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At least 379 records · Page 21Linked to original sources
PubMed2006

Reverse first dorsal metatarsal artery flap for reconstruction of traumatic defects of dorsal great toe.

BACKGROUND: Soft-tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. This study investigates the feasibility and reliability of reverse first dorsal metatarsal artery flap (FDMA) for reconstruction of the dorsal great toe soft-tissue defects. METHODS: Six male patients with dorsal great toe defects (mean 2.2 x 4.7 cm) underwent reconstruction using the reverse FDMA flap. Preoperative angiography was performed to confirm the existence and patency of the distal communicating artery between the FDMA and plantar metatarsal artery. The flap was raised by dividing the dorsalis pedis artery and proximal communicating arteries and rotated 180 degrees to cover the defect. RESULTS: All flaps survived completely. Mean follow-up time was 3.3 months. Painless full range of motion was recovered and the contour of the flap was satisfactory. All patients returned to their normal walking and running activities and none necessitated special footwear. No donor-site morbidity was encountered. CONCLUSION: Reverse FDMA flap presents a viable alternative for reconstruction of soft-tissue defects of dorsal great toe when local flap coverage is required. Because of anatomic variations, preoperative angiography is necessary for successful reconstruction, especially in patients with comorbidities affecting patency of their vasculature.

Adult↗
PubMedDate not supplied

Electromyography of idiopathic toe walking.

Eighteen idiopathic toe walkers were evaluated by gait electromyography to define muscle timing abnormalities. This group was compared with a matched group of normal children walking on their toes and to a group of patients with cerebral palsy and equinus deformities. Although timing in all three groups differed from normal timing, the two patient groups showed some statistically significant differences in phasic timing from the control group. However, no significant differences existed between toe walking and spastic children. Historical data (family history, male predominance, and learning disabilities) suggest that idiopathic toe walking is a true entity, although the gait electromyograms were not diagnostic.

Adolescent↗
PubMed1995

Skin capillary circulation is more impaired in the toes of diabetic than non-diabetic patients with peripheral vascular disease.

The aim of the present study was to investigate if diabetes negatively influences the skin microvascular reactivity in the toes of patients with peripheral vascular disease (PVD). Twenty healthy subjects, 20 diabetic, and 20 non-diabetic patients with PVD participated. One foot in each subject was investigated. The patient groups were matched for age, sex, and toe pressure. The capillary blood cell velocity in the nailfold of the great toe was investigated by videophotometric capillaroscopy, and the total skin microcirculation within the same area by laser Doppler fluxmetry. Capillary blood cell velocity and laser Doppler flux were studied during rest, and following a 1 min arterial occlusion at the toe base. The skin microvascular reactivity was impaired in both diabetic and non-diabetic patients. In the diabetic patients the disturbances were mainly seen in the capillaries, and the capillary blood flow was severely reduced during reactive hyperaemia (p < 0.01). In contrast, the total skin microcirculation was normal, indicating that sufficient blood reaches the area, but does not come out into the capillaries. The ratio between capillary blood cell velocity and laser Doppler flux, representing the distribution of blood between nutritional and non-nutritional blood compartments, was reduced in the diabetic patients (p < 0.05). These findings may contribute to the higher risk for development of chronic foot ulcers in diabetic patients with PVD.

Aged↗
PubMedDate not supplied

Discrepancy in skin capillary circulation between fingers and toes in patients with type 1 diabetes.

The aim of the present study was to investigate skin microcirculation in patients with diabetes to see if any differences in microvascular reactivity could be found between a skin area with low (fingers) or high risk (toes) of complications. Twelve male patients with type 1 diabetes were investigated, the age was 34.7 +/- 8.5 years, and diabetes duration 12.8 +/- 7.7 years (mean +/- SD). Twelve healthy male subjects served as controls. Capillary blood cell velocity (CBV) in the nailfolds of the great toe and left fourth finger was investigated with videophotometric capillaroscopy, and total skin microcirculation with laser Doppler fluxmetry (LDF). CBV and LDF were studied during rest, and following a 1-min arterial occlusion at the proximal phalanx of the digit. Skin temperature was similar in patients and controls. The diabetic patients showed normal CBV and LDF values in skin microcirculation of the fingers, while a reduced (p < 0.01) CBV was found during reactive hyperemia in the toes. The ratio between CBV and LDF was decreased (p < 0.01), indicating a maldistribution of blood between skin capillaries and subpapillary vessels in the toes of diabetic patients. These disturbances may be of importance for the development of foot complications in diabetic patients.

