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When "sausage-like" swelling of the toes occurs in the absence of clinical Reiter's disease or psoriasis, definite classification is hardly possible. Nine patients with isolated "sausage toes" (dactylitis) and minor involvement of other joints are described. The relationship between this syndrome and HLA B27 permits better classification and more rational treatment.
53 patients underwent 68 Swanson's Silastic prosthesis implantations in great toes from 1979-1984. 51 patients (96%) with 66 implantats were followed up from 1 to 7 years. The results of self-judgement and clinical examination at control were favourable, in contrast to the large number of unfavourable radiologic findings at control. Statistical analysis revealed a significant association between the number of weared prostheses with narrowing or fragmentation and increasing follow-up time (p = 0.04), but no significant association between the results of self-judgement and clinical examination and follow-up time.
Since 1971, a cartilaginous sesamoid or nodule has been identified in the plantar ligament of the interphalangeal joint of the big toe in 29 of the 58 patients (50%) from whom spurs of the plantar medical aspect of the adjacent phalanges were removed because of painful callouses. It is felt that the firm mass of the cartilaginous sesamoid may have contributed to the callous formation in many cases. These cartilaginous sesamoids have all been removed when found.
The proximal interphalangeal joint (PIPJ) has always been considered as a low-motion joint with an almost constant angle during loading of the limb. Until very recently, its motion was not taken into account in kinematic studies in vivo. Recent in vivo studies yielded surprisingly high ranges of motion in this joint. The aim of this study was to measure, in terms of the 3 possible rotations (flexion/extension, collateromotion and axial rotation), the movements of the PIPJ in vitro during limb loading in a neutral position (500-6000 N) and after the addition of heel and toe wedges (6 degrees and 12 degrees). The joint coordinate system, as it was recently described for use in the horse, was used to compute the 3 components of rotation. With the hoof in neutral position, low-amplitude flexion movements (7.9 degrees) were observed. They were not associated with collateromotion or axial rotation. The flexion of the joint increased exponentially with load suggesting that, during the midstance phase, heavy loads are necessary to evoke substantial flexion. Raising the heels induced an early flexion of the joint with an increase of its total amplitude. Raising the toe produced an extension at 500 N, beyond which the amount of flexion was reduced. These results show that PIPJ flexion/extension during in vitro loading remains substantially smaller than suggested by in vivo studies based on skin markers. Raising the toe or heel directly affects the behaviour of this joint, but does not induce motion outside the sagittal plane. Hoof wedges are commonly used in clinical practice for purposes other than affecting PIPJ motion. In these cases, their biomechanical effects on this joint should be taken into account.
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Radiologic changes in the temporomandibular joint (TMJ) and in the joints of the hand and foot were recorded for 90 adult patients with rheumatoid arthritis. The severity of the changes was graded according to the Larsen classification of six grades (O to V), and mainly erosive changes were recorded. The assessment of the radiographs was performed with the aid of reference films. The radiologic changes in the TMJs corresponded to grade II (definite early abnormality) and paralleled those of most of the metacarpophalangeal and metatarsophalangeal joints. The most severe changes were localized to the wrists, with a median grade of III (moderate destructive abnormality). The severity of the changes was similar on the right and left sides of the TMJ. We conclude that TMJ involvement in patients with rheumatoid arthritis is severe and warrants a thorough initial clinical examination. Such a strategy will facilitate the diagnosis and treatment of TMJ changes in the early stages of the disease.
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The successful free microvascular transplantation to the hand of a second metatarsal phalangeal joint with associated epiphyses is described, with follow-up data 2 1/2 years later indicating epiphyseal growth.
Nine vascularized autogenous whole joint transfers were employed in the reconstruction of traumatized joints of six male patients ages 6 to 38 years. The proximal interphalangeal joint was involved in four patients, the thumb metacarpophalangeal (MP) joint in two, and the small finger MP joint in one. In five patients, the donor joint came from the foot, and in one patient an MP joint was transferred from a digit that had sustained a more distal amputation. The mean follow-up was 24 months (range 13 to 38). Bony union as well as full radiographic preservation of the articular space has occurred in each case. Four joints were transferred with an open epiphysis and three demonstrated longitudinal growth and an intact epiphyseal plate. The mean range of active motion was 22 degrees/55 degrees. We believe the early results demonstrate the feasibility of this method of joint reconstruction in the young patient.
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This is the first report of combined digital distraction lengthening followed by free vascularized metatarsophalangeal joint transfer. This restored mobility, stability, length, and growth potential in the ring finger of the mutilated hand in a child.
Digital surgery is commonplace for foot and ankle surgeons. The techniques of arthrodesis are more exacting and complex than techniques of arthroplasty. They are generally performed in cases of more severe deformity or underlying biomechanical abnormalities, which strongly influence the development and propagation of the deformity. When performed properly in a patient with good compliance, the results are consistently good and rewarding to patients and surgeons. Attention to detail cannot be overemphasized in managing digital deformities. Failure to do so is likely to result in a less than satisfactory outcome for physician and patient. Traditional techniques are proven effective approaches. Meticulous attention to detail and precise execution of the procedure will minimize complications. The exact role of newer implants for fusion is yet to be determined. Further short-term and long-term experience will determine their role in foot surgery.
The purpose of this article is to discuss the static mechanics of the foot and ankle. First, the motions of the ankle and foot available during nonambulatory activities are described by reviewing the literature discussing the axes of motion for the ankle and joints of the foot. Conflicting terminology is presented and clarified, and a scheme for a reasonable terminology is presented. The role of the ankle-foot complex in closed and open kinetic chains is also discussed. Terminology describing structural and functional positions of the foot is presented, including definitions of the subtalar neutral position. A systematic format of terminology is offered to reduce the current inconsistencies. Finally, the weight-bearing area of the foot and muscle activity in quiet standing are reviewed.
Four cases of unilateral temporomandibular (TM) joint ankylosis were successfully treated by metatarsophalangeal to TM joint replacement by microvascular technique. Results 6 to 20 months postoperatively were encouraging. Further follow-up studies are necessary to evaluate the long-term results.
A rare panmetatarsophalangeal dislocation of the foot in a young male is described. Hyperflexion was instrumental in causing this injury. The dislocation was in the plantar direction.
The purpose of this study was to quantify small amplitude rotational movements in the metacarpophalangeal joint (MPJ) of the horse and to measure the influence of asymmetric placement of the foot on these articular angles. Trihedrons, supporting kinematic markers defining a local frame, were screwed into the third metacarpal bone and the proximal phalanx of 4 isolated forelimbs. The limbs were loaded in a press, and the lateral or medial aspects of the foot were raised alternately by a 12 degrees wedge. The use of the joint coordinate system permitted the simultaneous and continuous computing of the 3 angles of rotation of the joint. During neutral loading, the extension of the MPJ (38.4 +/- 8.7 degrees) was associated with lateral axial rotation of the proximal phalanx (1.8 +/- 0.9 degrees). Addition of a lateral wedge induced medial rotation (-0.9 +/- 0.2 degree) and abduction (2.1 +/- 0.4 degrees) of the proximal phalanx. The opposite phenomenon was observed with a medial wedge. These quantitative results confirmed the combination of axial rotation and widening of the articular space on the opposite side to the raised part of the foot that had earlier been observed in semi-quantitative studies. Despite the high congruence of this joint, this study demonstrated the significant influence of uneven bearing of the foot on the three-dimensional (3-D) behaviour of the MPJ. Even though the amplitude of these movements remained small, their biomechanical effects should be considered to improve our understanding of MPJ injuries and to rationalise exercise management and corrective shoeing in the lame horse.