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At least 451 records · Page 25Linked to original sources
PubMed1998

[Psoriasiform onychopachydermoperiostitis of the large toes: the OP3GO syndrome].

A 46-years old male patient suffered for several years from painful swelling of the distal soft tissues of the great toes associated with onychodystrophy. Mycological studies were negative. By means of radiological and scintigrafic examination and because of the typical clinical signs, the diagnosis of psoriatic onycho-pachydermo-periostitis of the great toes was established. The syndrome which is highly evocative of rheumatoid psoriasis was first described by Fournié and co-workers in 1989. Oral retinoids were helpful in diminishing both pain and soft tissue swelling of the great toes.

Diagnosis, Differential↗
PubMed2002

[Technique and value of arthrosonography in rheumatologic diagnosis--3: Ultrasound diagnosis of the ankle joint, foot and toes].

The clinical investigation of ankles, feet, and toes is frequently equivocal in rheumatology. Sonography can distinguish between underlying pathologies. We suggest following standard scans: 1) anterior longitudinal scan to diagnose effusions in the ankle and talonavicular joints, to display erosive and osteoarthrotic pathologies, and to diagnose tenosynovitis of the extensor tendons; 2) anterior transverse scan to document the findings in an additional dimension; 3) lateral transverse scan and 4) lateral longitudinal scan to diagnose tenosynovitis of the peroneus tendons; 5) medial transverse scan and 6) medial longitudinal scan to diagnose tenosynovitis of the flexor tendons; 7) posterior longitudinal scan and 8) posterior transverse scan to evaluate the Achilles tendon, the retrocalcaneal bursa, and the posterior recess of the ankle joint. Additionally we suggest optional scans: 9) plantar longitudinal scan for the plantar fascia and the plantar calcaneal surface; 10) distal anterior longitudinal scan to evaluate the midtalar joints; 11) distal anterior longitudinal scan to evaluate the toes; and 12) plantar, distal transverse scan to evaluate the flexor tendons of the toes. Additionally, the correlating longitudinal and transverse scans can be used to confirm the findings. The frequency of the transducer should be about 7.5 MHz for ankles and the peroneus, flexor, and extensor tendons. Ten to over 20 MHz are possible for more superficially located structures. Using modern equipment with higher resolution a hypoechoic border may be normal up to 3 mm in the ankle joints, the MTP joints, and around the peroneus tendons, and up to 4 mm around the tibialis posterior tendons.

Ankle Joint↗
PubMed2001

Flexible hinge toe implant arthroplasty for rheumatoid arthritis of the first metatarsophalangeal joint: long-term results.

We report the long-term clinical results and survival rate of the implant in flexible hinge toe implant arthroplasty of the first metatarsophalangeal joint, combined with a shortening oblique osteotomy of the metatarsal neck in the lateral toes, in patients with rheumatoid arthritis. Between 1983 and 1990, arthroplasty was performed on 97 feet in 66 patients. Twenty-seven patients died; follow-up information was available for 60 feet in the remaining 39 patients, who were followed for an average of 12 years. Twenty-nine patients (74%) were satisfied with the outcome after surgery, 7 were satisfied but had some pain or recurrent deformities, and 3 were unsatisfied. Radiologically, visible fracture was identified in nine implants. Four implants were removed because of infection (n = 2) or recurrent deformity (n = 2); no implant was removed because silicone synovitis developed. With revision as the endpoint, the implant survival rate was 93% at 10 years, and with radiographic implant fracture as the endpoint, the implant survival rate was 87% at 10 years. Shortening oblique osteotomy of the lateral toes appeared to decrease the rate of implant fracture and should be performed concomitantly with implantation when rheumatoid forefoot deformities are being reconstructed.

Adult↗
PubMedDate not supplied

Reconstruction of adactyly for 4th and 5th toes: the study of foot pressure.

Analysis of foot pressures in cases of reconstructed adactyly of the lateral toes is presented. Two cases with adactyly of the 4th and 5th toes in which new toes were created by cross-knee tubed pedicle flap were chosen and foot pressures of both the operated foot and the contralateral normal foot were measured postoperatively. The results did not indicate any functional disturbance after this method of reconstruction.

Female↗
PubMed1992

Operation for polysyndactyly of the fifth toe using Z-plasty.

A new operative procedure was devised to treat polysyndactyly of the fifth toe. This procedure, which consists of removal of the fifth toe, correction of the alignment of the preserved sixth toe by arthroplasty and construction of an interdigital space by Z-plasty, is technically simple and produces good results, both functionally and aesthetically.

Adolescent↗
PubMed1988

Effects of gravity on regional and capillary blood flows in the human toe.

