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PubMed2002

Polydactyly of the foot. Literature review and case presentations.

Polydactyly is a fairly common congenital condition of the foot and is characterized literally by supernumerary toes (digit or metatarsal). The frequency of polydactyly varies widely among populations. It may be an isolated condition or part of a congenital syndrome. Polydactyly is generally classified into three major groups: medial ray (preaxial), central ray and lateral ray (postaxial). The duplication may appear at the distal and middle phalanges or at the whole digit and metatarsal. The complexity of the deformity ranges from a simple soft-tissue problem to a completely developed accessory ray. Careful clinical and radiographic evaluation should be made prior to treatment to achieve good functional and cosmetic results. Most cases are treated during childhood before walking age. Adult cases are more rare, and surgical management of the deformity is still debated. Nevertheless, surgery can be performed at any age as in our series with good results.

Adult↗
PubMed1997

[Inflammatory foot disease].

The pathology of the foot is frequent in the inflammatory rheumatisms. It can finally contribute to the diagnosis. In rheumatoid arthritis, the metatarso-phalangeal joint involvement appears earlier and more obvious. The lesion of the midrearfoot is later and the beginning is more indisious, they often evolve in pes plano valgus deformity. In spondylarthropathies the involvement of the heel and of the toes predominates, but there are more specific symptoms for each disease particularly for the psoriasic rheumatism. Local cares, plantar orthoses, casts, corticosteroid injections, synoviortheses as well as a good hygiene of life are very useful. Surgery helps to keep the functional ability of the patient and its indications must be known.

Adult↗
PubMed1995

Advances in microsurgical reconstruction of the congenitally adactylous hand.

A series of 18 microsurgical toe transfers for congenitally adactylous hands was done from 1983 to 1994. The functional results achieved depended on the approach and technical features applied to hand reconstruction in congenital amputations. Function was improved significantly by using 3-jointed second toes, including the metatarsophalangeal joint, and by performing meticulous intrinsic repair. The use of donor arteries changed during the 11-year study period toward the goal of perfect revascularization with a minimized ischemic time. Abundant nerve supply was found to be important for achieving near normal growth of the transferred digit. The results showed improvement in the use of the defective extremities. The ability to pinch was restored successfully in 14 of 17 congenitally defective extremities. Growth measurements were obtained from 11 transfers at followup, which ranged from 1.5 to 6 years (mean, 4 years). Linear growth was observed at the phalangeal epiphyses, whereas the metatarsal head epiphyses showed clear disturbances in at least 2 patients.

Child↗
PubMed1995

Clinical study of symbrachydactyly of the foot.

Seventeen patients with symbrachydactyly of the foot are described. Patient characteristics including sex, the side of the affected foot, age at first medical examination, and condition of the nails were recorded. Compared with the unaffected side, the lengths of the proximal phalangeal and metatarsal bones were significantly shorter. The abnormalities of the feet were classified into four types: typical axial, atypical axial, medial ray, and rudimentary. The anomaly progresses from hypoplasia of the central rays to a deformity of the great toe, but rarely involves the fifth toe. The fact that this differs from symbrachydactyly of the hand is of considerable interest.

Adolescent↗
PubMed2000

[Clinical evaluation of frozen-phalanx-joint-tendon-sheath composite tissue allograft].

OBJECTIVE: To evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen-phalanx-joint-tendon-sheath composite tissue allograft in 270 cases. METHODS: The patients were followed up with reexamination in the ambulant clinic, communication, X-ray photography, lab-examination, isotope 99mTc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years). RESULTS: Enveloping the allogeneic finger composite tissue with self-HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two-point discrimination was 3 mm to 15 mm. The junction between implanted allo-phalanges and auto-phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99mTc MDP was used to take X-ray photography in 24 cases for four months to 9 years and seven months, which showed that the blood vessels grew into the allo-phalanges. However, the Charcot's arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft. CONCLUSION: The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self-phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption.

Adolescent↗
PubMed1997

Radiographical assessment of interphalangeal rotation in the evaluation of equine digital conformation.

