Ainhum

Definition

Definition of Ainhum
Ainhum (also known as bankokerend, dactylolysis spontanea, and sukhapakla) is a painful constriction of the base of the fifth toe frequently followed by bilateral spontaneous amputation (autoamputation) a few years later. The disease occurs predominantly in black Africans and their descendants. The exact etiology is still unclear.

Epidemiology: Ainhum predominantly affects black people, living in West Africa, South America and India. In Nigeria it is a common disease with an incidence of 2.2%. Daccarett recorded retrospectively a rate of 1.7% in a mainly African American population in Chicago. Up to now only a few cases had been reported in Europe. Ainhum usually affects people between 20 and 50 years. The average age is about thirty-eight. The youngest recorded patient was seven years old. There is no predominant gender ratio.

Symptoms

Symptoms of Ainhum
Pain is present in about 78% of cases. Slight pain is present in the earliest stage of ainhum, caused by pressure on the underlying nerves. Fracture of the phalanx or chronic sepsis is accompanied with severe pain.

Causes

Causes of Ainhum
The true cause of ainhum remains unclear. It is not due to infection by parasites, fungi, bacteria or virus, and it is not related to injury. Walking barefoot in childhood had been linked to this disease, but ainhum also occurs in patients who have never gone barefoot. Race seems to be one of the most predisposing factors and it may have a genetic component, since it has been reported to occur within families. Dent et al. discussed a genetically caused abnormality of the blood supply to the foot. Peripheral limb angiography in five limbs with ainhum showed that the posterior tibial artery became attenuated at the ankle, and the plantar arch and its branches were absent. The dorsal pedis artery was constituting the only supply to the forefoot and little toe.

Diagnosis

Diagnosis of Ainhum
Ainhum is an acquired and progressive condition, and thus differs from congenital annular constrictions. Ainhum has been much confused with other diseases such as leprosy, diabetic gangrene, syringomyelia, scleroderma or Vohwinkel syndrome.

Treatment

Treatment of Ainhum
Incisions across the groove turned out to be ineffective. Excision of the groove followed by z-plasty could relieve pain and prevent autoamputation in Grade I and Grade II lesions. Grade III lesions are treated with disarticulating the metatarsophalangeal joint. This also relieves pain, and all patients have a useful and stable foot.

Prognosis

Prognosis of Ainhum
Consult with your doctor.

Prevention

Prevention of Ainhum
Consult with your doctor.