Abstract Ainhum is a rare idiopathic condition that occurs in those with African heritage usually affecting the 5th toe. We present a case report of 50 year old Haitian male presented with a painful 5th right toe with constricting band encircled the 5th toe at the base with loss of voluntary motion, a bulbus appearing distal toe, and external rotation of the nail plate. The pain and groove progressed over 6 months, starting as a crease appearing at the medial digitaltoplantar fold. He was prescribed a course of antibiotics for concern of cellulitis this failed to provide relief and referred to foot and ankle specialist. Initial radiographs revealed narrowing of the shaft of the proximal phalanx distal with annular indentation in the soft tissues at the base of the 5th toe, marked rotation of the 5th toe, triangular appearance of the distal phalanx . MRI showed absence of the majority of the 5th proximal phalanx and distal to the base consistent with frank bone destruction,, with osteitis at the residual base of the phalanx , soft tissue irregularity and enhancement of the 5th digit surrounding the phalanges, no fluid collection present. Due to advanced stage of ainhum with bony changes of the phalanges underlying Cole stage III the patient elected for 5th digit amputation, disarticulation at the mpj to reduce discomfort. Pathology report revealed a right 5th toe with apparent slight proximal constriction with no inflammation or necrosis identified. The post operative period was uneventful incision healing without keloid and 5th toe pain was resolved. Amputation for late-stage ainhum is a viable option. Healing without keloid suggests it is a genetic condition that occurs spontaneously not due to trauma.
Int J Foot Ankle (2022) 6:068
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