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At least 487 records · Page 27Linked to original sources
PubMed1986

The blue toe syndrome: hemodynamics and therapeutic correlates of outcome.

We reviewed the limb and digit hemodynamics of 67 extremities of 48 patients evaluated for blue toe syndrome in our vascular laboratory during 7 years. These patients represented 1.4% of the arterial examinations during this period. Abnormal ankle/arm pressure indices (less than 0.9), signifying proximal arterial obstruction, were present in 31 limbs (47%). Toe/ankle indices were abnormal (less than 0.6) in 57 extremities (85%), indicating pedal or digital artery obstruction. Arteriograms were obtained in 40 of 64 extremities (63%) available for follow-up, which revealed atherosclerotic disease in 90% (aortoiliac 20%, femoropopliteotibial 30%, and combined 40%), aneurysm in 7.5%, and no disease in only one extremity (2.5%). Of 64 extremities followed for 1 to 84 months (mean, 26 months), only 28 (44%) manifested an uncomplicated outcome. Tissue loss was noted in 24 (38%), recurrent digital ischemia occurred in nine (14%), and 14 limbs (22%) required amputation of toe(s) (seven), forefeet (three) or legs (four). Nine patients (20%) died in the follow-up period. Outcomes did not correlate with limb or digit hemodynamics or with therapy (surgical in 31, medical in 11, or none in 22) except that tissue necrosis was more common in patients undergoing operation. The blue toe syndrome deserves recognition as an important sign of potential limb-threatening arterial disease, but the optimal therapy remains to be established.

Adult↗
PubMed2000

The usefulness of a laser Doppler in the measurement of toe blood pressures.

OBJECTIVE: The purpose of this study was to evaluate the clinical value and reproducibility of laser Doppler (LD) versus photoplethysmography (PPG) in the measurement of the systolic toe blood pressure. METHODS: Toe blood pressure was measured in 60 patients in different stages of peripheral vascular disease with simultaneous digital sampling of PPG and two LD signals, each with a different filter setting (3 second [LD(3)] and 0.03 second [LD(0.03)]), and cuff pressure. These measurements were repeated after 1 week. The signals were analyzed with previous results ignored. The agreement of the PPG and LD pressures and reproducibility after 1 week were assessed by calculating the intraclass correlation coefficient (ICC). The agreement variation across the range of pressure values was visually explored by means of difference plots. RESULTS: In 19 legs with a very low pressure only LD could adequately measure the pressure, whereas PPG did not. The ICCs between PPG and LD(3) and LD(0.03) were 0.95 or more. The ICCs of the 1-week reproducibility of the PPG, LD(3), and LD(0.03) pressures were 0.92, 0.88, and 0.86, respectively. The variation was equally distributed across the range of pressures in all three methods. CONCLUSION: LD is a reliable alternative to PPG to measure toe blood pressures. Furthermore, LD is able to measure low pressures, which is relevant in the assessment of the presence of critical ischemia.

Aged↗
PubMed2006

Adhesion and friction in gecko toe attachment and detachment.

Geckos can run rapidly on walls and ceilings, requiring high friction forces (on walls) and adhesion forces (on ceilings), with typical step intervals of approximately 20 ms. The rapid switching between gecko foot attachment and detachment is analyzed theoretically based on a tape model that incorporates the adhesion and friction forces originating from the van der Waals forces between the submicron-sized spatulae and the substrate, which are controlled by the (macroscopic) actions of the gecko toes. The pulling force of a spatula along its shaft with an angle between theta 0 and 90 degrees to the substrate, has a "normal adhesion force" contribution, produced at the spatula-substrate bifurcation zone, and a "lateral friction force" contribution from the part of spatula still in contact with the substrate. High net friction and adhesion forces on the whole gecko are obtained by rolling down and gripping the toes inward to realize small pulling angles between the large number of spatulae in contact with the substrate. To detach, the high adhesion/friction is rapidly reduced to a very low value by rolling the toes upward and backward, which, mediated by the lever function of the setal shaft, peels the spatulae off perpendicularly from the substrates. By these mechanisms, both the adhesion and friction forces of geckos can be changed over three orders of magnitude, allowing for the swift attachment and detachment during gecko motion. The results have obvious implications for the fabrication of dry adhesives and robotic systems inspired by the gecko's locomotion mechanism.