This study is a part of a work to design a radiographical method to objectively define the conformation of an equine digit and to assess the individual appropriate trimming of a horse. Various angles were measured directly from the phalangeal bones. The authors observed that the bone relief of the sesamoid ligament insertions on the proximal phalanx was an essential landmark to determine the phalangeal alignment. The same angles were measured from specific radiographs and made it possible to quantify the rotation imposed to the proximal phalanx. The authors also noticed that the phalangeal rotation had little influence on the radiographic image of articular asymmetry.

Animals↗
PubMed1996

[Treatment of hallux valgus by varus osteotomy of the first phalanx associated with adductor plasty].

PURPOSE OF THE STUDY: Sixty two hallux valgus treated by first phalanx varus osteotomy associated to adductor hallux plasty were reviewed with a minimum follow-up of 4 years. MATERIAL AND METHODS: 48 females and 2 males were operated. Average age was 46 years. The forefoot was grecian 40 times. The pre-operative metatarsus varus was at an average of 14.2 degrees when the metatarso-phalangeal valgus was 33.3 degrees. The interphalangeal valgus was 8.25 degrees. The first phalanx base lateral translation measured an average of 5.8 mm. Sesamoids were always dislocated. 36 patients were treated in the same operative time, using this associated approach at different level. RESULTS: Results were evaluated according to 3 Groulier's criteria. In 10 cases, a post-operative pain persisted. Shoe wearing continually improved. The great toe valgus was corrected in 31 cases (50 per cent). The correction was partial in 20 cases (32.3 per cent) but on radiographs, only 34 cases (54.8 per cent) conserved a normal joint space. The first phalanx base lateral translation only improved partially. It measured an average of 408 mm. The global result was good in and very good, 67 per cent, while patients subjective estimation was good or very good in 90.3 per cent. DISCUSSION: The study of this series of first phalanx varus osteotomy associated to adductor plasty shows lateral subluxation partial correction, factor of long term modification on articular metatarso-phalangeal joint space. The adductor plasty associated to abductor disinsertion showed a results improvement compared with other published series. CONCLUSION: The first phalanx varus osteotomy associated to adductor plasty should be limited to moderate hallux valgus deformity with interphalangeal valgus and without any major articular incongruity.

Adult↗
PubMedDate not supplied

Digital gangrene associated with idiopathic hypereosinophilia: treatment with allogeneic cultured dermal substitute (CDS).

In the present case study, the patient was a 65-year-old man who suddenly developed purpuric and necrotic lesions with severe pain in his fingers and toes. Laboratory investigations revealed marked eosinophilia (77.9%), but there was no evidence to support a diagnosis of parasitic infections, allergic disease, neoplasm or connective tissue disorder. The histopathological findings did not show any distinct vasculitis, but there were obliterative changes of the arterioles. The digital gangrene gradually progressed and was unresponsive to corticosteroid therapy. The patient eventually underwent amputation of the distal phalanges. We applied allogeneic cultured dermal substitute (CDS) to the skin defect. The allogeneic CDS was prepared by culturing fibroblasts on a two-layered sponge of hyaluronic acid and atelo-collagen. This CDS is able to release a number of cytokines including VEGF. The present case had a good clinical result.

Aged↗
PubMed1991

Pre- and postnatal growth retardation--severe mental retardation--acral limb deficiencies with poorly keratinized nails. Another example of a distinct syndrome of inherited intrauterine dwarfism?

In this report, we further delineate an autosomal recessive syndrome with prenatal growth retardation, severe postnatal growth failure, profound mental and motor retardation, characteristic face and acral limb deficiencies with poorly keratinized nails and hypoplastic distal phalanges.

Child Development↗
PubMed1981

Comparison of two surgical procedures for arthrodesis of the proximal interphalangeal joint in horses.