Adult↗
PubMedDate not supplied

Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players.

Metatarsophalangeal joint injuries of the great toe (turf-toe) are receiving increasing attention in the literature because of the prevalence of synthetic surfaces and lighter, more flexible shoes. Eighty active professional football players were evaluated. The mechanism of injury was hyperextension in 85% of the players. Eighty-three percent reported their initial injury on artificial turf (P less than 0.05). Other factors significantly related to the incidence of turf-toe included player age (P less than 0.01), number of years in professional football (P less than 0.01), and range of ankle dorsiflexion (P less than 0.05). Turf-toe injury resulted in significantly decreased range of motion of the first metatarsophalangeal joint (P less than 0.01).

Adult↗
PubMed1992

A technique for measuring absolute toe pressures: evaluation of pressure-sensitive film techniques.

Although a number of pathologies of the forefoot in ballet dancers on pointe have been described, pressures and deforming forces have not been adequately measured. To evaluate the possible use of pressure-sensitive film (PSF) in measuring the pressures on the external soft tissues in such a confined space as the dancer's toe shoe, it was tested and calibrated with 20 cadaver toes. Each cadaver toe was internally stabilized and loaded longitudinally against PSF on a flat surface. The resultant films were analyzed with a video imaging system and the pressures and total forces were determined. Results showed that the linearity of the PSF to pressure had a regression value of 0.98. By using two sensitivity ranges of films, the total force measured by the PSF was found to be within 10% of the known applied force on each toe. The PSF, therefore, may very well be a useful and accurate method of measuring external soft tissue pressures on the forefoot.

Biomechanical Phenomena↗
PubMed1998

Results of preprocedure and postprocedure toe cultures in orthopaedic surgery.

This study was to determine whether there is any benefit to wrapping the toes sterilely during orthopaedic procedures not involving the foot but performed on the lower extremity. The group studied consisted of 12 patients who had an orthopaedic procedure performed in which the foot and toes were included in the surgical prep, but not involved in the surgical procedure. Nine of the 12 patients (75%) had positive results from preprocedural aerobic cultures and two of the 12 (16.6%) had positive results from preprocedural fungal cultures. Recolonization of the bacteria between the toes was also demonstrated. Sterile draping of the toes would minimize the risk of infection and also protect against bacteria that recolonize during the procedure.

Adolescent↗
PubMed2006

An unusual case of toe ulceration.

We describe an unusual presentation of toe ulceration in a 39-year-old otherwise healthy man. The left fifth toe was painful for several months with ulceration at the tip. The other toes appeared cyanotic and discolored. Foot pulses were normal. Laboratory testing revealed the platelet count at 1208 thousand/microliter, with hemoglobin 19.2g/dl and hematocrit 57%. The erythropoietin level was found to be markedly decreased at 1 mU/ml. The patient was given the diagnosis of polycythemia vera with iron deficiency. Phlebotomy was performed and aspirin and cytoreductive therapy with hydroxyurea was prescribed with resolution of the toe ulceration.

Adult↗
PubMed1990

The importance of the toes in walking.

The importance of well-functioning toes has long been recognised but has not previously been assessed in biomechanical studies. We have examined the weight-bearing function of the foot in 160 normal subjects by use of the pedobarograph. The function of the toes was assessed by reference to the time they were in contact with the ground and the peak pressures they exerted individually in comparison with other parts of the foot. The toes were in contact for about three-quarters of the stance phase of gait and exerted peak pressures similar to those of the metatarsal region. When the foot was bearing the second peak of total force, the area in contact with the ground (the metatarsal heads and toes) was decreasing.

Adolescent↗
PubMed2001

Selective lengthening of the proximal flexor tendon in the management of acquired claw toes.

We report the management of the acquired claw-toe deformity in ten adults. Each patient developed a varying number of claw toes at a mean interval of six months after the time of injury. There was clinical evidence of an acute compartment syndrome in one case. The clawing occurred at the start of heel-rise in the stance phase of gait. At this stage the patients complained of increasing pain and pressure on the tips of the toes. The deformities were corrected by lengthening flexor hallucis longus and flexor digitorum longus alone or in combination. The presence of variable intertendinous digitations between the tendons of flexor hallucis longus and flexor digitorum longus means that in some cases release of flexor hallucis longus alone may correct clawing of lesser toes.

