Ainhum Clinical Presentation

  • Author: Samuel T Selden, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Sep 16, 2015


Criteria for diagnosis involves three conditions: soft tissue constriction, bulbous enlargement of the toes, and thinning or lysis of phalangeal bones. As the condition progresses, confirmation can be made via radiographic imaging.

The four stages of ainhum are as follows:

  • Grade I involving a groove with no swelling visible and no bone involvement
  • Grade II is a bulbous enlargement of the digit distally, resulting in external rotation
  • Grade III consists of osseous involvement
  • Grade IV is the development of autoamputation




The clinical presentation depends on the stage to which the ainhum has progressed. The initial sign of a painful fissure under a toe may not be defining, but the progressive constriction at the base of the toe with distal edema is diagnostic of ainhum. The toe may become rotated, clawed, and dorsiflexed at the metatarsophalangeal joint. Ultimately, before the toe is shed, it may be attached by an increasingly slender thread of fibrous tissue.

The clinical, histologic, and radiographic appearances in pseudoainhum are similar or identical to true ainhum.



In 1952, Wells and Robinson[7] proposed 4 distinct sources of annular constrictions of the digits. The sources include (1) annular scarring from frostbite, burns, or trauma, (2) true ainhum, (3) constricting bands that simulate ainhum, and (4) congenital bands.

The exact etiology of true ainhum is unclear. Race and climate apparently are predisposing factors. Ainhum also may have a genetic component, since ainhum has been reported to occur within families. Infection and walking barefoot in childhood are linked to ainhum but probably are not major factors in its development. Abnormal scarring does not appear to be a cause; ainhum and keloid formation rarely occur in the same individual.

Contributor Information and Disclosures

Samuel T Selden, MD Assistant Professor Department of Dermatology Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Samuel T Selden, MD is a member of the following medical societies: American Academy of Dermatology, International Society of Geriatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.


Smeena Khan, MD Private Practice, Adult and Pediatric Dermatology Associates

Smeena Khan, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

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Ainhum of the finger. Courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
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