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At least 343 records · Page 19Linked to original sources
PubMed1993

Arteries to the great and second toes based on three-dimensional analysis of 100 cadaveric feet.

Three-dimensional arteriography was used to analyse the arterial supply of the great and second toes of 100 cadaveric feet down to the microsurgical level. This information will aid in successful composite tissue transfers of these toes to the hand. The arterial blood supply of the great toe came principally from the first dorsal metatarsal a. (78%) and the first plantar metatarsal a. (22%), and secondarily from the medial tarsal aa. and the three terminal branches of the medial plantar a. For the second toe, the first dorsal metatarsal a. (78%) and the first plantar metatarsal a. (22%) supplied blood from the medial side, and the second dorsal metatarsal a. (78%) and the second plantar metatarsal a. (22%) supplied blood from the lateral side. Seven arterial patterns were found in the interdigital web space. The so-called general pattern was seen in the first web space in 65% of the feet examined. In the second web space it was found in 85%. The first intermetatarsal space sometimes contained a large artery arising directly from the dorsalis pedis or first proximal perforating a. as well as the first dorsal and first plantar metatarsal arteries. In this space, arterial patterns were classified into 4 types and 9 subtypes based on the origins and proximal courses of these arteries. The so-called standard pattern was found in only 19% of the feet, while an arterial pattern with a common proximal trunk on the plantar side for the first dorsal and first plantar metatarsal aa. was found most frequently (46%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Voluntary toe-walking gait initiation: electromyographical and biomechanical aspects.

This study was carried out to investigate the biomechanical constraints of toe-walking gait initiation and the associated changes in motor program compared to the well documented heel-toe walking gait initiation. Seven healthy subjects volunteered for this study. Gait was initiated on a force platform, at three self-selected speed conditions, from an erect spontaneous posture in the control situation (CS) and from a posture with heels raised in the test situation (TS). Surface electromyographical (EMG) activities of muscles soleus (Sol) and tibialis anterior (TA) were recorded on both limbs. We analysed the consequences of the heel-off posture on EMG patterns and biomechanical activities. Whatever the speed condition, the centre of foot pressure was initially located more ahead of the ankle axis in TS than in CS, with an increased Sol and TA EMG activity. The EMG pattern which expresses the motor program governing gait initiation was modified in TS in comparison to CS and induced adaptations of the anticipatory postural adjustments (APA) that precede toe-off of the stepping limb. A lengthening of the APA duration allowed the subjects in TS to reach a gait velocity similar to the one obtained in CS at the end of the anticipatory movements and also at the end of the first step. In TS, the velocity of the centre of gravity at time of toe-off covaried, as in CS, with CG velocity at the end of the first step, still resulting from TA muscular actions during the APA but also probably from other combined muscular actions.

Adaptation, Physiological↗
PubMed2006

Structural correlates of increased adhesive efficiency with adult size in the toe pads of hylid tree frogs.

Tree frogs are able to climb smooth, vertical substrates using specialised toe pads which adhere via an area-based wet adhesive mechanism. Although the link between pads and arboreality in frogs is well-established, few studies have investigated the influence of morphology on adhesion. Trinidadian tree frogs from the genus Hyla are geometrically similar. There is a tendency towards comparatively reduced mass in larger species, but toe pad area increases as expected with isometry. As adhesion is area-dependent, forces are affected directly by the increase in mass relative to pad area, and there is a decrease in the ability of larger species to adhere to smooth rotation platforms. However, there is an increase in force per unit area that suggests larger species have more efficient toe pads. Toe pad structure is very similar though there are variations in the details of a number of features. Crucially, although differences in morphology appeared small they had demonstrable effects on adhesive efficiency of the pads. Epithelial cell area correlates positively with frog length and adhesive efficiency, related features of cell density and intercellular channel length correlate negatively. These findings are discussed in relation to the different forces involved in the tree frogs' wet adhesive system.

Adaptation, Physiological↗
PubMed1987

Warfarin-related purple toes syndrome and cholesterol microembolization.

The "purple toes syndrome" is a rare complication of oral anticoagulant therapy. Four patients who presented with "purple toes syndrome" several weeks after warfarin therapy was initiated are described. The diagnosis of cholesterol microembolization was made by biopsy in three cases. Malignant hypertension and renal failure developed in two patients who died within three to six months of onset of purple toes. Postmortem examination in one of these patients showed widespread cholesterol microembolization. Renal failure has not developed in the other two patients, who are doing well. These biopsy and autopsy results suggest that the warfarin-related "purple toes syndrome" is due to cholesterol microembolization.

Aged↗
PubMed1986

Cerebral potentials preceding voluntary toe, knee and hip movements and their vectors in human precentral gyrus.

