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Fourteen-year results of a reversed vascularized second metatarsophalangeal joint transfer: a case report.

We report a case of free vascularized, second-toe metatarsophalangeal joint transfer in a 34-year-old manual laborer. The metatarsophalangeal joint of the left second toe was transferred to the metacarpophalangeal joint of the right ring finger in a reversed fashion. Fourteen years after surgery the transferred joint is painless and stable and flexion is 80 degrees with extension lag of 52 degrees without arthritic changes on radiographs.

Adult↗

The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe.

BACKGROUND: The purpose of the study was to evaluate the outcome of flexor digitorum longus (FDL) transfer to the dorsum and to identify a possible continued role for this transfer in conjunction with additional surgeries for second metatarsophalangeal joint (MTPJ) instability. METHODS: We carried out a retrospective analysis on patients with second MTPJ instability for which the FDL transfer was done as the primary procedure between 1996 and 2001. The patients were examined for functional status, residual pain, and satisfaction. RESULTS: A total of 64 feet (59 patients) were evaluated, with an average followup period of 45.2 (16 to 82) months. A cross-over second toe deformity was present in 56 feet (87%) with a stage II deformity being the most common (18 feet). There also were seven feet with vertical subluxation. An additional second metatarsal Weil osteotomy was done in 29 feet (45%), a proximal interphalangeal (PIP) joint resection arthroplasty in 22 feet, and a PIP joint fusion in nine feet. At final followup of the 59 feet that were physically examined, 22 (37%) had residual second MTPJ dorsiflexion contracture and 16 feet had persistent medial deviation. The second toe was stable to stress manipulation in 46 feet (78%). The mean toe pulp to ground distance on standing was 3 mm, and strong toe grasp was possible in 45 feet. There were 20 complications in 64 feet. Twenty-five patients (29 feet) were very satisfied, 15 satisfied with minor reservations, six with major reservation, and 14 patients were unhappy with the outcome. The American Orthopaedic Foot and Ankle Society functional score was on average 82 points (47 to 100) at final followup. CONCLUSION: Although the function of the second toe improved in most patients as a result of pain relief, a substantial number of the patients in this study remained dissatisfied because of residual stiffness of the toe. The flexor tendon transfer remains an important procedure in correction of second toe instability but must be used with a full understanding of potential complications and patient dissatisfaction.

Adult↗

Total contact casting and Keller arthoplasty for diabetic great toe ulceration under the interphalangeal joint.

Interphalangeal (IP) ulcerations of the great toe are frequently encountered in neuropathic diabetic feet. While total contact casting is usually effective as a first line treatment, recalcitrant ulcers continue to present substantial management challenges. The authors retrospectively reviewed the results of Keller arthroplasty employed to accelerate ulcer resolution with total contact casting in fourteen patients with neuropathic ulcers under the great toe interphalangeal (IP) joint that were resistant to casting alone. These data were compared to a group of similar patients whose ulcers were successfully treated by non-operative measures. No operative complications were observed, and all ulcers healed within twenty-four days with no recurrence documented at an average follow-up of 26 weeks. In cases of resistant great toe IP plantar ulcers associated with hallux rigidus that have failed casting trials, this treatment method can be effective.

Adult↗

Total joint replacement in digits of the foot.

Digital deformities present one of the most common entities seen by the podiatric physician today. Surgical correction of these deformities has historically centered upon the "arthroplasty" or phalangeal head resection, but the advent of Silastic implants that replace the interphalangeal joints of the lesser digits may improve the results of revision arthroplasties or severely arthritic joints. This paper will present two types of lesser digital implants that have successfully been used when the proper indications are met.

Humans↗

Residual calcaneovalgus deformity: review of the literature and case study.

The treatment of pediatric deformities is relatively common in the typical foot and ankle practice. Talipes calcaneovalgus deformity represents one of the more prevalent deformities. This postural deformity, which is present at birth, is characterized by marked dorsiflexion and valgus position of the foot in relation to the leg. It is essential that an accurate diagnosis is established early and conservative treatment instituted. In most cases, the deformity is highly responsive to conservative therapy consisting of manipulation and casting. Deformity not identified at birth or soon thereafter, or residual deformity treated later in life, presents a greater challenge to the physician. This paper is intended to provide an overview of the deformity of calcaneovalgus including a discussion of etiology, incidence, clinical and radiographic manifestations, differential diagnosis, and recommended treatment. The authors present an unusual case of residual talipes calcaneovalgus left untreated since birth and the approach to management.

Adolescent↗

Fractures and dislocations of the digits.

Digital trauma is a common, but often underappreciated, entity in podiatric practice. This article outlines the pathomechanics, diagnosis, and treatment of digital fractures and dislocations as well as injuries to the toenail and nailbed.

Fracture Fixation↗

[Free toe transplantation in congenital hand defects].

From 1983 to 1990, 30 free toe transplantations were performed in 30 children suffering from congenital malformations of the hand. Especially the two severe forms of symbrachydactylia presented major indications. In addition to toe transplantation onto the ulnar ray, lengthening of the radial ray was frequently necessary. Whereas 25 transplantations were successful, there were one necrosis and four partial necroses of the toe. In the monodactylous form, all 15 children with successful transplantation showed good and very good functional results. Children suffering from the peromelic form could gain a grip function which could not have been achieved by prosthetic supply alone. The basal joint of the thumb is of major importance since most of the mobility of the two fingers is achieved in this joint. This is true even if the thumb has to be surgically formed. If there is no carpometacarpal joint, a toe transplantation should not be performed since the mobility in the toe joints would be severely limited.

Child↗