The purpose of this study was to investigate the relative effects of gravity on capillary and regional blood flows in human extremities. Eighteen male subjects 20 to 40 years of age consented to have capillary blood cell velocity (CBV) measured in nailfold vessels of the large toe via video densitometry, and to have total blood flow (TBF) to the toe measured via plethysmography. These measurements were made first with the foot at heart level (HL), then after the foot had been lowered an average of 56 cm below the heart (BH). In the HL position CBV and TBF averaged respectively 0.26 mm/sec and 2.0 ml/min/100 ml. Lowering the foot elicited a decrease in CBV in all vessels studied (P less than or equal to 0.001). Average CBV in the BH position was 0.11 mm/sec. By contrast TBF on the average increased to 2.9 ml/min/100 ml in the BH position (P less than or equal to 0.05). However, this was not a consistent finding since both increases and decreases in TBF were observed among the individual subjects. These results indicate that the immediate precapillary vessels in the cutaneous circulation of the toe will consistently vasoconstrict when the foot is placed in a dependent position. However, the net effect on vessels governing regional flow in this area, e.g., A-V shunts, appears to result from a competition between dilator and constrictor influences. The overall result of these adjustments is that during orthostasis blood is shifted away from the superficial capillaries of the lower extremities. The relevance of this to blood-tissue fluid balance is discussed.

Adult↗
PubMed1993

Fundamental patterns and characteristics of the laser-Doppler skin blood flow waves recorded from the finger or toe.

Three different components, Basic Wave (BW), Cardiac Wave (CW) and Reflex Wave (RW), among the laser-Doppler (L-D) skin blood flow waves on the finger- or toe-tip, were studied in 32 healthy volunteers. The cycle of the rhythmic BW was 8.1 +/- 1.7.min-1 and was independent of respiratory movements. The BW was synchronous with the baseline fluctuation in the digit-photoplethysmogram. Power spectral analysis of rhythmic fluctuations in the simultaneously recorded R-R interval on ECG, systolic blood pressure, and L-D skin blood flow disclosed that the BW was correspondent with the Mayer wave, i.e., low frequency component. The cycle of the CW was consistent with the heart rate and was superimposed on the BW. The RW was a transient marked reduction in blood flow, which was induced by a deep inspiration or various sensory stimuli. A sympathetic skin response on the palm and a venoconstrictive response on the occluded arm were observed concomitantly with the RW. Good synchronization was observed in each component of the L-D skin flow waves between the fingers and toes. These findings suggest that the BW and the RW on the finger- or toe-tip are predominantly driven by tonic and reflex phasic activities of descending sympathetic outflows via the supraspinal center, respectively.

Adult↗
PubMed1991

Free toe pulp transfer in thumb reconstruction. Experience in the West of Scotland Regional Plastic Surgery Unit.

We report a detailed evaluation of 13 patients who have undergone free toe pulp transfer in thumb reconstruction at the West of Scotland Regional Plastic Surgery Unit. Using the lateral aspect of the great toe pulp, the average time for transfer was 7.5 hours and the average moving 2 P.D. achieved in the thumb reconstructions was 9.6 mm. Morbidity in the donor toe was minimal, but pain and hypersensitivity limited the usefulness of some reconstructed thumbs and cold intolerance was frequent (73%).

Accidents, Occupational↗
PubMed2005

A case of toe macrodactyly treated by application of a vascularised nail graft.

Macrodactyly is a relatively rare congenital abnormality of the fingers and toes and is difficult to treat. We report a new method for treating toe macrodactyly in which a nail with a vascularised pedicle is raised, the toe is shortened to an appropriate length, and the nail transferred to an aesthetically appropriate proximal site. Although this technique is of a higher level of difficulty than conventional procedures involving pedicled nail flaps, allows aesthetically more favourable nail reconstruction by single-stage operation.

Adult↗
PubMed2006

Precision grip function after free toe transfer in children with hypoplastic digits.

Although toe-to-hand transfer has a defined role in the management of congenital hand deformities, it remains unclear how well children integrate the transferred digits into physiological grasping. We analysed fingertip forces in the precision grip of 13 patients when lifting a test object more than three years after free toe transfer for absent or hypoplastic digits. Clinically, most patients showed normal sensibility of transferred digits, but active motion and pinch strength were limited as compared to the normal hand. For the control of fingertip forces, two key features of the normal two-digit opposition grip were seen in all operated hands: adaptation of grip force to object weight and parallel coordination of lift and grip forces. These physiological grasping strategies developed independently of the patients' age at the time of operation, which ranged from one to 13 years. In four patients, we observed increased tangential load forces with the operated hand due to misalignments in the application of fingertips on the grasp surfaces. Such forces lead to increased grip force requirements on both fingers that may overload transferred digits with limited motor function. The need for optimal alignment of the grip axis during toe-transfer surgery is emphasised.

Adaptation, Physiological↗
PubMed2005

Painful foot neuromas after toe-to-thumb transfer.

Reconstruction of the thumb by transfer of a toe has evolved technically to the point that this complex procedure can result in a mobile, sensate, and aesthetically pleasing digit that contributes to an almost-normally functioning hand. Donor site deformity is well recognized, primarily as it relates to the appearance of the foot after transfer of the hallux to the thumb position and stiffness of the remaining portions of the big toe. The present report describes donor site disability related to painful neuromas of the superficial and deep peroneal nerves and the common plantar digital nerve to the first webspace. Salvage of the disabled donor foot is possible by applying techniques used to treat painful neuromas of the upper extremity, neuroma resection, and muscle implantation. The specific techniques used in treating this painful foot donor site after toe-to-thumb transfer are described.

