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PubMed2006

The ACC synthase TOE sequence is required for interaction with ETO1 family proteins and destabilization of target proteins.

The Arabidopsis ETO1 protein is a negative regulator of ethylene biosynthesis. It specifically inhibits the enzyme activity of type 2 1-aminocyclopropane-1-carboxylate synthases (ACC synthases or ACS) and promotes their degradation by a proteasome-dependent pathway. To further understand the function of the ETO1 family in the plant kingdom, we cloned a cDNA of LeEOL1 (Lycopersicon esculentum ETO 1- LIKE 1), an ETO1 homolog from tomato. LeEOL1 encodes a putative protein with domain architecture conserved in the Arabidopsis ETO1/EOL1/EOL2 proteins and in the predicted rice EOL proteins. LeEOL1 is expressed in leaf, stem, root, flower, and the full ripe stage of fruit, suggesting diverse regulatory roles in the development of tomato. Yeast two-hybrid analysis revealed specific interactions between LeEOL1 and type 2 ACC synthases. When the C-terminal 14 amino acids (TOE; target of ETO1) of LE-ACS3 specific to type 2 ACC synthases were fused to a type 1 ACS, LE-ACS2, at the corresponding position, it allowed LE-ACS2 to strongly interact with LeEOL1. A GFP-TOE(LE-ACS3) fusion protein expressed in rice calli and in the roots of wild-type Arabidopsis showed reduced stability compared to native GFP. However, the fluorescence of GFP-TOE(LE-ACS3) was comparable to that of the native GFP in Arabidopsis eto1-4 mutant. Furthermore, MG132 treatment significantly enhanced the fluorescence of GFP-TOE(LE-ACS3) in the roots of wild-type Arabidopsis. These results suggest that the ETO1-family-mediated ACS protein degradation pathway is conserved in both monocots and dicots, and that TOE acts as a protein destabilization signal recognized by the ETO1 protein family.

Amino Acid Sequence↗
PubMed1998

Increasing obstacle height and decreasing toe-obstacle distance affect the joint moments of the stance limb differently when stepping over an obstacle.

Foot placement during gait is important in regulating the dynamics of the joints of the supporting limb and in maintaining balance of the whole body. We hypothesized that increasing obstacle height and decreasing toe-obstacle distance (distance between the trailing foot and the obstacle during stance of the trailing foot just prior to stepping over the obstacle) would affect the joint moments of the stance limb differently when stepping over an obstacle. A total of 14 healthy young adults stepped over an obstacle 51, 102, 153, and 204 mm in height in a self-selected manner (i.e. toe-obstacle distance was not controlled) and for toe-obstacle distance targets of 10, 20, 30, and 40% of their step lengths measured during unobstructed gait. The adduction and internal rotation moments at the ankle joint increased as toe-obstacle distance decreased. The adduction and internal rotation moments at the hip joint during early stance, the internal rotation moment at the knee joint during late stance, and the dorsiflexion moment at the ankle joint during late stance increased with obstacle height. Reductions in toe-obstacle distance had greater effects on the moments of the ankle joint, and increases in obstacle height had greater effects on the moments of the hip joint. These greater demands on joint moments may affect the abilities of those elderly having decreased muscle strengths to safely step over obstacles. Copyright 1998 Elsevier Science B.V.

Journal Article↗
PubMed2006

Post-traumatic big toe reconstruction using free flaps.

The big toe is of great importance for good stability and gait, but few reports have documented reconstruction of big toe defects. In this study, seven male patients, aged 17 to 59 years at surgery (average: 35 years), were treated for big toe defects. The metatarsophalangeal (MTP) joints of the big toe were intact in all patients. Five patients were treated with free peroneal flaps (including one perforator flap), and two with free scapular flaps; flap sizes ranged from 9 x 4 to 24 x 6 cm. Follow-up periods ranged from 10 to 29 months, (average: 16.6 months). The iliac was used as the grafted bone in four patients and the scapula in one. Six flaps survived completely, and bone unions were achieved within 3 months. One flap became partially necrotic due to arterial thrombosis. All patients returned to their original jobs, and the cosmetic appearances of all toes were acceptable.

Adolescent↗
PubMed2004

Characteristics of triple and quadruple toe-loops performed during the Salt Lake City 2002 Winter Olympics.