Adhesiveness↗
PubMed1992

The mutant axolotl Short toes exhibits impaired limb regeneration and abnormal basement membrane formation.

The mutant axolotl Short toes develops with abnormal kidneys, Mullerian ducts, and limbs and provides one of the few experimental systems for developmental studies in amphibia. The present paper describes another deviation from this animal's normal physiology, which is very characteristic of the wild type: amputated limbs of Short toes fail to regenerate. A blastema is formed but differentiation does not occur. Detailed histological analysis provides evidence of abnormal formation of the basement membrane and accumulation of extracellular matrix within the blastema, which could be attributed to an imbalance of extracellular matrix and basement membrane proteins. The basement membrane develops much thicker and is convoluted in the arrested blastema of mutant animals. In contrast to the limbs, the tails of Short toes regenerated normally with no apparent abnormalities. No gross genomic aberrations have been detected between normal and mutant DNA, indicating that a large deletion or insertion is not likely to be the cause of this mutation.

Ambystoma↗
PubMed2003

Comparative analysis of Dp427-deficient mdx tissues shows that the milder dystrophic phenotype of extraocular and toe muscle fibres is associated with a persistent expression of beta-dystroglycan.

The cell biological hypothesis of Duchenne muscular dystrophy assumes that deficiency in the membrane cytoskeletal element dystrophin triggers a loss in surface glycoproteins, such as beta-dystroglycan, thereby rendering the sarcolemmal membrane more susceptible to micro-rupturing. Secondary changes in ion homeostasis, such as increased cytosolic Ca2+ levels and impaired luminal Ca2+ buffering, eventually lead to Ca2+-induced myonecrosis. However, individual muscle groups exhibit a graded pathological response during the natural time course of x-linked muscular dystrophy. The absence of the dystrophin isofom Dp427 does not necessarily result in a severe dystrophic phenotype in all muscle groups. In the dystrophic mdx animal model, extraocular and toe muscles are not as severely affected as limb muscles. Here, we show that the relative expression and sarcolemmal localization of the central trans-sarcolemmal linker of the dystrophin-glycoprotein complex, beta-dystroglycan, is preserved in mdx extraocular and toe fibres by means of two-dimensional immunoblotting and immunofluorescence microscopy. Thus, with respect to improving myology diagnostics, the relative expression levels of beta-dystroglycan appear to represent reliable markers for the severity of secondary changes in dystrophin-deficient fibres. Immunoblotting and enzyme assays revealed that mdx toe muscle fibres exhibit an increased expression and activity of the sarcoplasmic reticulum Ca2+-ATPase. Chemical crosslinking studies demonstrated impaired calsequestrin oligomerization in mdx gastrocnemius muscle indicating that abnormal calsequestrin clustering is involved in reduced Ca2+ buffering of the dystrophic sarcoplasmic reticulum. Previous studies have mostly attributed the sparing of certain mdx fibres to the special protective properties of small-diameter fibres. Our study suggests that the rescue of dystrophin-associated glycoproteins, and possibly the increased removal of cytosolic Ca2+ ions, might also play an important role in protecting muscle cells from necrotic changes.

Animals↗
PubMed2004

Agility, gnosis, and graphaesthesia for the toes and fingers in children: normative data (ages 7-14 years).

The differential representation of the toes/feet and fingers/hands along the medial and lateral surfaces of the cerebral cortices, respectively, may have diagnostic utility. Normative data for errors for toe and finger graphaesthesia and gnosis, as well as foot and finger agility, were collected for 86 children (ages 7 to 14). The fingers were more agile than the feet, and the right side of the body was more agile than the left side, regardless of age. A marked improvement in toe gnosis, but not in finger gnosis occurred in children after 11-12 years of age. A statistically significant interaction between laterality and gender was due to the greater numbers of errors for both toe and finger gnosis, displayed by girls for the left sides of their bodies compared to their right sides. This discrepancy was not significant for boys.

Adolescent↗
PubMed1988

Repeatability of peripheral pulse measurements on ears, fingers and toes using photoelectric plethysmography.

