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At least 307 records · Page 17Linked to original sources
PubMed2004

Effect of botulinum toxin type A on gait of children who are idiopathic toe-walkers.

The purpose of this study was to determine the effects of botulinum toxin type A treatment on ankle muscle activity during gait of children who are idiopathic toe-walkers. Five children who were idiopathic toe-walkers with a mean age was 4.34 years participated. Gait of the subjects was evaluated prior to, 20 days following, and 12 months following bilateral botulinum toxin type A injection of the gastrocnemius and soleus muscles. Subjects received physical therapy following the 20-day evaluation. Dependent variables were type of foot contact pattern and duration of swing-phase tibialis anterior activity and onset of stance-phase gastrocnemius relative to ground contact. Prior to treatment 51% of foot contacts were with the toe (heel just off the ground) or were digitigrade, while the remaining contacts were flat foot or heel strike. At approximately 20 days following treatment, only 8% of foot contacts were toe contact or digitigrade. Prior to treatment, mean gastrocnemius onset was 30 ms prior to foot contact and the duration of swing-phase tibialis anterior was only 345 ms. Following treatment (and a more normal foot contact pattern), mean gastrocnemius onset followed ground contact by 36 ms and tibialis anterior duration increased through terminal swing and into the loading response. The posttreatment improvement was maintained at 12-month follow-up. It appears that botulinum toxin type A treatment normalizes the ankle EMG pattern during gait and a more normal foot-strike pattern is obtained. These data are discussed in terms of a neuromotor rationale for the rehabilitation of children who are idiopathic toe-walkers to maintain posttreatment improvements.

Botulinum Toxins, Type A↗
PubMed2004

Turf toe: ligamentous injury of the first metatarsophalangeal joint.

Injuries to the metatarsophalangeal (MTP) joint of the great toe have increased in incidence over the past thirty years following the introduction of artificial playing surfaces and the accompanying use of lighter footwear. Although most common in American football players, similar injuries can also occur in other sporting activities including soccer and dance, or following trauma to the great toe. The mechanism of injury is typically hyperextension of the MTP joint, but injuries have also been reported secondary to valgus or varus stress, or rarely as a result of hyperflexion injury. The abnormal forces applied to the first MTP joint at the time of injury, result in varying degrees of sprain or disruption of the supporting soft tissue structures, leading to the injury commonly referred to as turf toe. The extent of soft tissue disruption is influential in treatment planning and can be used to determine the prognosis for recovery. This report will review the anatomy of the first MTP join, followed by a discussion of the mechanism of injury and the typical clinical presentation of an individual with turf toe. Finally, the role of imaging including radiography and magnetic resonance imaging, and standard treatment options for turf toe will be discussed.

Adult↗
PubMed2005

[Decorative repair and reconstruction of subtotal thumb and finger defect with trimmed toe flap transfer].

OBJECTIVE: In partial loss of distal finger segment, a corresponding part of the toe tissue compound is harvested and transplanted for repair or reconstruction. This new procedure gives forth a new concept and is called decorative repair or reconstruction. METHODS: In a series of 77 patients with 88 thumb and/or finger subtotal defects in forms of lateral half, dorsal half or volar half composite tissue defects were reconstructed with lateral nail-skin flap, dorsal skin-nail flap or pulp flap taken from corresponding part of the toes. The blood circulations were re-established by anastomosing digital arteries of the toe transplants and fingers. RESULTS: In this series 75 patients with 78 fingers reconstructed are successful. The overall survival rate is 97.5%. Follow-up examinations made half to 12 years postoperatively showed the fingers are having a normal length, outward appearance and function. There are nails preserved. The pulps are full. Sweating function are present. Two-point-discrimination tests are between 4-6 mm. CONCLUSION: By decorative reconstruction of subtotal dorsal, lateral, or volar halves defect of thumb and/or fingers by transplanting corresponding part of soft tissue taken from the toe has the merit of repair of any parts of tissue loss precisely what is needed. This procedure is better than any traditional toe-to-hand transfer and realizing the exact meaning of decorative reconstruction.

Adolescent↗
PubMed1990

The role of nonvascularized toe phalanx transplantation.

