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PubMedDate not supplied

[Osteoarticular changes in the feet in diabetes mellitus according to the data of roentgenological examination].

In roentgenological examination of 40 patients suffering from diabetes mellitus bone and articular changes were revealed in 65% of cases. They were equally incident in patients of both sexes. These changes did not depend directly on the severity and duration of diabetes mellitus, although they were more frequent in persons with the widespread micro- and macroangiopathies and other complications of this disease. A case of osteoarthropathy occurring in a young patient given no antidiabetic treatment for a period of several years is presented.

Adolescent↗
PubMed1983

The use of Kirschner wire fixation in forefoot surgery.

This article reviews the indication and use of Kirschner wire fixation in forefoot surgery. Although Kirschner wire fixation is a relatively easy means of fixation, it is not without complications. The operative technique and postoperative considerations are also included to assist the foot surgeon.

Arthrodesis↗
PubMed2006

Indications for and technique of first metatarsophalangeal joint arthroscopy.

BACKGROUND: Arthroscopy of the great toe metatarsophalangeal joint has been used for a variety of indications, ranging from synovitis to osteochondral defects. The purpose of the present study was to define the indications for arthroscopy, assess its efficacy, and demonstrate the limitations of this procedure. METHODS: Hallux metatarsophalangeal joint arthroscopy was used in 20 patients (25 feet). Indications included degenerative disease with early osteophytosis, chondromalacia, osteochondral defects, loose bodies, arthrofibrosis, synovitis, gouty arthritis, first metatarsophalangeal joint pain with no obvious findings clinically and radiographically in young adults, and intra-articular fracture of the first metatarsophalangeal joint. All patients had a minimal followup of 2 years and were evaluated clinically and radiographically. RESULTS: Arthroscopic surgery resulted in pain free first metatarsophalangeal joints in 95% (19 of 20 patients). Patients with degenerative disease had a pain-free joint for a minimum of 2 years. The patients with gouty arthritis and intra-articular fracture had good functional outcomes. Arthroscopy also helped in identifying the pathology in painful joints with no obvious radiographic features that included conditions such as 'meniscoid' and other impingement lesions. CONCLUSION: Arthroscopy of the first metatarsophalangeal joint is not suitable for patients with extensive degenerative changes and large osteophytes and those that require cheilectomy or arthrodesis. Arthroscopic management of certain painful hallucal metatarsophalangeal joints is a specialized technique, which if performed for the right indications, gives a favorable outcome with minimal complications.

Adolescent↗
PubMed2005

Polyarticular osteoarthritis--two major phenotypes hypothesized.

Osteoarthritis is the commonest form of arthritis, at least amongst Caucasians and is frequently polyarticular. Genetic factors are now considered pivotal in the aetiopathogenesis of polyarticular osteoarthritis (POA). This document proposes a nexus between the gene most commonly mutated amongst Caucasian peoples, notably the HFE gene and an appreciable subset of POA patients who have a clinically recognisable OA phenotype. It is hypothesised that there are at least 2 major POA phenotypes each of which is associated with discrete genotypes. Type 1 POA characterized by Heberden's or Bouchard's nodes with prominent DIP, PIP, knee joint (medial compartment) and Great toe MTP joint involvement corresponds to the putative nodal generalized form of OA or NGOA (proposed Type 1 POA phenotype). As yet no genetic marker has been defined for this POA subset. The second is a hitherto less well recognized phenotype characterized by involvement of the index and/or middle finger metacarpophalangeal (MCP2,3) joints and the elbows, ankles and possibly the intertarsal and tarsometatarsal joints. The hip and knee joints may sometimes also be involved. This different joint distribution corresponds closely to the pattern observed in the arthropathy that often accompanies hereditary haemochromatosis. It is predicted that mutations in the HFE gene will associate strongly with the proposed Type 2 POA phenotype and serve as a genetic marker for this clinically recognisable subset.

Humans↗
PubMed1994

Jones transfer to the lesser rays in metatarsalgia: technique and long-term follow-up.