Peripheral pulses have been recorded and analysed to determine the accuracy with which pulse transit times (PTTs) can be measured. Measurements of PTT between the ECG Q-wave and various peripheral sites were made in 10 normal subjects on 10 separate days. Mean values were determined for the ears (174 ms), fingers (245 ms), and toes (361 ms). The technique was sufficiently accurate to detect small changes in PTT due to changes in posture; sitting to lying, 5.2 ms. When comparing simultaneous measurements on bilateral sites only small differences in PTT were discovered, and these were not significant in the study group as a whole. However, these differences were significant in some individuals. When the subjects raised a single arm or leg, significant differences (38 ms and 49 ms respectively) were recorded between sides. The day-to-day repeatability sigma (expressed as the square root of the within-subject mean square variance) of individual PTT measurements on a subject (supine) was for ears, fingers and toes respectively 9.4, 9.2 and 12 ms. For right-left differences the repeatability was 7.2, 5.9 and 14 ms. Hence changes in PTTs, or differences between right and left sides, can be detected from single measurements with 95% confidence if they exceed approximately 20 ms in ears or fingers and 30 ms in toes.

Adult↗
PubMed1995

Intraosseous wiring in toe-to-hand transplantation.

Although there are many reports on bony fixations in finger replantations, information pertaining to fixation methods in toe-to-hand transplantations is scarce. The results of intraosseous wiring were evaluated in 68 toe-to-hand transplantations in 47 patients. Clinical and radiological evaluation of bony union was conducted an average of 30 months after the procedure. There was no malunion. There was one painless pseudarthrosis, with an overall nonunion rate of 1.5%. Intraosseous wiring is a simple, quick, dependable, and consistent method of fixation in toe-to-hand transplantation.

Adolescent↗
PubMed1977

Gangrene of toes with normal peripheral pulses.

Ten patients with pregangrenous and gangrenous changes of the toes in the presence of normal peripheral pulses are described. In the absence of diabetes this is an uncommon condition and is only rarely reported upon in the literature. Four patients had non occlusive arteriosclerotic changes in large arteries; three suffered from thrombocytosis and one from polycythemia vera; one patient had a monoclonal gamopathy and one was exposed to cold three months before the onset of gangrene. None of these patients smoked regularly. Severe pain usually preceded the gangrene. The process did not progress proximally in any patients, and in those who underwent toe amputations the healing was uneventful. Vasodilators and low-molecular dextran were not effective. Lumbar sympathectomy was performed in three patients, also with no effect on the course of the disease. Treatment of hematological disorders gave relief in three patients. Proximal arteriosclerotic changes should be corrected if possible to eliminate a source of emboli. In two patients anti-platelet aggregation agents provided relief. Toe amputation should be conservative and performed when definite demarcation appears between necrotic and viable tissue. This condition has a benign prognosis.

Adult↗
PubMed2001

Complications of lesser toe surgery.

Surgical procedures for lesser toe problems are among the most common surgeries done on the foot. In a shoe wearing population, the incidence of lesser toe pathologic disorders is high. The complications associated with lesser toe surgery can be troublesome for patients and physicians. Understanding the possible common complications and how to avoid them is essential to maximizing satisfactory clinical results.

Biomechanical Phenomena↗
PubMedDate not supplied

The stubbed great toe: importance of early recognition and treatment of open fractures of the distal phalanx.

Stubbing injuries to the great toe can be a cause of occult open fractures and osteomyelitis. Five such patients were identified after conducting a retrospective review of injuries to the hallux between January 1998 and December 1998. The study was conducted to draw attention to the association between this trivial trauma and its possible complications. All five children had open fractures of the distal phalanx of the great toe. Osteomyelitis did not develop in the children whose injuries were recognized early and who were treated with antibiotics. However, three children with delayed diagnoses and treatment developed osteomyelitis. At a mean follow-up of 10 months (range, 9-11) after injury, all five fractures had healed with no active signs of infection. Two of these children experienced a partial growth arrest and two experienced a full growth arrest of the distal phalanx of the great toe, the significance of which is yet unknown. Clinical signs such as bleeding from the eponychium and a laceration proximal to the nail bed should alert physicians to the presence of a possible open fracture. Early detection and treatment of these injuries may reduce or eliminate hospital stays and prolonged intravenous antibiotic treatment for osteomyelitis.

Child↗
PubMed1980

Toe-to-hand transfer.

