EXTREMITY, HAND, AND FOOT DEFORMITIES
EXTREMITY, HAND, AND FOOT DEFORMITIES: Excerpt from Differential Diagnosis in Primary Care
Most deformities of the extremities are due to neurologic or joint
diseases, but because there are some exceptions to this rule the clinician
needs a method for easy recall of all the causes when faced with the
complaint. The mnemonic VINDICATE provides the key.
V—Vascular disease includes arteriosclerosis, Buerger disease, and
Raynaud syndrome, which may lead to gangrene or loss of a foot or digit.
I—Inflammatory diseases that deserve special mention include the
deformities of poliomyelitis, osteomyelitis, and septic arthritis. Syphilis
of the bone causes the saber shin, rarely seen today.
N—Neurologic disorders cover the largest group of deformities. The
beefy red hand of syringomyelia, the wrist and foot drop of peripheral
neuropathy (especially lead poisoning), the claw hand and foot of
amyotrophic lateral sclerosis or progressive muscular atrophy, the preacher
hand of myotonic dystrophy, and the tight-fisted, flexed, and pronated hand
of hemiplegia are the most important ones. Friedreich ataxia causes a hammer
toe, and Charcot–Marie–Tooth disease causes a stork leg.
D—Degenerative diseases include the degenerative neurologic diseases
mentioned above and degenerative osteoarthritis. Deficiency diseases include
the bowlegs of rickets. Paget disease causes bowing and hypertrophy of the
tibia.
I—Intoxication should remind one of the toxic neuropathies such as
lead and arsenic, but it also brings to mind the Dupuytren contractures of
alcoholic cirrhosis.
C—Congenital disorders form another large group. Many of the
disorders in this group have been mentioned under neurologic disorders.
However, congenital dislocation of the hip, talipes, equinovarus or valgus,
and calcaneovarus or valgus should be remembered. These are often signs that
a congenital lesion exists elsewhere. Hallux valgus is a frequent deformity
of the toes. Pes planus and pes cavus belong in this category, although they
are not nearly as significant. The deformities of Marfan syndrome (long
fingers with syndactyly), Down syndrome (e.g., short fingers and simian
crease), Laurence–Moon–Biedl syndrome, and achondroplasia are mentioned
here.
A—Autoimmune diseases include the spindle deformities of lupus
erythematosus and rheumatoid arthritis; the gangrene, autoamputation, and
smooth, swollen hands of scleroderma; and the gangrene of periarteritis
nodosa.
T—Traumatic lesions need little prompting to recall, but Pott
fracture with eversion of the foot and fracture of the neck of the femur
that causes eversion of the entire leg are noteworthy. Dislocations of
various joints should be easy to spot, but the mallet or baseball finger of
ruptured tendons is tricky.
E—Endocrine disorders include the large hands of acromegaly, the
short fingers of cretinism and pseudohypoparathyroidism, and the swollen
hands of myxedema. The accoucheur hand (“pelvic exam hand”) of tetany is appropriate
to mention here.
Approach to the Diagnosis
It is usually a simple matter to decide whether the deformity is due to
neurologic disease or to joint or bone disease. An x-ray film of the hands
or feet may be useful in acromegaly and many congenital disorders. Referral
to an orthopedic or neurologic specialist is usually indicated if bone or
neurologic involvement is probable. An arthritis workup can be done if joint disease is the
cause of the deformity.
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Foot conditions
More Medical Textbooks Online about Foot conditions
Review other book chapters online related to Foot conditions:
Medical Books Excerpts
- Clubfoot
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Footdrop
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Footdrop
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: FOOT, HEEL, AND TOE PAIN (Differential Diagnosis in Primary Care)
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