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Chapter 37

Ainhum

Why should any toe amputate itself? Ainhum is a puzzling affliction of the toes (usually the fifth and often bilateral) occurring primarily in middle-aged blacks who are usually otherwise healthy. It was first mentioned by Clarke in Ghana in 1860, and then da Silva Lima in Brazil described the disease in detail in 1867. Wucherer gave this unusual disease its name in 1872, using terminology either of Nigerian (Yoruba) derivation (i.e., a saw or file) or of Brazilian origin (i.e., a fissure).

Synonyms

Ainhum. Dactylolysis spontanea. Serrar or quijila (Brazil). Banko-kerende (Sudan). Maxacata (Xhosa, South Africa). Sp: Ainhum. Dactilolisis espontanea. Fr: Ainhum. Ger: Ainhum. Absagen.

Definition

Ainhum consists of a deep, painful, constricting groove that gradually encircles the base of a toe, often leading to auto-amputation. It occurs rarely in the fingers. The etiology is unknown.

Geographic Distribution

Ainhum occurs predominantly in black Africans and their descendants in North and South America, Panama and the West Indies; a few cases have been reported from India, and also in Polynesians. It is especially common in adult males but occurs over the age of 6 years in both sexes. It is found most frequently in West Africa, where a rate of 2.2% was noted in Ibadan, Nigeria, among 1,000 randomly chosen outpatients. By contrast, a survey in the northern Democratic Republic of Congo (formerly Zaire) showed a rate of 0.2% in 45,000 persons examined. The condition is reported to be relatively common also in Sierra Leone, Ghana, Niger, Uganda, Zambia, Zimbabwe, and South Africa, especially in the Transkei and the Johannesburg area. In 1967, Fetterman reported 13 cases in blacks from Louisiana and Alabama and there have been other scattered reports of ainhum from the southern United States.

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