Adult↗
PubMed2002

Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study.

OBJECTIVE: The objectives of this study were to compare intrinsic foot muscle cross-sectional area (CSA) in patients with diabetic polyneuropathy and nondiabetic control subjects and to examine the association between intrinsic muscle CSA and clawing/hammering of the toes in neuropathic feet. RESEARCH DESIGN AND METHODS: High-resolution T2-weighted fast spin-echo images and parametric T2 multiple spin-echo images were acquired using multiple spin-echo magnetic resonance imaging (MRI) of frontal plane sections of the metatarsal region of the foot in a sample of eight individuals with diabetic polyneuropathy and eight age- and sex-matched nonneuropathic nondiabetic control subjects. The configuration of joints of the second toe was obtained using a three-dimensional contact digitizer. RESULTS: Remarkable atrophy was found in all the intrinsic muscles of neuropathic subjects as compared with nondiabetic control subjects. Quantitative T2 analysis showed a 73% decrease in muscle tissue CSA distally in the neuropathic subjects. Muscle comprised only 8.3 +/- 2.9% (means +/- SD) of total foot CSA compared with 30.8 +/- 3.9% in control subjects. No significant differences were found between the groups in the metatarso-phalangeal and proximal and distal interphalangeal joint angles of the second ray. Moreover, clawing/hammering of the toes was found in only two of eight neuropathic subjects. CONCLUSIONS: Although sensory neuropathy is often emphasized in considerations of diabetic foot pathology, our results show that the consequences of motor neuropathy in the feet are profound in people with diabetes. This has implications for foot function and may play a significant role in postural instability. However, intrinsic muscle atrophy does not necessarily appear to imply toe deformity.

Adult↗
PubMed1998

Ontogeny of two-point discrimination for fingers and toes in children (ages 7 through 15 years).

Accuracies of two-point discrimination (successive 2-min increments between 0 and 10 mm) for the middle fingers and the middle toes for 87 children from ages 7 through 15 years were measured to obtain normative data. The finer discriminative capacity for the fingers rather than the toes was evident. Whereas discriminative accuracy approached the asymptote with distances equal to or greater than 4 mm for the fingers, distances equal to or greater than 8 mm were required for the toes. For this ontogenetic range, the effects for toes vs fingers was much greater than the effect size for age.

Adolescent↗
PubMed1998

SPECT (HMPAO) support for activation of the medial prefrontal cortices during toe graphaesthesia.

This experiment was designed to test the construct validity of psychometric analyses that suggested a strong functional association between the accuracy for toe graphaesthesia and selective activation of neurons within the medial prefrontal regions. Single Photon Emission Computerized Tomography (SPECT) profiles were obtained for three volunteers (2 men, 1 woman) after they had been exposed to a toe graphaesthesia task or had been exposed to the control setting. The two measurements for each participant were separated by at least one week. Qualitative evaluation, using criteria employed for clinical diagnoses, of serial coronal, sagittal, and horizontal sections clearly indicated a specific increase in uptake of tracer within the rostral one-third to one-half of the medial prefrontal cortices of all three subjects during the toe graphaesthesia task compared to that during baseline conditions. The results are consistent with our neuropsychological research which indicates that toe graphaesthesia may be an accurate and useful indicator of the functional integrity of the medial surfaces of the anterior cerebral hemispheres.

Adult↗
PubMed1998

Zanoli's procedure for overlapping fifth toe: retrospective study of 18 cases followed for 4-17 years.

Digitus quintus superductus pedis (overlapping fifth toe) is a congenital deformity, often bilateral, in which the fifth toe is medially directed, rotated and hyperextended. There is no consensus regarding the best treatment. We describe our experience using Zanoli's procedure, which is a tenodesis procedure using the extensor tendon of the fifth toe. Between 1979 and 1993, we operated on 16 patients (7 bilateral, total 23 feet). 13 (10 women) patients (18 feet), with a mean age of 26 (19-40) years, were seen on follow-up. The mean follow-up time was 8 (4-17) years. Pain relief was achieved in all patients. From the surgeon's point of view, 3 toes overcorrected due to technical errors were considered unsatisfactory. All patients, however, were satisfied with the result and would advise other patients to undergo the same operation.

