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PubMedDate not supplied

[Biomechanics of the metatarsophalangeal joints].

Koehler-Freiberg's disease is found to most commonly manifest itself in the metatarsal head of the second ray. Occasionally it is observed to occur in the metatarsal head of the third and less commonly it is seen to appear in the other rays of the foot. An investigation into probable causes of the disorder calls for consideration of the biomechanical conditions in the region of the metatarsophalangeal joints. A review of the literature pertaining to this matter has failed to reveal any detailed information in this respect and therefore a series of experiments have been conducted involving determination of a) the ground force under the metatarsophalangeal joints and under the toes in normal barefoot walking b) the direction of the flexor tendons and such others that cross the joint and that might play an important role in exerting force between the toes and the ground, c) the geometry of the articulating surfaces and d) the forces that act between the metatarsal head and the corresponding phalangeal joint surface. It is shown that the specific loading of the MP-II joint (due to forces acting across the joint) could amount to nearly twice that to which MP-I is subjected to. This might explain the more frequent occurrence of osteonecrosis of the second metatarsal head as compared to that observed within the head of the first. Furthermore, the direction of the joint resultant force in the MP-II joint is seen to be more dorsally inclined than that in MP-I, which agrees well with clinical findings regarding the site of localized lesions. Lastly, a hypothesis which still requires closer investigation is presented to explain the development of the bone lesions that are known to occur just below the subchondral cortex.

Biomechanical Phenomena↗
PubMed2006

Compensation for changes in hoof conformation between shoeing sessions through the adaptation of angular kinematics of the distal segments of the limbs of horses.

OBJECTIVE: To determine the mechanism that enables horses to partially counteract the shift of the center of pressure under the hoof induced by changes in hoof morphology attributable to growth and wear during a shoeing interval. ANIMALS: 18 clinically sound Warmblood horses. PROCEDURES: Horses were evaluated 2 days and 8 weeks after shoeing during trotting on a track containing pressure-force measuring plates and by use of a synchronous infrared gait analysis system set at a frequency of 240 Hz. All feet were trimmed toward straight alignment of the proximal, middle, and distal phalanges and shod with standard flat shoes. Results-Temporal characteristics such as stance time and the time between heel lift and toe off (ie, breakover duration) did not change significantly as a result of shoeing interval. Protraction and retraction angles of the limbs did not change. Compensation was achieved through an increase in the dorsal angle of the metacarpohalangeal or metarsophalangeal (fetlock) joint and a concomitant decrease of the dorsal angle of the hoof wall and fetlock. There was an additional compensatory mechanism in the hind limbs during the landing phase. CONCLUSIONS AND CLINICAL RELEVANCE: Horses compensate for changes in hoof morphology that develop during an 8-week shoeing interval such that they are able to maintain their neuromuscular pattern of movement. The compensation consists of slight alterations in the angles between the distal segments of the limb. Insight into natural compensation mechanisms for hoof imbalance will aid in the understanding and treatment of pathologic conditions in horses.

Animals↗
PubMed1999

Prenatal sonographic diagnosis of Aarskog syndrome.

In 1970, Aarskog described a rare X-linked developmental disorder characterized by short stature in association with a variety of structural anomalies involving mainly the face, distal extremities, and external genitalia (faciodigitogenital syndrome). The major facial manifestations of this syndrome include hypertelorism, broad forehead, broad nasal bridge, short nose with anteverted nostrils, long philtrum, widow's peak hair anomaly, and ocular and ear anomalies. Limb abnormalities consist of short broad hands, brachydactyly, interdigital webbing, hypoplasia of the middle phalanges, proximal interphalangeal joint laxity with concomitant flexion and restriction of movement of distal interphalangeal joints, and flat broad feet with bulbous toes. Genital anomalies are characteristics and include shawl scrotum, cryptorchidism, and inguinal hernia. Most affected patients have normal intelligence, but some authors have noted mild neurodevelopmental delay in up to 30% of the cases. We describe a case of Aarskog syndrome diagnosed prenatally by sonography at 28 weeks' gestation in a high-risk pregnancy for this disorder.

Abnormalities, Multiple↗
PubMed2001

[Interpositioned metallic prosthesis for hallux rigidus: review of 42 cases with a metatarsophalangeal prosthesis].