Stabilization of boneless finger stumps or lengthening of partially aplastic digits in congenital malformations is difficult, because the bone graft, placed on top of the existing bone, will undergo resorption. Only the periosteum-covered proximal toe phalanx will withstand resorption and show a complete take. With the toe phalanx, including the plantar plate and the collateral ligaments of the metatarsophalangeal joint as a half-joint, it is possible to construct a new joint with the cartilage-covered distal end of the recipient bone (metacarpal or proximal phalanx) as the proximal half-joint. Flexor and extensor tendons exist in almost all cases. Between 1976 and 1990, 97 toe phalanx transplantations were performed in 57 children. The indications were boneless digital stumps with partial absence of digits and large bone defects in fingers in symbrachydactyly and ring-constriction syndrome. Follow-up examinations of 44 patients with 69 transplanted toe phalanges (95% of the patients operated on by March 1989) have shown a 100% take of the bone graft, provided it had been unsplit and the periosteal cover undamaged. The earlier in life the operation was performed, the more postoperative growth was recorded. The shortening of the donor toe was less because a tendon interposition was used. A joint construction was attempted in 64 digits with variable results. The range of active motion varied between 0 (fusion) and 90 degrees.

Bone Transplantation↗
PubMed1989

Combined second and third toe transfer.

Historically, restoration of hand function following multiple digital amputation has been unsatisfactory. The evolution of digital reconstruction with toe transfer has enabled surgeons to reestablish prehension in these severely injured hands. A 4-year experience with 26 consecutive combined second and third toe transfers to replace missing adjacent fingers was reviewed in order to delineate the indications and technical considerations and to emphasize prevention of donor-site complications. Combined second and third toe transfer is reserved for adjacent finger amputations proximal to the digital web space with remaining fingers no longer than the small finger. Radial amputations are replaced with contralateral combined toe units, while ipsilateral toes are more ideal for ulnar amputations. Limited dorsal and plantar skin flaps extending only to the midpoint of the first and third digital web spaces allow for direct donor-site closure and uncomplicated healing. Maintenance of the plantar metatarsal arch by avoiding metatarsal shaft osteotomies or bone grafting-shortened metatarsals eliminates potential gait disturbances. When properly applied in selected patients, this single-stage microsurgical procedure can restore prehensile function, improve the appearance of the hand with multiple digital amputations, and preserve near-normal donor-foot function.

Adolescent↗
PubMed1985

[Free transplantation of the 2d toe. Technical features, problems and solutions].

On the basis of seven transfers of the second toe and one "en bloc" transfer of the second and third toe, technical features are discussed. The use of a plate for osteosynthesis is proposed. It has been found very useful, particularly when a MP-arthrodesis is performed between the first metacarpal and the second toe. It gives stability and therefore secondary displacement and/or rotation of the toe are avoided. It enables more accurate tension to be placed on the repaired tendons. For the flexor tendons it is suggested to repair the communis longus only, whereas both extensors, longus and brevis, and eventually the distal tendon of the lumbrical muscle should be sutured to avoid a PIP flexion contracture. In one case the revascularisation of the transfer was effected through the dorsalis pedis artery. In the seven other cases the digitalis plantaris communis I artery was used either as a substitute or as a complementary vessel. Under good conditions the repair of only one vein can be sufficient. Collateral plantar nerves as well as dorsal nerves must all be repaired. The use of fibrin glue for their suture is mentioned. A cutaneous defect is frequent on the lateral sides of the transferred toe. It can be first covered with Epigard and secondarily grafted after one or two weeks. That method was used in five out of eight cases.

Adolescent↗
PubMed1985

[Free toe transfer to the forearm stump following wrist amputation--a current alternative to the Krukenberg operation].

A new and simplified technique for reconstruction of the gripping ability after total loss of the hand is introduced. Previous techniques have not gained popularity because of the rather complicated procedures trying to extend the stump with two additional toes. Poor skin in the distal end of the stump has been a limiting factor and technically transplantation of two separate toes has been a difficult procedure. The stability in such a grip may be compromised. In the author's modification only one toe is used with an island flap from the big toe. The opposing post in this grip is the stable resection plane of the radius, covered partly by dorsal sensible skin and partly by the first web space skin with the island flap from the big toe. The stability is good because of the width of the post. The mobility of the new "thumb" may be excellent if the balance between the different muscle transfers is optimal and the rehabilitation is done in an adequate way from the beginning. This is a preliminary report of the technique and the preliminary results in three similarly operated patients are very promising. The technique is introduced especially as a modern alternative to the Krukenberg-plasty and may have its greatest value among blind patients with long forearm stumps.

Adult↗
PubMedDate not supplied

Toe temperature change: a measure of sleep onset?