In this study, the brain potentials related to voluntary, self-paced plantarflexions of the left toes, flexion of the right knee and isometric extensions of the left hip were examined in 3 groups of 10 subjects each. In the first half of the foreperiod, the Bereitschaftspotential (BP) or readiness potential for all movements was symmetrically distributed over both hemispheres. For toe and knee movements, an ipsilateral preponderance of the BP developed in the later foreperiod, which was statistically significant for toe movements. For hip movements, BP topography was symmetrical during the entire foreperiod including its second half. Since finger, hand or shoulder movements of previous experiments show a strong contralateral preponderance of the BP, the results are discussed as further support of the hypothesis that the lateralisation of the BP is due to the orientation of the precentral electrical field vector generated by an active source in the MI motor cortex. Thus, part of the somatotopic representation of the human precentral gyrus can be mapped by this non-invasive means: upper limb movements are located on the convexity; toe, foot and knee movements are generated on the mesial cortex between the hemispheres; and hip movements seem to be located at the mantle edge.

Adolescent↗
PubMed1994

Effects of neural blockade and general anesthesia on the laser-Doppler skin blood flow waves recorded from the finger or toe.

Effects of neural blockade and general anesthesia on the basic wave (BW) and the reflex wave (RW) among the laser-Doppler (L-D) skin blood flow waves recorded on the finger or toe were studied in 2 volunteers and 42 patients. The BW was continuous, rhythmic and independent of respiratory movements. The RW, which was induced by a deep inspiration or a snapping sound, was a transient marked reduction in blood flow. The BW was almost flattened and the RW was no longer induced at the finger under complete wrist block (n = 2), or under cervical or upper thoracic epidural anesthesia extended caudally over T7 (n = 2). On the other hand, the BW was still detected with reducing frequency and the RW could be provoked with one exception at the finger on the side with a sympathetic ganglion block at the C6 vertebral level (n = 14). The BW and RW at the toe were retained under lumbar subdural anesthesia (n = 6) as well. However, under the combination of lumbar subdural anesthesia and lower thoracic epidural anesthesia extending rostrally over T4 (n = 6), both the BW and the RW disappeared at the toe. In the course of deepening nitrous oxide/enflurane anesthesia (n = 10), the BW gradually reduced in frequency until it was almost flattened, and it became difficult to provoke the RW. L-D flowmetry of the finger or toe could be a useful clinical measure for detecting the presence or absence of sympathetic function controlling cutaneous vasomotion.

Adult↗
PubMed1993

Composite finger metacarpophalangeal joint reconstruction in combined second and third free toe-to-hand transfers.

Composite metacarpophalangeal joint reconstruction using the toe proximal phalanx and the metacarpal head, with a capsular repair, is an option during free toe transfer procedures for absent fingers. Eleven composite metacarpophalangeal finger joint reconstructions were performed in four patients concurrent with combined second and third toe-to-hand transfer. The average follow-up period was 5 years. Postoperative assessment included range of motion, stability, radiographic changes, and pain. The average range of motion was 52 degrees, average ulnar stress deviation was 14 degrees. No patients complained of pain. Composite metacarpophalangeal joint reconstruction should be considered in free toe-to-hand procedures when metacarpal head articular cartilage is preserved.

Adolescent↗
PubMed2005

The use of the reverse radial fasciosubcutaneous flap to provide soft tissue coverage and a distal recipient artery in a difficult case of toe-to-thumb transfer.

Traumatic amputation of the thumb is a devastating injury. Toe-to-hand [Wei FC, Chen HC, Chuang CC, Chen HT. Microsurgical thumb reconstruction with toe transfer: selection of various techniques. Plast Reconstr Surg 1992;93:345; Wei FC, Tarek AE. Toe-to-hand transfer: current concepts, techniques and research. Clin Plast Surg 1996;23:103] transfer is a sophisticated option for replacing this vital structure, but this challenging procedure, is even more demanding if recipient vessels are difficult to locate, inadequate or even absent. Another frequently encountered difficulty in cases of traumatic thumb amputation is inadequate soft tissue cover in the region of the amputation stump or the first web space. Often this defect or potential defect requires a preliminary tissue transfer procedure, before toe-to-hand transfer can be considered.

Adult↗
PubMed2006

Identification and classification of toe-walkers based on ankle kinematics, using a data-mining method.