PURPOSE OF THE STUDY: We report outcome at a mean 4.8 years follow-up in 42 patients with hallux rigidus treated by metatarsophalangeal interposition thin prosthesis flat concave with a lateral capsular fixation. MATERIALS AND METHODS: The 42 patients were treated from 1987 to 1997. Sixtine prostheses were implanted for osteoarthritis was grade I (n=2), grade II (n=28), and grade III (n=12). Groulier's clinical criteria and Regnauld's radiologic criteria were used to assess outcome. RESULTS: We observed 22 very good, 12 good, 4 fair, and 4 poor results. There was no significant modification in the forefoot morphology. DISCUSSION: The Sixtine prosthesis provided a global improvement in pain and motion though there was an important difference between patients with grade I and grade II osteoarthritis, who experienced major improvement, and those with grade III disease. A good overall result requires proper prosthetic centering. Subluxation or translation does not appear to be compatible with good results. Among 3 cases with overt dislocation, 1 recovered an acceptable articular space with a good overall result. Two poor results and 3 fair results were observed in patients with condensation of the phalangeal base. These bone condensations appeared in postoperative Egyptian feet. The Sixtine prosthesis may protect the interphalangeal articular space of the great toe, avoiding damage and rearward displacement of sesamoid bones. It ensures primary stability and may be left in place. CONCLUSION: We found that the Sixtine prosthesis is best indicated in hallux rigidus patients with grade II osteoarthritis.

Adult↗
PubMed1975

[Tricho-rhino-phalangeal syndrome with autosomal dominant inheritance (author's transl)].

Sparse, slowly growing hair, a big pear-shaped nose and deformities of the fingers are the main characteristics of the tricho-rhino-phalangeal syndrome (TRP); dwarfism is a facultative sign. The cone shaped invagination of the epiphysis into the diaphysis of the fingers and toes causes clinodactyly and brachydactyly. The typical physiognomy of the TRP leads to the suspected diagnosis which may easily be confirmed by X-ray examination. In a 13-year-old girl the classical signs of a TRP were found; several members of the family demonstrated some features of the syndrome. Dermatoglyphic examinations were performed on 9 members of the family.

Abnormalities, Multiple↗
PubMed1995

[Intraosseous epidermoid cysts of the toe phalanx in dogs].

Out of 1057 amputated canine toes with tumours, tumour-like or other lesions, 17 cases were histopathologically diagnosed as epidermoid cysts of the terminal phalanx (EP). They were accompanied by osteolysis, reactive bone formation and chronic inflammation of phalanx 3. Extension of reactive changes to the phalangeal joint and phalanx 2 was less frequent. Various breeds were involved. There was no breed predisposition. The average age was 10.8 years; the male-female ratio 2.4:1. Nine EP were located on the forelimbs, 4 on the hindlimbs. In 4 cases location was unknown. Toes 4 and 5 were most frequently affected. A traumatic origin is suspected.

Animals↗
PubMedDate not supplied

Phalangeal periosteal (juxtacortical)chondroma of the foot.

The author discusses a benign cartilaginous tumor involving the tubular bones, more frequently in the hand than the foot. Its rare occurrence in the second toe of an adult male is illustrated. Pain and swelling required excisional biopsy, whose diagnosis was aided by radiographic findings of calcification and cortical erosion.

Adult↗
PubMed1984

Bicycle injury pattern among children in rural India.

205 children treated with bicycle injuries during the four year period 1979-1982 at General Hospital, Sangli, in rural Western Maharashtra were reviewed. Amputation of the right toe was the most common injury comprising 74% of all the injuries. This occurred in children carried as passengers on the rear carrier of the bicycle, who hang their legs on either side of the spoke wheel. The right big toe of the passenger is then trapped by the chain above, the spokes at the extreme inner end, horizontal fork below and the free wheel posteriorly. Peddling of the bicycle in a reverse direction followed by forward propulsion results in amputation of the toe by the rotating teeth of the free wheel. In 122 cases amputation was through the proximal phalanx, in 28 cases through the distal phalanx and in 2 cases at the level of the metatarso phalangeal joint. A disarticulation through the proximal joint was performed in these cases. A four year follow up showed no residual disability.

Amputation, Traumatic↗
PubMed1998

The feet in Pfeiffer's syndrome.

