The merging or uniting of the toes, or the surgical ankylosis or arthrodesis of the toes.

Conditions that may cause a need for fusion of the toes include:

• deformity of the toe joints, such as hallux valgus (see Diagnostic Code: 5280);

• clawtoe;

• mallet toe;

• hammer toe (see Diagnostic Code: 5282);

• osteoarthritis (see Diagnostic Code: 5003);

• multi-joint arthritis, such as rheumatoid arthritis (see Diagnostic Code: 5002);

• local trauma, such as from hallux rigidus (see Diagnostic Code: 5281);

• chronic foot or leg pain from flatfeet (see Diagnostic Code: 5276); and

• fractures of the toes from overuse, such as excessive walking.

Congenital defects may also be responsible for toe fusion.

Symptoms revolve around the underlying cause leading to fusion of the toes. These symptoms may include pain, swelling, and a hematoma. If the fusion was surgically implicated, there may be pain postoperatively.

Diagnostic measures include radiologic studies, a comprehensive history, and physical examination.

Treatment for fusion of the toes is directed toward postoperative management. Medication for pain and inflammation may be given. Assistive devices for ambulating may be necessary early in the recovery period.

Limitation of motion in varying degrees may be the greatest residual. There is potential for chronic pain and abnormal gait.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• When multiple foot disabilities are present, but the etiology of the symptoms cannot be separated, assign a single disability evaluation for the predominant symptoms. If the etiology of the symptoms can be delineated, separate disability evaluation may be assigned under multiple DCs for foot disabilities provided that the principles of 38 CFR 4.14 have not been violated.

• Ankylosis is a condition of, or term used for the sign/symptom of, abnormal stiffness, immobility, or abnormal bending of a joint.  It is a stiffness or immobility in a joint caused by bones fusing as a result of disease or injury or by intentional fusion through surgery. Favorable ankyloses is fixation of a joint in a neutral position (at 0 degrees). Unfavorable ankyloses is fixation of a joint in flexion or extension that results in significant functional impairment. 

• 38 CFR 4.40 and 4.45 apply when considering whether LOM results in the functional equivalence of ankylosis of the joint. The functional equivalence of ankylosis arises when application of the effect of pain or other factors identified under 38 CFR 4.40 or 4.45, to include during flare-ups and repetitive use over time, results in additional loss of motion to the joint that effectively results in functional impairment consistent with ankylosis

• None.