Hammertoes are a common everyday issue, so much so that when we are affected, we don’t look for solutions or causes for developing one. Instead, we simply accept the situation and let the hammertoe progress.
Symptoms
The main ones are: The big toe rotates and overlaps the second toe. The affected person feels pain in the affected joint, and it worsens with the pressure from shoes. The skin appears calloused and reddened along the inner edge of the big toe.
Causes
Hereditary factors are the most influential, but it can also be caused by inflammatory rheumatism or even foot conditions such as cavus foot or flat feet. Some injuries can also lead to joint and bone deformities.
Women are the most affected by hammertoes due to the type of footwear they typically wear (generally, the design of women's shoes is more likely to cause these conditions). For example, shoes that taper at the toe contribute significantly to foot deformation, especially if there are already signs of hammertoe, or high heels that exert pressure on the foot at the tip of the shoe.
Classification of Hammertoes
The Manchester Scale is a classification used to measure the severity or progression of Hallux Valgus (Hammertoe) in a patient. This scale is the result of research published in 2001 titled “The Grading of Hallux Valgus” in the Journal of the American Podiatric Medical Association, where the authors Adam P. Garrow, Ann Papageorgiou, Alan J. Silman, Elaine Thomas, Malcolm I. V. Jayson, and Gary J. Macfarlane from the Manchester Medical School described a new non-invasive method to assess the severity of Hallux Valgus deformity.
The study used a set of standardized photographs, then six podiatrists independently rated the deformity level of thirteen subjects (26 feet) on a scale of 1 to 4, where 1 shows no deformity and 4 represents severe deformity. The reliability of the four-point scale was verified through Kappa statistics (Kappa coefficient) for more than two evaluators.
The result showed that the rating method had excellent repeatability (approximately 0.86 with combined Kappa statistics), making it a suitable tool for clinical and research purposes.
A: Grade 1 (no deformity). B: Grade 2 (mild deformity). C: Grade 3 (moderate deformity). D: Grade 4 (severe deformity).
Menz and collaborators concluded in their 2010 study with 138 patients that the Manchester Scale demonstrates high reliability based on results from different examiners and patient self-assessments, indicating an association between both. These findings suggest that the tool can be confidently used in mail surveys to document the presence and severity of Hallux Valgus.
Also, in 2010, D'Arcangelo and others conducted a study with 201 participants and 402 X-rays to correlate the radiographic stages of Hallux Valgus and the Manchester Scale. According to the observations, a strong relationship was found between the four radiographic stages and the four Manchester Scale scores.
However, despite the unanimous validity of the Manchester Scale, it has been observed in scientific literature that the values of the scale may vary depending on whether the authors use a range of 0-3 or 1-4. This parameter should be considered when conducting our own assessments and/or studies.
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