Arthrodesis of the proximal interphalangeal joint in horses, with 2 screws crisscrossing the joint, was compared with arthrodesis achieved by placement of 3 screws crossing the joint parallel to the long axis of the bone. The comparison was made by means of radiography, gross and histologic examinations, and motion evaluation. Additionally, the fused 1st and 2nd phalanges resulting from each method were subjected to breaking forces. Motion evaluation and direct examination of the fused area demonstrated that either procedure can be used to achieve arthrodesis consistently, and the breaking procedure indicated that the fused joints were as strong or stronger than areas penetrated by the cortical screws used in internal fixation. The fused area resulting from the parallel procedure was stronger than that from the crisscross procedure. The parallel procedure was easier, gave better alignment of 1st and 2nd phalanges, and was prone to less error in screw placement. It was concluded that arthrodesis by either procedure was satisfactory for treating osteoarthritis and related problems of the proximal interphalangeal joint in horses, but that the parallel procedure created a superior union between the 1st and 2nd phalanges during the first 120 postoperative days.

Animals↗
PubMed1996

Sequential changes of programmed cell death in developing fetal mouse limbs and its possible roles in limb morphogenesis.

Apoptotic cell death in the developing limb of mouse fetuses was examined sequentially on days 11-15 of gestation by means of Nile blue (NB) sulfate staining with special reference to its relation to limb morphogenesis. With some exceptions, programmed cell death (PCD) in the hand and foot was observed in the mesenchyme but not in the surface ectoderm. We found that during digital formation PCD begins at the proximal portion of the interdigital mesenchyme and subsequently expands distally. Therefore, the initial PCD that occurs in the interdigital zones may determine the proximal ends of digital separation and also contribute to the demarcation between the palm (sole) and digits (toes). During digital separation, the areas of PCD in the interdigital zones were found to become larger and expand distally on day 13, which may be necessary for the separation of digits and for determining the interdigital area to disappear. PCD in presumptive phalangeal joints was also found to proceed from proximal to more distal joints. The PCD in presumptive joints may be required for the separation of phalanges and metacarpal (metatarsal) bones and for the formation of joint cavities. In addition, intense PCD was observed in the radial (tibial) and ulnar (fibular) margins of the hand and foot plates for 4-5 days. Such PCD at marginal areas seems to prevent the formation of supernumerary digits (preaxial and postaxial polydactyly) and other digital malformations. Therefore, the timing when PCD commences and ends, the sites where PCD occurs, and the intensity, duration, and proximo-distal progress of PCD appear to be genetically determined, and the elimination of unnecessary cells by PCD may be essential for normal limb morphogenesis. The present findings also suggest that the normal progress of PCD in the hand and foot plates of rodent fetuses may prevent the formation of some limb malformations such as webbing fusion of digits, polydactyly, or cleft hand/foot.

Animals↗
PubMed2004

Cenani-Lenz syndactyly in a patient with features of Kabuki syndrome.

We report a 5 9/12-year-old male with Cenani-Lenz syndactyly (CLS). He presented with three malformed digits on each hand and bilateral 2,3 partial cutaneous toe syndactyly. The expression of this presumed autosomal recessive disorder is variable and has been confused with split hand foot malformation (SHFM). Not all CLS patients show the typical 'spoon hand' configuration originally described. Affected CLS patients show a disorganized appearance of the phalanges with some degree of syndactyly/oligodactyly, in addition to metacarpal and carpal fusions. Radioulnar synostosis may be present. Cases lacking radioulnar synostosis may show proximal dislocation of the radial heads. The distal limb anomalies seen in our patient resemble other reported CLS patients. Radiographic evaluation showed a disorganized appearance of the phalanges, a 'kissing delta phalanx' of one proximal phalanx, metacarpal fusions, carpal coalitions and posterior subluxation of the radial heads. Clinical examination revealed features suggestive of Kabuki syndrome including large, prominent ears, sparse, medially flared and arched eyebrows, wide palpebral fissures, long eyelashes, and oligodontia with flat head 'screwdriver-shaped' incisors, in addition to persistent finger and thumb-tip pads. The faces of CLS patients are rarely shown or described. However, some patients in published reports have large, prominent ears. A recent report suggested midfacial dysmorphism in two patients with CLS (). Although the findings of CLS with features of Kabuki syndrome in our patient may be coincidental, the faces of CLS patients need to be carefully evaluated and described to determine if there is a distinctive accompanying facial phenotype.

