An unusual cause of ulceration: ainhum (dactylolysis spontanea)

We describe a case of ainhum, a mutilating condition, usually seen in peoples of West African origin. A patient presented at the Diabetic Foot Clinic, Kings College Hospital, with a painful infected ulcer between the fourth and fifth toe of his right foot. He was a 43-year-old Nigerian and did not have diabetes. He reported that his left fifth toe had autoamputated some months before. Radiograph of the right fifth toe showed absorption of the proximal and intermediate phalanges, and a diagnosis of ainhum was made. Ainhum or dactylolysis spontanea is a rare condition of unknown aetiology in which a groove or fissure of constricting tissue forms around the proximal end of the fifth toe. Eventually, the groove extends to encircle the toe, the underlying structures are absorbed and the toe autoamputates. It may present as chronic fissuring at the base of the fifth toe or as foot ulceration. This condition is seldom seen in the United Kingdom, but it is likely that this condition is underdiagnosed. It is important that wound care specialists be aware of the diagnosis.