Adult↗
PubMed1999

[Analysis of the causes of necrosis of retained flap on tibial side after transplantation of the great toe nail flap].

OBJECTIVE: In order to investigate the causes of necrosis of the retained flap after transplantation of the great nail flap, according to the principle of plastic surgery, the following operation was designed. METHODS: A tongue-shaped great toe flap was made with its base on the tibial side of the great toe and the width of the base was 1 cm to 1.5 cm. The flap contained the supporting vessels and nerves and the periosteum was also preserved. RESULTS: From June 1982 to November 1997, the flap was used to repair 267 case, 277 fingers defects. After operation, the retained flap on the tibial side developed necrosis in 13 sides, an incidence of 4.69%, and in 78 sides, there was necrosis on the grafted skin on the donor site, an incidence of 28.7%. Most of the wounds healed after changing dressing, while 37 wounds healed from another skin graft. Of these cases, 178 cases had been followed up for 5 months to 16 years. It was found that the retained tibial tongue-shaped flap showed hyperplasia which extended to the weightbearing area of metatarso-phalangeal of great toe. It showed that the taking off of great toe nail flap according to first dorsal metatarsal artery (FDMA) I, II or III type, the incidence of development of necrosis of retained flap on tibial side showed no significant difference (P > 0.05). CONCLUSION: It was believed that the necrosis of the retained flap was not related to the FDMA classification but had relation with the design, operative technique and presence of infection.

Adolescent↗
PubMedDate not supplied

Effect on balance and gait secondary to removal of the second toe for digital reconstruction: 5-year follow-up.

Foot anatomy and lower limb function were analyzed in 11 children (aged 6.5-12.5 y) 5 years after removal of one or two second toes for digital reconstruction. In addition to physical examination and x-rays, postural balance and three-dimensional measurements of gait were analyzed. Among the 15 operated feet, five had bridle scars, three had claw deformities of the third toe, five had pain in the first intermetatarsal space, and seven had overt or early-stage hallux valgus (including five after unilateral toe removal). Hallux valgus deformation was also observed in three nonoperated feet. Maintenance of balance and rate of displacement of the center of pressure when standing on one foot with eyes closed were significantly altered for operated limbs compared with nonoperated limbs. Gait was rapid because of increased step cadence. Foot progression angle and ankle and knee joint sagittal kinematics during walking were normal. Although children appeared to not be affected in their daily life by the removal of the second toe(s), related foot anatomic and functional modifications require further follow-up.

Amputation, Surgical↗
PubMedDate not supplied

Etiology of toe-web disease in Al-Ain, United Arab Emirates: bacteriological and mycological studies.

We examined and sampled 45 patients with toe-web intertrigo for bacteriological and mycological studies. Prominent isolated pathogens were the genus Candida (57.7%), genus Aspergillus (28.8%), Pseudomonas aeruginosa (26.7%) and coliforms (24.4%). Dermatophytes scored 4.4% (Trichophyton rubrum). There were 43 patents (95.5%) who presented with marked hyperkeratosis and maceration of the toe-webs involved. The tradition of the Emirati population of sitting cross-legged may, over time, induce in the toe-webs of overweight individuals a macerated pressure-reaction hyperkeratosis that is colonized by environmental germs. T. rubrum and T. mentagrophytes are uncommon in the Al-Ain environment and this may explain the rarity of dermatophytes in toe-web intertrigo in our study.

Adolescent↗
PubMed2004

[Results of Kirschner wire osteosynthesis and intramedullary bone peg in toe-transfers].

During 1995-2002 in General and Hand Surgery Department 21 digits were reconstructed by toe to hand transplantation performed in 16 patients. There were 10 cases thumb was reconstruction with 4 great toe and 6 second toe transfers. Rest 11 fingers there were index, middle and ring were restored by II and III toe. Twelve osteosynthesis were performed by Kirschner wire and nine by bone peg. All fixations were sufficient stable to start early rehabilitation. In one case after Kirschner fixation occurred ostitis and malunion. This patient was cured by autovaccine. After bone peg we do not recorded any complication.

Adolescent↗