In an attempt to provide a more "physiological" measure of sleep onset, temperature of the great toe was monitored for 166 sleeper-nights in both insomniac and control groups. All subjects were women between 21 and 45 years of age. Earlier published reports had suggested that toe temperature elevation was the result of lowered sympathetic tone and marked a "vegetative preparedness for sleep." More recently, elevation of the toe temperature has been used to denote a level of chemical anesthesia sufficient for major surgery. In this study, however, the mean latency of the time course of the temperature elevation of the toe was uncorrelated with sleep onset determined by EEG criteria. Temperature elevations were frequently of large magnitude but were not uniformly observed across all subjects and all nights. It is suggested that the toe temperature elevation is reflective of metabolic adjustments which coincide with the onset of the night's first period of slow wave sleep.

Adult↗
PubMed1981

Arteriography before toe to hand free tissue transfer operation.

During the last two years the hand surgeons performed toe to hand transfer operations on eight patients. Preoperative hand and foot arteriography was carried out in all cases. This is important in order to determine which arteries can be used and which toe should be selected for the transfer. The great toe was transplanted in three patients and the second toe in five. In seven cases the operation was successful but in one the transferred second toe was lost. There was no difference between the diameters of the anastomosed arteries in the successful cases and in the failure, but the diameter of the digital artery in the latter was smaller than in the successful cases.

Adolescent↗
PubMed1995

[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↗
PubMed1994

Raynaud's phenomenon of fingers and toes among vibration-exposed patients.

Eleven patients with Raynaud's phenomenon of the toes as well as the fingers were encountered among about 1,000 vibration-exposed patients. They consisted composed of four chain-saw operators, five rock drillers, a stone quarrier and a welder in a shipyard. All the cases were examined carefully for differential diagnosis, but there were no particular abnormalities in hematological, immunological and homodynamic examinations. The rock drillers, quarrier and welder had direct vibration exposure of the foot, which was considered to be responsible for their Raynaud's phenomenon of the toe. Four chain-saw operators, who had been little exposed to vibration of the foot directly, were examined further on skin temperature of fingers and toes every three hours except at night and in a 30-min cold provocation test at 5 degrees C. The skin temperature of both their fingers and toes was lower than in age-matched healthy controls. The chain-saw operators started to work in the 1960's and early in the 1970's, when the chain saw vibration level was high. It is, hence, considered that they were exposed to strong vibration of the hand from chain saws, and then suffered severe Raynaud's phenomenon of both fingers and toes.

Aged↗
PubMed1995

Syndactylic toe transfer for fingertip reconstruction.

In the case of multiple fingertip reconstruction requiring toe transfer, double toes can be elevated in the syndactylic fashion with a single vascular pedicle for transfer, followed by separation a few weeks later. The biggest advantage of this procedure is that the problem of limitation of recipient arteries for multiple toe transfer is solved. We reconstructed fingertips of three patients by this procedure with three variations based on combinations between the wrap-around flap and whole-toe transfer. All three patients survived completely and achieved an aesthetically pleasing result. This report introduces the concept and technique of the syndactylic toe transfer for fingertip reconstruction.

Adult↗
PubMed1994

[Thumb and finger reconstruction by anastomosing the digital arteries of the toe to finger transplant].

In a series of 295 cases of toe-to-finger reconstruction, 30 cases with 40 digits were reconstructed by arterial anastomosis between digital arteries of the toe transplant and the recipient thumb or fingertoe. Among them 5 thumbs were reconstructed by the distal segment of the big toe. 11 thumbs (10 cases), 15 fingers (8 cases) and 1 case with concomitant thumb and 3 fingers were reconstructed by toe transfer. Six cases of thumb pulp defect were also reconstructed by the big toe pulp transfer. The anastomosis of digital arteries instead of dorsalis pedis artery and radial artery and saphenous vein with cephali vein to re-establish circulation is an innovation and has the advantages of simplifying the operative procedure, minimizing operative trauma, reducing operation time, attenuating patients suffering, and obtaining good appearance and function after reconstruction. Besides the operation would not be hindered by anatomical variations of the artery and would reduce blood supply disturbance of the donor foot.

Anastomosis, Surgical↗
PubMed1977

Habitual toe-walkers. A clinical and electromyographic gait analysis.

Six children who were habitual toe-walkers were studied using electromyographic techniques. In the initial gait evaluation, the muscle synergy pattern was found to be abnormal during the toe-toe gait as well as during the heel-toe gait. After treatment with casts, each patient had a normal electromyographic pattern during heel-toe gait.

Child↗
PubMed1996

Incidence of osteoperiostitis of the great toe in psoriatic arthritis.