Toe-to-hand transfer was performed in 28 patients, involving 33 fingers, using microvascular technique. Of this number, 26 patients (31 fingers) had experienced trauma, and the remaining 2 patients (2 fingers) had a congenital deformity. The toew used for grafting were the great toe (1), the second tow (30), and third toe (2). Success was achieved in all cases, sensory recovery was good, and remarkable improvement was attained in function and cosmetic appearance. Metacarpal hand, amputation of thumb, and amputation thumb and three fingers were good indications for this procedure, which gave satisfactory aesthetic results, even in patients with amputation of single digits.

Adult↗
PubMed1988

A modification of the great-toe transfer for thumb reconstruction.

A modification of the great-toe-to-thumb transfer is presented, which includes sculpting the transferred toe with removal of soft-tissue pulp and bone from the lateral side of the toe. This modification provides the aesthetic advantages of the wrap-around flap while avoiding problems of bone graft resorption, pulp mobility, and a very difficult dissection. Function in our three patients has been excellent.

Adult↗
PubMed1988

Microsurgical transfer of the second toe for congenital deficiency of the thumb.

Twelve second-toe transfers have been performed to substitute for thumbs congenitally deficient through constriction ring syndrome, symbrachydactyly, and true transverse arrest. The children were on average 3 years of age, and the youngest was undertaken at 10 months. Anatomic variations were the rule in the six cases of transverse absence and the three cases of symbrachydactyly, requiring nerves, tendons, and vessels in the toe be connected to whatever appropriate structure could be located. All transfers survived, and only one required exploration. Sensation appeared good in the 11 seen in later review, but interphalangeal motion was achieved in only 3. However, good use was made of the digit by all except one patient, an early patient in whom there was not an adequate skeleton on which to base the transfer. This small series suggests that in appropriate cases toe transfer can be undertaken early for congenital deficiency with little fear of encountering microsurgical problems unique to the infant.

Child↗
PubMed1991

Congenital curved nail of the fourth toe.

Five cases of congenital curved nail of the fourth toe are reported. Patients included four males and one female; four cases were bilateral, and one was unilateral. There were no other significant associated anomalies of the extremities, and only the fourth toes were affected. The features of the deformity are a curved nail and hypoplasia of the soft tissue and bone of the distal phalanx of the fourth toe. This anomaly may be transmitted autosomally and is unique in that it may be of mesodermic origin.

Child↗
PubMed1995

Pulp plasty after toe-to-hand transplantation.

Pulp plasty is a simple procedure that is used to debulk the bulbous-appearing pulp of a transplanted digit after toe-to-hand transplantation. A retrospective review of the effect of pulp plasty on the appearance and function of the debulked digit was conducted of 82 digits on 51 patients. Pulp plasty was performed on average of 14 months after toe-to-hand transplantation; the average follow-up interval was 20 months. Subjective improvement in appearance and function was reported in 67.1 and 63.4 percent, respectively, of the debulked digits. Painful scarring was rare, and hypersensitivity was not reported. Sensation was not affected adversely by pulp plasty. The procedure was considered to be worthwhile in 87.8 percent of the cases. Pulp plasty is a simple and effective procedure after toe-to-hand transplantation that enhances the appearance and function of the transplanted digit. Patient satisfaction with the procedure is high.

Adolescent↗
PubMed1996

Reconstruction of incomplete syndactyly of the toes using both dorsal and plantar flaps.

A new modified method for surgical correction of simple incomplete syndactyly of the toes has been devised. This procedure involves both a dorsal and a plantar skin flap and does not require a skin graft. Reconstruction of syndactyly using only skin flaps situated near the toes almost always results in skin deficiency. Use of a plantar flap from the sole provides sufficient skin for one toe and can be closed primarily. Fourteen cases involving 11 patients have been treated by this method, which is described herein.

Child, Preschool↗
PubMed1997

Muscle abnormalities in idiopathic toe-walkers.

The cause of toe-walking is unknown. Muscle biopsies were taken from a group of 25 toe-walkers who were treated at this hospital to try to identify the pathological cause of the condition. The most common abnormality noted was an increase in the proportion of type I muscle fibers with type grouping; other less common changes included the presence of angulated atrophic fibers and thickened capillaries and cases in which occasional fibers were undergoing active degeneration and regeneration. The combination of these changes suggests that there may be an underlying neuropathic process in idiopathic toe-walkers.

Biopsy, Needle↗