Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chief complaint of a fixed flexion deformity of the second digit of the right foot. Reports progressive pain at the dorsal aspect of the proximal interphalangeal (PIP) joint, exacerbated by closed-toe footwear. Denies history of trauma, numbness, or paresthesia. Symptoms are chronic and have failed conservative management with orthotics and shoe modification.
Clinical Examination Findings
Right foot examination reveals a rigid hammer toe deformity of the second digit. Dorsal PIP joint prominence noted with overlying hyperkeratotic lesion/corn. MTP joint is stable with no evidence of subluxation. Passive range of motion at the PIP joint is limited due to contracture. No signs of acute inflammation, infection, or neurovascular compromise. Pedal pulses are 2+ and capillary refill is <2 seconds.
Treatment Protocol
Recommended treatment plan includes: 1. Modification of footwear to include a wider toe box. 2. Application of offloading pads or silicone toe sleeves to reduce friction. 3. Referral for custom orthotics to address biomechanical imbalances. 4. If symptoms persist, surgical consultation for PIP joint arthroplasty or fusion is advised.