Adult↗
PubMed2004

The indications for toe transfer after "minor" finger injuries.

Toe-to-hand transfer is widely considered to be unjustified for "minor" finger injuries. In this invited personal view article the indications for toe-to-hand transfer for finger amputation and neurocutaneous and major pulp defects are discussed, and a classification of multidigital injury that has both prognostic and decision-making value is presented. In the author's opinion a toe transfer should always be considered as an option when reconstructing "minor" finger injuries, as it can reproduce significant long-term benefit to the hand and the patient's sense of well being. The procedure should be carried out in the acute period, not only because it is technically easier and better for hand function, but above all because the surgeon can save structures that will be lost if the transfer is delayed.

Amputation, Traumatic↗
PubMed2003

Free hand-to-toe transfer: a method to minimise donor-site morbidity in free joint transfers.

Reconstruction of a congenital hand anomaly in a child using single free vascularised transfer of the proximal interphalangeal joint of a second toe with the simultaneous microvascular reconstruction of the donor toe using the stiff joint and its dorsal skin paddle from the hand is described. This is not the first reported case of a toe-finger switch, but it is the first in a free joint transfer, for which it is especially indicated.

Child, Preschool↗
PubMed1995

Thumb reconstruction with extended twisted toe flap.

Twelve amputated thumbs were reconstructed with a neurovascular cutaneous flap from the great toe and an osteotendinous flap from the second toe. Both transfers were dependent on a single vascular pedicle. One of the 12 reconstructions failed. In the remaining 11, the mobility of the metacarpophalangeal joint ranged from 10 degrees to 50 degrees, and that of the interphalangeal joint from 10 degrees to 30 degrees. Opposition and key pinch were restored, and the shape and volume were similar to those of the normal thumb. Likewise, the great toe was preserved, and all patients had a normal gait. This technique preserves the epiphyses for future growth in children and maintains the aesthetic appearance of the foot, but it has the disadvantage of involving a lengthy surgical procedure with a 17% rate of major complications.

Adolescent↗
PubMed1978

Microvascular second toe transfer for digital reconstruction.

Reconstruction of a severely damaged hand, with multiple amputations of digits, presents a difficult reconstructive problem. The development of a safe method of transfer of the great toe for thumb reconstruction, using the dorsalis pedis artery and the saphenous vein, suggested the possibility of one-stage microvascular transfer of the second toe for reconstruction of fingers. In two patients a one-stage transfer of the second toe was done to replace an index finger and in another for restoration of part of the left ring finger. The transplants survived without anticoagulants and vessel complications were not encountered. Sensory return was adequate and a significant improvement in function was achieved.

Accidents, Occupational↗
PubMed1981

Free transfer of a large sensory flap from the first web space and dorsum of the foot including the second toe for reconstruction of a mutilated hand.

A 19-year-old man sustained a mutilating crush injury in August, 1978, in an 80-ton punch press. The injury resulted in transmetacarpal amputations of the index through little fingers. The thumb was revascularized by microvascular anastomoses. The replanted index to the little finger position failed. A free transfer of the patient's second toe to the fifth metacarpal was done to provide a post to oppose the thumb. The first web space of the toe was used in expanding the contracted single cleft of the hand. The innervated dorsal foot flap provided coverage for the dorsal surface of the hand. Anatomically, the entire composite transfer was supported by the dorsalis pedis artery anastomosed to the radial artery. The nerve sutures were between the plantar digital nerves and sensory fascicles of the median nerve and the deep peroneal to the dorsal branch of the radial. The extensor and flexor tendons were also repaired. This procedure differs from the neurovascular island transfer of the first web described by Strauch and Tsur by inclusion of the second toe in the free transfer.

Accidents, Occupational↗
PubMed1983

Evaluation of sensibility and function with microsurgical free tissue transfer of the great toe to the hand for thumb reconstruction.

Detailed evaluation of sensibility and function on 10 patients was carried out on an average of 42 months after thumb reconstruction by microsurgical free tissue transfer. Sensibility based on modified two-point discrimination and ridge criteria was found to be directly related to the patient's age at time of neurosuture. The plantar aspect of the distal 2 cm of the normal toe showed two-point value averaging 6 mm in 20 normal shoe-wearing adults, compared to values of 12 mm when the toe was tested over the plantar surface of the proximal half of the distal phalanx. Metacarpophalangeal joint motion and interphalangeal joint motion were limited when compared with the opposite normal thumb and unoperated great toe. Grip strength and pinch strength reflected the degree of associated injuries in the hand. Cold intolerance was present in all patients. Patients' subjective assessment of their ability to use their hand as compared to their hand prior to injury was rated at less than 10% preoperatively compared to 52% to 87% postoperatively. None of the patients perceived a problem of social acceptance after the surgery. Postoperative studies of the feet revealed concentration of weight bearing between the second and third metatarsal heads on Harris mat studies and slowing of the forward and medial progression of the center of pressure on gait analysis. Some weakness in push-off and cutting maneuvers in sports activities was reported in half of the patients. None of the patients experienced difficulty when running long distances on level ground. All the patients returned to gainful employment postoperatively.

Adolescent↗