Broad toes are the classic clinical finding occurring in the feet in Pfeiffer's syndrome patients, but few cases undergo formal radiological assessment. However, the feet in other craniosynostosis syndromes resulting from mutations of the fibroblast growth factor receptor 2 gene have anomalies at many other sites within the feet, which raised the possibility that there may also be a wider range of anomalies other than broad big toes in the feet of those with Pfeiffer's syndrome. The object of this study was to assess prospectively the incidence and pattern of clinical and radiographic anomalies of the feet of patients with a confirmed diagnosis of Pfeiffer's syndrome. Twenty-two Pfeiffer's syndrome patients were examined both clinically and radiologically for anomalies of the feet. Clinical examination revealed broad big toes in 12 patients and syndactyly in 2. Radiographs of the feet were evaluated by a radiologist with an interest in skeletal dysplasia as well as by members of the Craniofacial team. A wider range of radiological than clinical anomalies involving the phalanges, metatarsals, and tarsals was seen. The severity of the anomalies observed ranged from normal to those resembling the feet of Apert's syndrome patients. Only 4 patients had radiologically normal feet. These radiographic findings suggest that there is a range of foot anomalies more extensive than the broad big toes, which are classically associated with Pfeiffer's syndrome.

Acrocephalosyndactylia↗
PubMed1999

Symphalangism in children. Case report and review of the literature.

Symphalangism is an uncommon syndrome characterized by fusion of the interphalangeal joints of the hands and feet. The fusion can involve the proximal or the distal joints; however, involvement of the proximal interphalangeal joints is more common. Symphalangism often is associated with several other skeletal and nonskeletal abnormalities. Analysis of the pedigrees of affected families reveals this trait to be autosomal dominant. The authors present the case of a 9-year-old boy with bilateral symphalangism of the proximal interphalangeal joints in the fingers and toes. His father is affected similarly. A comparison of these cases with those published in the literature indicates that although the radiologic appearance of symphalangism appears disabling, the fused phalanges seldom cause disability or loss of function of the hand. Surgical intervention is not required in most patients. The father and son reported also had capitellar hypoplasia and subluxation of the radial head associated with limitation of elbow flexion and extension.

Adult↗
PubMed1980

Cleidocranial dysostosis, severe micrognathism, bilateral absence of thumbs and first metatarsal bone, and distal aphalangia: a new genetic syndrome.

Five patients from three families have a new genetic syndrome. The features include cleidocranial dysostosis, bilateral absence of the thumbs and of the distal phalanges of the fingers, hypoplasia of the first metatarsus, absence of the distal phalanx and hypoplasia of the proximal phalanx of the big toe, pelvic dysplasia, bilateral hip dislocation, a constant facial dysmorphism with sparse hair, peculiar ears, severe micrognathism, and retracted and poorly delineated lips. The existence of consanguinity in two of the families, both with two affected siblings, as well as the lack of sex predilection, allow us to postulate that this syndrome is inherited in a recessive manner.

Abnormalities, Multiple↗
PubMed2002

Frequency of feeding and formation of bone growth marks in frog, Rana cyanophlyctis (Schn.).

Frogs, R. cyanophlyctis (n = 45) divided into four groups, were exposed to different feeding regimens (live guppies were used as food) such as, daily, alternate day, every fourth day and weekly feeding for 5 months, during wet months of the year (April-September). Two toe clippings were made, one at the beginning and the other at the termination of the experiment. Clipped toes were demineralized, and processed for histology. In 6 out of 45 frogs one line of arrested growth (LAG) was present in the phalangeal histology at the beginning of the experiment while, at the termination of experiment 34 out of 43 frogs exhibited one LAG each indicating that in 26 frogs LAG appeared freshly during the experimental period. The fact that LAGs are formed in regularly fed frogs suggests the humid weather/seasonal rainfall may play relatively important role than the feeding in cyclic bone growth and formation of growth marks in this frog.

Animals↗
PubMed1997

Effect of proximal phalangeal epiphysiodesis in the treatment of macrodactyly.

The recommended treatment for macrodactyly of the foot will often include epiphysiodesis of the proximal phalanx in an attempt to halt further longitudinal growth of the toe. Nine patients who underwent open epiphysiodesis and debulking of the excess soft tissues involving 11 toes were reviewed to evaluate the effectiveness of this procedure. In 9 of 11 toes, overall length of the proximal phalanx did not change after surgery. Two toes demonstrated continued growth; one of these toes underwent a repeat epiphysiodesis of the phalanx, and the other foot underwent epiphysiodesis of the affected metatarsal. Overall, this surgical approach led to radiographic results that satisfied the surgical goals.

Animals↗