations, or fissures 4

• Associated Foot Deformities:

  • Note presence of other deformities (bunions, prominent metatarsal heads) 4
  • Document if Charcot foot is present 4
  • Assess for overall foot structure abnormalities that may contribute to hammertoe 5

Neurovascular Assessment

• Sensory Function:

  • Document results of 10-g monofilament testing 4
  • Include at least one additional neurological assessment (pinprick, temperature, vibration with 128-Hz tuning fork, or ankle reflexes) 4
  • Note any loss of protective sensation (LOPS) 4

• Vascular Status:

  • Document pedal pulses (dorsalis pedis and posterior tibial) 4
  • Assess capillary refill time 4
  • Note presence of rubor on dependency or pallor on elevation 4
  • Document venous filling time 4

Functional Assessment

• Biomechanical Impact:

  • Document evidence of increased plantar pressure (erythema, callus formation) 4
  • Note any pain with ambulation or shoe wear 1, 3
  • Assess impact on gait and mobility 1
  • Document any limitations in activities of daily living 6

• Footwear Assessment:

  • Evaluate current footwear for proper fit (should be 1-2 cm longer than foot) 4, 5
  • Note if width equals foot width at metatarsal phalangeal joints 4, 5
  • Document if specialized footwear is being used 4

Risk Stratification

• Complication Risk Factors:
  • Document history of diabetes and duration 4
  • Note history of previous foot ulcers or amputations 4
  • Assess for peripheral arterial disease 4
  • Document smoking status 4
  • Classify according to risk stratification system (e.g., IWGDF risk categories 0-3) 4

Clinical Pearls and Pitfalls

• Important Considerations:
  • Hammertoes in patients with neuropathy significantly increase risk for ulceration 4
  • The combination of hammertoes, peripheral neuropathy, and minor trauma creates high risk for foot complications 4
  • Patients with hammertoes and diabetes should be evaluated more frequently based on risk category 4
  • Documentation should guide appropriate referral to foot care specialists when indicated 4

By systematically documenting these key components during physical assessment of hammertoes, clinicians can effectively identify patients at risk for complications and implement appropriate preventive and therapeutic interventions.