The purpose of this study was to compare triple (T) and quadruple (Q) toe-loop figure skating jumps and quantify basic characteristics of these jumps to provide information to coaches that will assist them in teaching quadruple toe-loops to elite figure skaters. High-speed video was taken during men's practice and competition sessions at the 2002 Salt Lake City Winter Olympics; three-dimensional analyses of selected triple and quadruple jumps were completed. The most significant difference between triple and quadruple toe-loops was an increase in rotational velocity in the air. Additionally, increased vertical velocity at take-off and subsequent time in the air were also observed. Three main conclusions were developed: 1) The timing of rotation of the hips and shoulders was different for quadruple toe-loops compared to triples with the differences being observed before toe-pick; 2) Increases in rotational velocity occurred primarily as a result of the skaters assuming different body positions from take-off through landing which resulted in tighter rotating positions for longer durations of the jump; 3) Greater vertical velocity was gained during the propulsive phase due to the extension of the legs during the press off the ice.

Adult↗
PubMed2001

Efficacy of itraconazole, terbinafine, fluconazole, griseofulvin and ketoconazole in the treatment of Scopulariopsis brevicaulis causing onychomycosis of the toes.

BACKGROUND: Scopulariopsis brevicaulis is a common non-dermatophyte mould that can cause onychomycosis. OBJECTIVE: To evaluate the efficacy and safety of the oral antifungal agents griseofulvin, ketoconazole, itraconazole, fluconazole and terbinafine in the treatment of S. brevicaulis. PATIENTS AND METHODS: In a prospective, comparative, parallel-group, single-blinded, randomized, non-industry-sponsored study, patients with toe onychomycosis caused by S. brevicaulis sp. were randomized and treated with one of 5 oral antifungal agents, i.e. griseofulvin, ketoconazole, itraconazole (pulse), fluconazole or terbinafine. The treatment regimens were: griseofulvin 600 mg twice daily for 12 months, ketoconazole 200 mg daily for 4 months, itraconazole pulse therapy given for 3 pulses, with each pulse consisting of 200 mg twice daily for 1 week with 3 weeks off between successive pulses, terbinafine 250 mg daily for 12 weeks and fluconazole 150 mg daily for 12 weeks. RESULTS: There were 59 patients (48 males, 11 females, mean age 35.6 years, range 25-53 years). All patients had clinical evidence of distal and lateral onychomycosis, with moderate to severe disease of the target nail. Between the treatment groups there was no significant difference in the mean age of the patients or the mean area of involvement with onychomycosis at baseline. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was: griseofulvin, CC 3/11, MC 0/11, CC + MC 0/11; ketoconazole, CC 10/12, MC 8/12, CC + MC 8/12; itraconazole, CC 12/12, MC 12/12, CC + MC 12/12; terbinafine, CC 12/12, MC 11/12, CC + MC 11/12, and fluconazole, CC 8/12, MC 8/12, CC + MC 8/12. Adverse effects consisted of: griseofulvin, gastro-intestinal symptoms, allergic reaction, photodermatitis, hepatic and renal dysfunction in 11 patients with discontinuation of treatment in 3 patients; ketoconazole, hepatic dysfunction but no symptomatic changes in 2 patients; itraconazole, nausea and vomiting in 2 patients; terbinafine, taste disturbance in 2 patients, nausea in 3 patients, and fluconazole, severe gastro-intestinal events in 5 patients. None of the patients receiving ketoconazole, itraconazole, terbinafine or fluconazole discontinued treatment. CONCLUSIONS: Itraconazole and terbinafine demonstrate efficacy against some cases of S. brevicaulis toe onychomycosis. These agents also appear to be safe in the course of therapy for toe onychomycosis. Griseofulvin is ineffective against toe onychomycosis caused by S. brevicaulis. Ketoconazole is not recommended for toe onychomycosis given its potential for adverse effects, particularly with the availability of the newer antifungal agents.

Adult↗
PubMed1992

Great toe metatarsophalangeal joint arthrodesis: a user-friendly technique.

Thirty-four feet (23 patients) were treated with a metatarsophalangeal (MP) joint fusion of the hallux using five threaded 0.062-in K wires for fixation. Operations were done for the following diagnoses: rheumatoid arthritis (26 procedures), hallux rigidus (1), salvage of previous bunionectomies (3), hallux valgus with absent toe, bilateral fusion (2), severe hallux valgus with chronic MP joint synovitis (1), and congenital hallux varus (1). The ages ranged from 17 to 73 years, with an average of 55 years. Follow-up was available on 31 of the fusions by questionnaire and telephone contact, with an average follow-up of 24 months and a minimum of 1 year. The successful arthrodesis rate was 97%. In 9% of the procedures (three cases), the patients were dissatisfied: This was due to pain under the first metatarsal head in two cases and to impingement between the first and second toes in a third case. In 91% of the fusions (29 of 32 patient responses), the patients stated that they would have the surgery if they had to choose again. Patients indicated "complete satisfaction" in 15 fusions and "satisfaction with reservations" in 14. Patients felt that their ability to wear desired shoes was improved in 48% of the procedures, was unchanged by the fusions in 26%, and was worse than before the operation in 26%. Based on this study and review of the literature, a recommendation is made for fusing the rheumatoid hallux with 25 degrees to 30 degrees of valgus and 10 degrees of extension. In general, selection of toe position for fusion is based on reducing stress on the hallux interphalangeal joint and accommodating the position of the second toe. The multiple pin fixation technique gives a high incidence of fusion, it is easy to perform, and it is adaptable to the varying requirements for toe position.

