|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 2 | Page : 217-218
Ainhum: Rare disease
Gaurav Sali, Iqbal Ali, Gurjit Singh, Ayush Kumar
Department of General Surgery, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||10-Apr-2013|
Department of General Surgery, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sali G, Ali I, Singh G, Kumar A. Ainhum: Rare disease. Med J DY Patil Univ 2013;6:217-8
Ainhum or dactyolysis spontanea is a rare condition of unknown etiology in which a groove or fissure of constricting tissue forms around the proximal end of the 5 th toe.  The term Ainhum is derived from a Nago or Yoruba word meaning "to cut" or "to saw". 
A Brazilian physician, J. F. da Silva Lima, first described and introduced the name Ainhum in 1867. Ainhum is traditionally a disease of middle aged African males accustomed to walking bare foot.  In the tropic and subtropic climates its incidence has been reported as between 0.015% and 2% of the population  Auckland, Ball, and Griffiths stated that disease is unknown in India. 
It was, however, reported by Crombie in Pondicherry  and by Bharucha in Poona  Search of literature does not reveal many reports from India of Ainhum involving only 5 th toe. ,,
We report a case of 35-year-old male who presented with a constriction ring around left 5 th toe of 2 months duration. Local examination revealed a constriction ring at the base of left 5 th toe with distal part of toe appearing bulbous and edematous [Figure 1]. Patient was advised amputation of left 5 th toe which he refused.
|Figure 1: Left fifth toe ainhum showing constriction ring at the proximal end of the toe|
Click here to view
Ainhum usually affects 5 th toe. It may be unilateral but 75% of the cases are bilateral. None of the numerous etiological factors that have been advanced viz. leprosy, syphilis, infections, parasites, annular scleroderma, trophoneurosis, yaws, sickle cell disease, trauma, decreased vascular supply, and impaired sensations have been conclusively proved.
Radiological appearance is that of resorption or osteolysis of bone in the distal and middle phalanges occurring in the outer layer of the cortex of the phalynx producing a tapering effect. 
Diagnosis is simple and clinical. It should not be confused with pseudoainhum, which is of congenital and acquired variety secondary to other conditions.
Disease process cannot be arrested. If patient is symptomatic, amputation is indicated.
Disease caused by constricting bands proceeds slowly and often painfully over many years and, if not treated, eventuating in autoamputaion in severe cases. 
Absence of X-ray of the affected foot is an important limitation of this report. However, it will be useful to draw attention to its occurrence in our country where it is uncommon.
| References|| |
|1.||Jemmott T, Foster AV, Edmonds ME. An unusual cause of ulceration: Ainhum (dactylolysis spontanea). Int Wound J 2007;4:251-4. |
|2.||Castellani A, Chambers AJ. Manual of Tropical Medicine. 3 rd ed. London: Baillière, Tindall and Cox; 1919. |
|3.||Aggarwal ND, Singh H. Ainhum. Report of an atypical case. J Bone Joint Surg Am Br 1963;45-B:376-8. |
|4.||Carvalho N. Ainhum (Dactylolysis Spontanea): A case report. Foot Ankle 2000;6:189-92. |
|5.||Auckland G, Ball J, Griffiths DL. Ainhum. J Bone Joint Surg Am 1957;39-B:513-9. |
|6.||Crombie A. Ainhum. Transactions of Pathological Society of London 1881;32:302. |
|7.||Bharucha KB. Note on a case of ainhum. Indian Med Gaz 1957;52:403. |
|8.||Kandhari K, Manchanda SS. Ainhum and pseudoainhum. Report of three cases. Dermatol Trop Ecol Geogr 1963;2:6-10. |
|9.||Krishnamoorthy KV. Ainhum-a case report. Indian J Lepr 1985;57:396-8. |
|10.||Hunt M, Glucksman EE. Ainhum presenting to the accident and emergency department. Arch Emerg Med 1993;10:324-7. |
|11.||Brodell RT, Helms SE. Ainhum and pseudoainhum. In: Goldsmith LA ,Katz S, Gilchrest B, Parter AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in General Medicine. 8 th ed. vol. 1. New York City: McGraw Hill; 2012. p. 724-6. |