OBJECTIVE: To assess the incidence of osteoperiostitis of the distal phalanx of the great toe in psoriatic arthritis (PsA). METHODS: One thousand great toes (202 of PsA, 44 of cutaneous psoriasis, 274 of low back pain patients, 296 of rheumatoid arthritis, 136 of spondyloarthropathy, and 48 of connective tissue diseases) were studied for osteoperiostitis of the distal phalanx of the great toe (slight, moderate, or severe), destructive joint lesions of the feet, nail dystrophy, fungal infection, and HLA-B type (patients with PsA). RESULTS: Osteoperiostitis was observed in 92 great toes. Moderate and severe osteoperiostitis were observed only in PsA. Osteoperiostitis was statistically more frequent in PsA (53/202, 26.2%, especially in those with onychosis: 20/41, 48.8%) than in other groups (39/798, 4.9%) (p < 0.01). In PsA, osteoperiostitis was more frequent in patients with nail dystrophy (20/41, 48.8%) than in patients without (33/161, 20.5%) (p < 0.05). Fungal infection of the nail and HLA haplotype were not associated with osteoperiostitis. In patients with PsA, osteoperiostitis was associated with destructive joint lesions of the feet. CONCLUSION: Osteoperiostitis of the distal phalanx of the great toe is an enthesopathy evocative of PsA.

Arthritis, Psoriatic↗
PubMed1997

[Toe tourniquet syndrome].

In two boys aged 4 months and one girl aged 2 months one or two toes were red and oedematous, while in one boy aged 3 weeks one toe had become necrotic. In the first-mentioned three children the affected toes were encircled by a hair, the hair was removed under anaesthesia, after which the children recovered. In the last-mentioned child, amputation through the proximal phalanx was necessary. The toe tourniquet syndrome occurs mainly in infants. Strangulation of the toes by circular foreign material. such as hair or fibre, causes oedema and increasing constriction. Timely treatment is followed by good recovery. Delayed or incomplete treatment can lead to necrosis which may necessitate amputation.

Constriction, Pathologic↗
PubMed1976

Results of phalangectomy of the fifth toe for hammertoe. The Ruiz-Mora procedure.

The Ruiz-Mora procedure has been advocated for the correction of hammertoe deformities and congenital overlapping of the fifth toe, primarily on empirical grounds. This is a review of forty-one such procedures in which the operation was used for correction of a hammertoe deformity of the fifth toe with a painful corn overlying the proximal interphalangeal joint. Twenty-two patients with thirty-one procedures were followed for an average of 3.5 years. All of the patients had complete relief of symptoms and correction of deformity. However, in 23 per cent of the patients a painful prominent head of the fifth metartarsal or a bunionette developed, and in 32 per cent a hammertoe deformity of the adjacent fourth toe developed with a painful corn either over the proximal interphalangeal joint or on the tip of the fourth toe. These problems seem to be related to excessive shortening of the the fifth toe. Less bone resection (resection of only the head and neck of the proximal phalanx) might be preferable and might not lead to these complications.

Adult↗
PubMed1998

The hydrostatic measurement of systolic toe blood pressure: a preliminary validation of the method.

BACKGROUND: The hydrostatic method of measuring systolic toe blood pressure has not been validated. A comparison with established non-invasive methods is presented. PATIENTS AND METHODS: Conventional sphygmomanometry was applied to assess systolic arterial pressure at the ankle and brachial level; systolic arterial toe pressure was assessed by the hydrostatic method. An 8 MHz Doppler probe was used to demonstrate arterial pulsation in brachial, ankle, and toe arteries, respectively. 50 legs of patients with peripheral arterial occlusive disease were studied before and after successful arterial revascularisation. RESULTS: In all legs, ankle pressure and ankle/brachial pressure index (ABPI) increased postoperatively. Hydrostatic toe blood pressure (HSTBP) increased in 96% of cases, in 58% of cases above the upper detection limit of 70 mmHg. HSTBP and sphygmomanometric ankle pressures were significantly correlated (r = 0.754, p < 0.05). CONCLUSION: Successful arterial revascularisation in legs with peripheral arterial occlusive disease was associated with an increase in systolic ankle pressure and ABPI, assessed with sphygmomanometry. Similar changes were observed in systolic toe arterial pressure, assessed with the hydrostatic method. The correlation of the results obtained with both methods can be taken as a preliminary indication of the accuracy of the hydrostatic method, which may be particularly useful in cases of medial arterial calcification.

Adult↗