Adolescent↗
PubMed1994

The plantar plate of the lesser toes: an anatomical study in human cadavers.

The purpose of this study was to evaluate the anatomic structure and biochemical composition of the plantar plate of the lesser toes. Fresh frozen-human cadaveric feet were used to study 20 metatarsophalangeal and proximal interphalangeal plantar plates. The observations of foot dissections were compared with the finger volar plate. The plantar plate of the toe is a rectangular structure with a stout distal insertion and relatively flimsy proximal origin. The anatomic relationships to adjacent structures and composition are similar between the volar plates of the fingers and plantar plates of the toes. The plantar plate is known to experience extension forces that the volar plate does not experience. The weightbearing nature of the foot and forces imposed by toe-off may create chronic hyperextension of the metatarsophalangeal joint and predispose the plantar plate to attenuation or rupture, thus leading to instability of the metatarsophalangeal joint. These findings may explain in part the clinical condition of spontaneous metatarsophalangeal joint dislocation, most commonly found in the second toe.

Collateral Ligaments↗
PubMed1997

Possible interaction between vibration thresholds by sex and motor dominance in the index finger and big toe.

Two studies suggest a possible interaction among sex, motor dominance, and vibrotactile threshold for the great toe and index finger. In study 1 a forced-choice procedure with the Vibratron II (Physitemp Instruments, Inc.) was used; a significant interaction between sex and foot dominance for vibratory threshold was noted with no main effects for the great toe. The greatest difference between men and women was on the nondominant side on the foot. Study 2 replicated Study 1 using the index finger as well as the great toe and used the Semmes. Weinstein monofilament test for a cross-modal comparison. A method of limits procedure was used to increase the generalizability of the data. A similar interaction was found between sex and motor dominance for the index finger but not the great toe. This was attributed to skewing of data for the toe. No effects were found for the Semmes-Weinstein test. Possible usefulness in detecting neuropathies is considered. Larger normative studies including variables such as age, height, and weight are required for generalizable conclusions.

Adolescent↗
PubMed1982

Persistent toe-walking in children. A comprehensive clinical study of 28 cases.

In 28 children with persistent toe-walking, in whom no etiologic diagnosis was evident from the beginning, we have studied peri- and postnatal history, details of locomotor development and the evolution of the symptom (toe-walking). A detailed neurological and orthopaedic examination was performed. Four main groups could be identified: 1. minimal spastic diplegia (5 children), 2. habitual toe-walking (9 children), 3. congenital short tendo calcaneus (4 children), 4. mixed or unclassified (10 children). A detailed reevaluation of this latter group has enabled us to reclassify them in one of the three major categories even if in certain cases several factors seemed to play a role in the toe-walking. Diagnostic criteria, the evolution and consequences of the symptom, and the familial aspect are discussed. Regarding habitual toe-walking, the history of pre-walking locomotor development, the characteristics of behaviour and the knowledge of normal development of independent gait do not offer a general explanation for this particular motor behaviour.

Adolescent↗
PubMed1990

Proximal toe phalanx transplantation for bony stabilization and lengthening of partially aplastic digits.

In congenital malformations the lengthening of partially aplastic digits, by on-top plasty of a bone graft or the bony stabilization of finger stumps consisting of soft tissues without skeletal elements, is extremely difficult. The usual bone graft, taken from the iliac crest or the fibula, will undergo resorption and will have disappeared a few months postoperatively. Experience has shown that the proximal toe phalanx will with-stand any resorption if it is taken whole, covered by its periosteum. Another advantage is the possibility of the construction of a new joint between the metatarsophalangeal articular surface of the toe phalanx and the distal end of the recipient bone in the hand, which is usually covered by cartilage. Flexor and extensor tendons exist in most cases. Between 1976 and 1988, 69 transplantations of proximal toe phalanges were performed in 43 children. The indications were: boneless digital stumps or partial absence of digits in symbrachydactyly and ring constriction syndrome. Follow-up examinations of 40 patients with 63 transplanted phalanges at an interval of 36 months (12 to 160 months) has shown a 100% take of the bone graft provided it had not been split and the periosteum was undamaged. The earlier in life the operation was performed, the more postoperative growth was recorded. A joint construction was attempted in 46 digits with variable results; active mobility ranged from 0 degrees to 90 degrees. With the use of a tendon interposition, there is a less degree of shortening of the toes.