Thirty-three feet in 29 patients with metatarsalgia were reviewed after Jones transfer to the lesser rays to evaluate the long-term results and the indications for these procedures. Transfer of the long extensor tendons to their respective metatarsal necks and fusion of the interphalangeal joints with shortening of the toe were performed. The procedures were performed in patients with symptoms of metatarsalgia, secondary to anterior pes cavus deformity (clawfeet, 16 patients), and in patients with mild or severe spreadfoot deformity with fall of the central metatarsals (12 patients). In all of our patients, the striking clinical sign was the long toes. Rating of the results was based on (1) the presence of pain or calluses and (2) residual deformity of the forefoot and toes. Symptoms of metatarsalgia were relieved in 25 feet, occasionally present in 6 feet, and unchanged in 2 patients. Complete correction of the deformity was achieved in 26 patients, 6 patients had slight residual deformities, and in the 1 poor result, overcorrection was present after the procedure. This operation is believed to be an excellent choice for patients with metatarsalgia due to (simple) pes cavus deformity and in patients with clawing and metatarsalgia secondary to excessively long toes.

Adolescent↗
PubMed1986

A comparison of gout in men and women. A 10-year experience.

The clinical features of gout in men and women are compared in a retrospective study of hospital patients and outpatients attending an arthritis clinic. Men had a readily recognized pattern of disease in terms of age of onset, duration of disease, and tophaceous gout. Recurrent mono-arthritis of the big toe metatarsophalangeal joint culminating in tophaceous polyarticular gout after many years was a stereotyped pattern. In women, polyarticular/tophaceous disease was often the first manifestation of gout, and a preceding recurrent mono-arthritis was found in joints other than the big toe. The duration of disease before tophi appeared was shorter. The use of diuretics was commonplace, and associated disease such as hypertension or chronic renal failure is frequent in women.

Adult↗
PubMed2001

Effects of heel and toe elevation upon the digital joint angles in the standing horse.

Five sound mature horses, age 8-14 years, with toe angles 45.5-55.0 degrees were placed on a specially designed platform with only the left forelimb weightbearing, which allowed the successive production of 7 different conditions of foot orientation: neutral position (N), 5, 10, 15 degrees heel (H5, H10, H15) and toe (T5, T10, T15) elevation, performed according to 2 different sequences. For each condition, 2 lateromedial radiographs were taken to evaluate the metacarpophalangeal joint (MPJ) and both interphalangeal joint (PIPJ and DIPJ) angles, respectively. In addition, two-dimensional (2-D) kinematic recordings, using reflective skin markers placed laterally on the left forelimb joints, were performed. The value of each joint angle (JA) and its angular variation to N (AV) were considered for statistical analysis. For all JA and their AV determined radiographically, the condition effect was significant and the sequence did not influence the differences between conditions. The relationships between the JA and the conditions (in the sequence: T15, T10, T5, N, H5, H10, H15) were overall linear for the 3 joints. The maximal range T15-H15 was mean +/- s.d. 6.9 +/- 2.0 degrees for MPJ (dorsal angle decrease), 7.3 +/- 1.0 degrees and 29.5 +/- 1.8 degrees for PIPJ and DIPJ (palmar angle decrease), respectively. Contrary to JA and in spite of large variations in hoof conformation, AV did not show any significant horse effect. Wide differences were observed between the digital JA measured radiographically and from kinematics, which could be related to cutaneous displacement. Heel elevation induced elbow flexion, whereas a slight extension was observed with toe elevation. These movements, even slight (mean elbow angle amplitude: 3.6 +/- 1.3 degrees), may have consequences upon flexor tendon tension.

Analysis of Variance↗
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

Measurement of joint space width and erosion size.

Measurement of radiographic abnormalities in metric units has been reported by several investigators during the last 15 years. Measurement of joint space in large joints has been employed in a few trials to evaluate therapy in osteoarthritis. Measurement of joint space width in small joints has been reported by several investigators but has not yet found a place in clinical trials in rheumatoid arthritis or osteoarthritis. We review methods for measuring joint space width in finger, toe, and wrist joints; special attention is given to how the joint edges are found, the method used to measure distance between joint margins, size of an area of the sampled joint, and reproducibility of measurements. Methods for measurement of erosion size, which have had less attention, are briefly discussed.

Arthrography↗