Bone and Bones↗
PubMed1980

Acrolysis in pachydermoperiostosis. Primary or idiopathic hypertrophic osteoarthropathy.

A 45-year-old black woman was admitted for correction of an equinus deformity of the right lower extremity that resulted from shortening of the Achilles tendon. She exhibited classic findings of pachydermoperiostosis, including clubbing of the digits, periosteal new bone formation, and hypertrophy of skin and its adnexa, associated with several facial acne. In addition, she showed excessive resorption of distal phalanges of the hands and feet, a finding heretofore unreported in pachydermoperiostosis, to our knowledge. Reduced peripheral blood flow has been observed in patients with pachydermoperiostosis; the resorption of distal phalanges observed in our patient may have resulted from this mechanism.

Bone Resorption↗
PubMed1992

[Quintus varus supraductus. Results of the surgical treatment by cutaneous graft, internal capsulotomy and external transfer of the extensor of the 5th toe].

The overlapping fifth toe has often a congenital origin. It may be isolated or associated with an another pathology, congenital or acquired, but the relationship between them. Cannot be ascertained. The overlapping fifth toe is responsible for an esthetic deficit and/or a functional discomfort, it justifies a correct surgery. Twenty-one feet in 16 patients aged from 2 to 30 years (especially between 5 and 15 years) have been operated on and reviewed after a mean follow-up of 4 years. The technic associated a cutaneous dorsal Z-plasty on the cutaneous retraction a medial and dorsal capsulotomy of the metatarso-phalangeal joint, an external transfer of the fifth extensor tendon or its tenotomy and, in 10 cases, a plantar skin resection 19 results were excellent, one fair result and one failure. The condition of a stable result seems to be based on a complete and spontaneous correction of the deformity at the end of the operation.

Adolescent↗
PubMed1996

Rhomboid design for tubed inguinal flap in fingertip reconstruction.

The authors present a rhomboid design for the tubed inguinal flap mainly nourished by the superficial circumflex iliac vessels and the superficial inferior epigastric vessels. The length and width of the flap are mathematically determined based on the perimeter and length of the fingertip soft-tissue defect, respectively. The rhomboid tubed inguinal flap was used in the treatment of 21 patients with a variety of fingertip injuries. The thumb was involved in 12 patients and other digits in 9 patients. A complication, flap necrosis, occurred in one obese female patient and osteomyelitis of an amputated phalangeal bone developed in another. In all other patients, the rhomboid tubed inguinal flap healed uneventfully and provided satisfying results with minimal donor site morbidity. As a secondary procedure in thumb injuries, four neurovascular island flaps and one wrap around flap from the great toe were done for improved sensation. The precisely tailored rhomboid flap, with a safe and abundant vascular pedicle, allows for effective reconstruction of the fingertip with easy primary closure and minimal morbidity of the donor site.

Adult↗
PubMedDate not supplied

[Early results of implantation of an unconstrained metatarsophalangeal joint prosthesis of the first toe].

PURPOSE: Does the ReFlexion Implant System provide an alternative in operative treatment of hallux rigidus? METHODS: We have been using the non-constrained prosthesis since April 1997. 26 implants were reviewed 13-41 months after insertion, analysing radiological and clinical data. A questionnaire was answered by the patients. RESULTS: Surgery was either performed cementless (8 cases), as a hybrid, i.e., only phalangeal part cemented (14 cases), or cemented in both components (4 cases). So far, 3 joint replacements had to be removed for pain. Radiological signs of loosening around the cemented phalangeal components were evident in 11 cases. There was no correlation between radiological loosening and discomfort. CONCLUSIONS: The implant can reduce pain distinctly. Patients satisfaction with the treatment is relatively high. The range of movement in the first MTP is still limited. In our opinion the ReFlexion Prosthesis can be quoted as an acceptable alternative for surgical treatment in advanced cases of hallux rigidus. In case of failure a conversion to the distraction-arthrodesis is possible.

Aged↗