Adolescent↗
PubMed1996

Free vascularized transfer of the metatarsophalangeal and proximal interphalangeal joints of the second toe for reconstruction of the metacarpophalangeal joints of the thumb and index finger using a single vascular pedicle.

Previously described double-joint transfers from a single toe have required a separate vascular pedicle for each joint transferred. In this case report, however, we describe the use of a single vascular pedicle to perform a free vascularized double-joint transfer of the metatarsophalangeal and proximal interphalangeal joints of a single toe to the metacarpophalangeal joints of the thumb and index finger. Although a pollicization could have restored adequate function to the patient's hand, she desired five digits. Given the increased distance between the metacarpophalangeal joints of the thumb and index finger, an increased interjoint pedicle length was needed. We obtained this by mobilizing the digital vessels away from the joints of the second toe. This involved transecting the tibial digital vascular branches of the proximal interphalangeal joint and the fibular vascular branches of the metatarsophalangeal joint. Based on a single pedicle, the vascularity of the proximal interphalangeal joint was maintained by preserving the distal commissural vessels at the distal phalanx. Advantages of this technique include using a single donor artery and reconstruction of two metacarpal joints with a single toe.

Adult↗
PubMed2005

Removal of the second toe for severe hammertoe deformity in elderly patients.

BACKGROUND: Our hypothesis was that amputation of an isolated, painful second hammertoe is beneficial and has less morbidity than forefoot reconstruction when other associated deformities are not clinically painful. The objective was to evaluate the clinical outcomes of elderly patients undergoing amputation of painful second hammertoes instead of advanced reconstructive procedures. METHODS: We retrospectively reviewed all cases of removal of the second toe through the MTP joint for painful hammertoe deformities from May, 1998 to May 2004. Amputation for ischemic disease was excluded from the study. No patient had a concurrent hallux valgus reconstruction. The study group included 12 patients (17 amputations). A clinical questionnaire was used to determine patient satisfaction and postoperative changes in forefoot alignment. RESULTS: Ten patients were satisfied with the results, and the other two were satisfied with reservations. The activity level improved for nine patients. Eight patients noted continued valgus drift of the great toe. Nine patients would have the procedure again, and 11 thought that it met their expectations and would recommend it. No important complications were noted. CONCLUSIONS: Amputation of the second toe in elderly patients is acceptable for complaints of pain related solely to the hammertoe. The morbidity associated with more advanced reconstruction is avoided, while eliminating pain and improving shoe-wear and function. Patient satisfaction was high, and complications were minimal. Drift of the great toe into valgus did not appear to be a clinical problem.

Aged↗
PubMed1978

Great toe to hand free tissue transfer.

Thumb reconstruction is a complex subject and the method selected for each patient deserves individual consideration. The method of free toe-to-hand transfer for thumb replacement should be chosen only when the surgeon is familiar with all alternative methods of thumb reconstruction and feels that this technique represents the most reasonable method available. For the surgeon a clear understanding of the anatomic similarities and differences between the normal thumb and great toe are mandatory. In well selected adults and children the failure rate for free toe-to-hand transfer should be very small. The advantages of a single staged thumb replacement from tissue of similar character and quality without local tissue sacrifice are tremendous. With improvement in techniques, experience and case selectiion, much free tissue transfers will actively compete with well established methods of thumb reconstruction. Surely the free toe-to-hand transfer for thumb replacement of today is a forerunner of thumb and hand transplantation of tomorrow.

Adult↗
PubMed1996

Painful legs and moving toes associates with tarsal tunnel syndrome and accessory soleus muscle.

Painful legs, moving toes is a rare syndrome characterized by leg pain and uncontrolled toe movements. We present a 35-year-old man with a 1-year history of unilateral knee, calf, and medial ankle pain with spontaneous movements of second through fifth toes. Electrodiagnostic studies showed an absent lateral plantar nerve response consistent with a tarsal tunnel entrapment neuropathy. Cine magnetic resonance imaging revealed a large accessory soleus muscle compressing the flexor hallucis longus in the tarsal tunnel of the affected extremity. Lidocaine block of the tibial nerve at the popliteal fossa did not stop these movements, but blockade of the medial and lateral plantar nerves distal to the medial malleolus stopped them temporarily. Treatment with foot orthotics and cessation of running activity decreased the symptoms. We conclude that painful leg and moving toes in this patient resulted from a compression neuropathy at the tarsal tunnel possibly caused by a large adjacent accessory soleus muscle.