A database of 1,736 patients and 2,511 gait analyses was reviewed to identify for trials where the first rocker was absent. A fuzzy c-means algorithm was used to identify sagittal ankle kinematic patterns and three groups were identified. The first showed a progressive dorsiflexion during the stance phase, while the second had a short-lived dorsiflexion, followed by a progressive plantarflexion. The third group exhibited a double bump pattern, moving successively from a short-lived dorsiflexion to a short-lived plantarflexion and then returning to a further short-lived dorsiflexion before ending with plantarflexion until toe-off. The three patterns were linked to different neurological conditions. Myopathy, neuropathy and arthogryposis essentially revealed group 1 patterns, whereas idiopathic toe-walkers mainly displayed group 2 patterns. Cerebral palsy patients, however, were relatively homogeneously distributed amongst the three groups. Able-bodied subjects walking on their toes showed a high proportion of unclassifiable ankle patterns, due to a variable gait whilst toe walking. Despite the variety of neurological conditions included in this meta-analysis repeatable biomechanical patterns appeared that could influence therapeutic management.

Adolescent↗
PubMed2005

Long term follow-up of composite non-vascularized toe phalanx transfers for aphalangia.

The results of 21 non-vascularized toe phalanx transfers in 13 patients were reviewed radiologically with respect to function, physeal patency, growth and donor site morbidity at a mean follow-up of 7.4 (range 2.9-13.6) years. Physeal patency was maintained in 4 of 18 surviving transfers. The length of the transferred phalanx averaged 75% of the contralateral comparable toe phalanx and 44% of the contralateral digit proximal phalanx. Most patients had good or simple use of the hand with active joint motion. There was universal shortening of the donor toe with hypoplasia of the middle and distal phalanges. This review suggests that transfer of a non-vascularized toe phalanx provides a reliable but limited means for increasing length of a digit, stabilizing soft tissue "nubbins" and improving function. Longer follow-up has shown more modest gains in growth than in some previous reports.

Epiphyses↗
PubMed1999

The predictive value of plantar flexion of the toes in the assessment of neuropathic voiding disorders in patients with spine lesions at the thoracolumbar level.

OBJECTIVE: To correlate the presence of voluntary contraction of the plantar flexors of the toes with neuropathic voiding disorders in patients with spinal cord injury (SCI) after thoracolumbar fracture. SUBJECTS AND METHODS: Sixty-three SCI patients with thoracolumbar fractures were prospectively examined neurologically (American Spinal Cord Injury Association protocol) and urodynamically during their first hospitalization. To assess neurologic recovery, patients were reassessed after at least 1 year. Bladder function was also reevaluated and correlated to neurologic evaluation performed on the same day. SETTINGS: Primary care center, university facility. RESULTS: There was a significant correlation between score of the plantar flexors of the toes and the presence or absence of voluntary contraction of the external anal/urethral sphincter (p < .001). However, this was of no predictive value concerning neuropathic bladder type (p > .05). Seven patients recovered from their neuropathic voiding disorders. There was a significant correlation between the reappearance of a voluntary external anal/urethral sphincter contraction and bladder recovery (p < .01), but there was no significant correlation between the score obtained for the plantar flexors of the toes and the presence or absence of the bulbocavenosus reflex (p > .05). CONCLUSIONS: It appears that in SCI patients with thoracolumbar fractures, the presence of a voluntary contraction of the plantar flexors of the toes correlates with active contraction of the external anal/urethral sphincter but does not enable differentiation of the types of neuropathic voiding disorders. Urodynamic examination remains mandatory for assessment of the functional aspect of the neuropathic voiding disorders.

Adolescent↗
PubMed1997

Regeneration of sudomotor and sensory nerve fibres after digital replantation and microneurovascular toe-to-hand transfer.

The end-stage sudomotor and sensory recovery in patients with replanted fingers and patients after microneurovascular toe-to-hand transfer was studied using quantitative electrophysiological investigations (recovery of sensory nerve action potentials and the sympathetic skin response), the ninhydrin test and clinical testing of sensory regeneration (light touch, pain, static and dynamic two-point discrimination). 13 adult patients with 22 replanted digits (11 males, 2 females) aged 21-58 years (mean 42.2 years) and 12 adults and adolescents (8 males, 4 females) aged 13-45 years, (mean 26.8 years) following 14 microneurovascular great and/or second toe-to-hand transfers were studied. The replanted fingers were examined 2-7 years after injury and replantation. The toe-to-hand transfers were examined 2-12 years after injury and transfer. The results show better end-stage recovery of sudomotor and sensory function following finger replantation when compared to microneurovascular toe-to-hand transfer.

Adolescent↗
PubMed1997

Toe amputation in the diabetic patient.

BACKGROUND: We considered whether it is more practical to amputate the toe of a diabetic patient with osteomyelitis and good circulation or to treat the patient with antibiotics for a prolonged period. METHODS: We undertook a retrospective study of 141 diabetic patients who had undergone a toe-ray amputation for proven or documented osteomyelitis. RESULTS: The mean ankle/brachial index of all patients was 0.81 (range, 0.68 to 1.14); the mean functional days lost on antibiotic therapy was 39 (range, 7 to 84 days). The cost of 6 to 8 weeks of preoperative antibiotic therapy was $900 to $2240 (mean, $1440). CONCLUSIONS: Diabetic patients with good circulation and osteomyelitis of the toe may benefit from prompt toe amputation.

Amputation, Surgical↗
PubMed1994

A survey of health care and child protective services provider knowledge regarding the toe tourniquet syndrome.

Recent efforts to increase public awareness of child abuse may result in an increased number of inappropriate reports of suspected child abuse. The authors believe that digital hair strangulation should be included among the conditions that may be confused with child abuse. Digital hair strangulation (toe tourniquet syndrome) occurs primarily in infants and is characterized by a constricting band of foreign material that becomes tightly wrapped around a digit or digits (most often the toes). The consensus in the medical literature is that this condition is not the result of intentional injury. As no reference to the toe tourniquet syndrome exists in the child abuse literature, it was hypothesized that child welfare workers would be more likely than physicians and public health nurses to misinterpret this condition as resulting from intentional injury. A survey was conducted to test this hypothesis. Professionals from the fields of medicine, nursing, and child welfare were provided with a history and photographic findings of a child with a typical case of the toe tourniquet syndrome. Participants were surveyed regarding their interpretation of the described injuries. More than 50% of all respondents indicated that they would report this case as suspected abuse. Child welfare workers responded that the injuries were suggestive of abuse (83%), significantly more often than public health nurses did (45%), (chi 2 = 4.55, p = .03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Non-vascularized free toe phalanx transfers in congenital hand deformities--the Great Ormond Street experience.

Many options of varying complexity are available for the management of congenital short digits resulting from aphalangia in symbrachydactyly and constriction ring syndrome. We have used non-vascularized free toe phalanx transfers for these children when a vascularized toe transfer has been contraindicated. We describe our technique and experience with 22 children who underwent a total of 64 transfers of the proximal (35) or middle (29) toe phalanges (average 3 per child). The mean age at initial surgery was 15 months, and the mean follow-up was 5 years. Duration of time until epiphyseal closure could not be determined accurately, but total digital elongation averaged 6mm. Complications of this technique include joint instability, premature epiphyseal closure and, in one patient, infection and graft loss. Donor site deformity was determined according to measured growth deficit and toe function. This technique is a simple option for digital elongation and, if performed in the appropriate age group in short fingered and monodactylous subtypes of symbrachydactyly, has the potential to allow growth and function with minimal donor site deficit.

Bone Resorption↗
PubMed1995

Toe-to-finger transfer combined with wrap-around flap: a new technique for four-finger amputation.

A surgical technique for reconstruction of four-finger amputation, toe-to-finger transfer combined with wrap-around flap procedure, is described. Opposable ulnar fingers, reconstructed using the second and third toe, provide sufficient grip function. The long finger, reconstructed with the wrap-around flap using the lateral aspect of the great toe, provides pinch function. Improving the hand function is worthwhile despite morbidity from losing two toes.

Amputation, Traumatic↗
PubMed1982

Toe transfers for congenital hand defects.

From 1977 to 1980, 21 second toes were transferred with microvascular anastomoses for congenital hand defects in 17 patients. There have been no vascular failures. Four thumbs were reconstructed with very good functional and cosmetic results. Active motion of the transplanted toe is limited, and the functional results depend on the mobility and musculature of the metacarpal remnant. Growth has been continuous and at least equal to the other toe. Cosmetic results have been very good. It is essential to distinguish between patients showing aplasia and those presenting amniotic band "amputation" syndrome. In the latter case, all structures are close to normal and the results are therefore better. Operative indications must be carefully appraised. If surgical intervention is decided upon, the ideal age is about 18 months, at which time the best integration of the toe is observed.

Adolescent↗
PubMed1984

Toe-to-hand transfers in reconstructive surgery of the hand. Experience with seventy-one cases.

Based on a homogeneous series of 71 toe-to-hand transfers performed between February 1975 and December 1982 the same surgeon, the authors have tried to define their present day indications. Technical modifications have been described for the second toe transfer : isolated dorsal approach of the toe with early-stage resection of the second metatarsal bone, utilisation of the plantar metatarsal artery of the second interosseous space, utilisation of the volar vessels for the anastomosis at the recipient site, dorsal subcutaneous tunnel for the venous anastomosis of the hand. Aside from the usual indications for thumb reconstruction (11 cases) and 26 cases of transfers for reconstruction in long finger injuries, the indications for partial transfers have become more and more frequent : pulpar (9 cases), pulp + bone + nail (10 cases), isolated nail (1 case), nail + bone (2 cases), first web space (1 case), double twisted toe (5 cases) and articular (6 cases) transfers.

Adult↗