Adult↗
PubMed1986

Free peroneal flap coverage of the great toe defect resulting from a wrap-around flap transfer.

In thumb reconstruction, the wrap-around free flap from the great toe with distal terminal phalanx attached gives a better replica of a thumb esthetically and functionally and has many advantages. However, there are problems in the great toe, such as delayed wound healing, pain caused by long-time walking, ulceration, and skin erosion. We closed the skin defect of the great toe with a free peroneal flap in seven cases. In all cases of both the wrap-around flap and peroneal flap complete healing was obtained after the operation without trouble. The donor great toe causes no significant morbidity.

Adult↗
PubMed1995

Recovery of sensation and somatosensory evoked potentials following toe-to-digit transplantation in man.

Recovery of digital nerve function in 21 patients with toe-to-digit transplantation was evaluated by clinical sensory tests and somatosensory evoked potentials (SEPs) to median and digital nerve stimulation. The mean interval between injury and surgery was 7 months, and that between surgery and study was 31 months. The transplanted toes achieved a satisfactory but incomplete recovery in temperature (warm and cold), pinprick, touch, vibration, and two-point discrimination in that order. The overall sensory status of the transplanted toes appeared to be closer to normal toes than to normal fingers. In SEPs from the transplanted side, median N9, N13, and N20 components had normal latency but reduced amplitude, whereas digital N9 component was usually absent, but N13 and N20 components had prolonged latency and reduced amplitude. Transplantation performed within 1 month after injury prevented amplitude reduction in median SEPs and latency prolongation in digital SEPs. The SEP data suggest that timing of surgery was critical in preventing retrograde effect on the median nerve, and that recovery of digital nerve function was incomplete correlating with clinical sensory findings.

Adolescent↗
PubMed1995

Conduction study of digital nerve function recovery following toe-to-digit transplantation and a comparison with digit-to-digit replantation.

Recovery of digital nerve function following toe-to-digit transplantation was studied by nerve conduction in 16 patients, and a comparison was made with digit-to-digit replantation in 7 patients. For toe transplantation and digit replantation, the mean interval between injury and surgery was 7 months and 8 h, respectively, while the mean interval between surgery and study was 39 months and 25 months, respectively. Sensory nerve action potentials (NAPs) from digital nerve stimulation were recorded at the wrist and the elbow, whereas mixed NAPs from median nerve stimulation at the wrist were recorded at the elbow. Sensory NAPs from stimulation of the transplanted toe were detectable in 14 patients and showed reduced amplitude, prolonged latency, and slowed conduction velocity. There was retrograde amplitude reduction in the median nerve and in the proximal segment of the digital nerve. Sensory NAPs from the replanted digit were not different from those of the normal digit, nor was a retrograde effect observed. The present data indicate that digital nerve function recovery was incomplete in toe transplantation and nearly complete in digit replantation. The reasons for the differences in recovery following two types of nerve repair are discussed.

Action Potentials↗
PubMed1983

Magnetic fields of the human brain (Bereitschaftsmagnetfeld) preceding voluntary foot and toe movements.

Voluntary movements are preceded by a slow electrical potential of the brain (Bereitschafts-potential, BP) or readiness potential. The BP is accompanied by a magnetic field shift of similar time characteristics (Bereitschaftsmagnetfeld, BM). The BM preceding volitional right foot or toe movements was recorded from anterior, posterior, and lateral positions of the scalp using a SQUID (Superconducting Quantum Interference Device) third-order gradiometer. Controls were implemented to reduce head movements, which were simultaneously recorded with a mechanograph. The results showed that movements of the lower extremities are also preceded by a BM. However, contrary to finger movements, BMs with field lines directed into the head were found predominantly for foot movements and exclusively for toe movements. The BM preceding foot movements was maximum over a position 2 cm left of the vertex, i.e., contralateral to the movement. Two centimeters right of the vertex it was smaller, thus exhibiting a normal contralateral preponderance and not sharing the paradoxical side preponderance of the electrical BP preceding foot or toe movements. The BM preceding toe movements was only apparent at the vertex and was smaller than the one preceding foot movement. This may suggest a source that is located still deeper in the brain than with foot movements.

Brain↗