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At least 505 records · Page 28Linked to original sources
PubMed2005

Post-traumatic distal interphalangeal finger joint reconstruction using a free hemi-joint transfer from the fifth toe middle phalanx.

We present three cases of finger distal interphalangeal joint reconstruction in children using a new donor site, the middle phalanx of the fifth toe, transferred as a non-vascularized graft. The patients were followed a minimum of 36 months with serial radiographs, magnetic resonance imaging and photographs. Alignment was improved and persisting growth was demonstrated in all cases. Postoperative magnetic resonance imaging of the grafted phalanx and control toe showed comparable signals. The absence of a proximal epiphysis of these toe phalanges may have an important role in their survival after free transplantation, and may promote continued growth.

Child, Preschool↗
PubMed2006

Wet but not slippery: Boundary friction in tree frog adhesive toe pads.

Tree frogs are remarkable for their capacity to cling to smooth surfaces using large toe pads. The adhesive skin of tree frog toe pads is characterized by peg-studded hexagonal cells separated by deep channels into which mucus glands open. The pads are completely wetted with watery mucus, which led previous authors to suggest that attachment is solely due to capillary and viscous forces generated by the fluid-filled joint between the pad and the substrate. Here, we present evidence from single-toe force measurements, laser tweezer microrheometry of pad mucus and interference reflection microscopy of the contact zone in Litoria caerulea, that tree frog attachment forces are significantly enhanced by close contacts and boundary friction between the pad epidermis and the substrate, facilitated by the highly regular pad microstructure.

Adhesiveness↗
PubMed1980

Second-toe to hand transplantation: a clinical experience of 25 cases.

Twenty-five cases of second-toe transplantation to replace the thumb and other fingers are reported. There were 20 toal successes, four partial successes and one total failure. A total of eight patients had circulatory complications at some stage after operation. The overall motor and sensory functions of the transplanted toes were highly satisfactory. The donor foot did not suffer functionally despite the absent second toe.

Adolescent↗
PubMed1991

The effect of cooling on toe systolic pressures in subjects with and without Raynaud's syndrome in the lower extremities.

The effect of changes in local and body temperature on the toe systolic pressures was studied in 20 subjects with and 30 without Raynaud's syndrome in the toes. The pressures were significantly lower in the group with Raynaud's syndrome under all experimental conditions (P less than 0.01). The pressures were significantly lower during body cooling than during body warming in both groups (P less than 0.01). The mean decrease with body cooling was 58 mmHg in the group with Raynaud's syndrome and 24 mmHg in the control subjects (P less than 0.01). During body cooling pressures fell to less than 30 mmHg in 70% of subjects with Raynaud's syndrome and in 3% of the controls. Local cooling from 30 to 10 degrees C during body cooling resulted in a significant mean decrease in pressure of over 40 mmHg in both groups (P less than 0.01) and the pressure fell below 30 mmHg in over 90% of the group with and in 26% of those without Raynaud's attacks. The results indicate the importance of body cooling and local temperature in the mechanism of vasospasm in the toes. They are also relevant to the diagnosis of Raynaud's syndrome in the lower limbs and have implications for the testing of patients with arteriosclerotic occlusion since erroneously low pressure values could be obtained in tests when the feet are cold.

Adolescent↗
PubMedDate not supplied

Endometrial cancer metastasis presenting as a grossly swollen toe.

Metastasis to the peripheral skeleton, especially in the face of low stage disease, is rare. This report describes the case of a 77-year-old lady with stage IC disease who underwent curative total abdominal hysterectomy and bilateral salpingo-oopherectomy 2 years prior to presenting with a painless gigantism of her fourth toe. A histologic diagnosis of dedifferentiated endometrial metastasis with sarcomatous differentiation was made following amputation of the toe. Osseous metastasis to bone is discussed in the context of endometrial carcinoma and the literature reviewed. This paper reports the first case of endometrial carcinoma metastasis presenting as gross swelling of a toe.

Aged↗
PubMed2001

Effects of heel and toe elevation upon the digital joint angles in the standing horse.

Five sound mature horses, age 8-14 years, with toe angles 45.5-55.0 degrees were placed on a specially designed platform with only the left forelimb weightbearing, which allowed the successive production of 7 different conditions of foot orientation: neutral position (N), 5, 10, 15 degrees heel (H5, H10, H15) and toe (T5, T10, T15) elevation, performed according to 2 different sequences. For each condition, 2 lateromedial radiographs were taken to evaluate the metacarpophalangeal joint (MPJ) and both interphalangeal joint (PIPJ and DIPJ) angles, respectively. In addition, two-dimensional (2-D) kinematic recordings, using reflective skin markers placed laterally on the left forelimb joints, were performed. The value of each joint angle (JA) and its angular variation to N (AV) were considered for statistical analysis. For all JA and their AV determined radiographically, the condition effect was significant and the sequence did not influence the differences between conditions. The relationships between the JA and the conditions (in the sequence: T15, T10, T5, N, H5, H10, H15) were overall linear for the 3 joints. The maximal range T15-H15 was mean +/- s.d. 6.9 +/- 2.0 degrees for MPJ (dorsal angle decrease), 7.3 +/- 1.0 degrees and 29.5 +/- 1.8 degrees for PIPJ and DIPJ (palmar angle decrease), respectively. Contrary to JA and in spite of large variations in hoof conformation, AV did not show any significant horse effect. Wide differences were observed between the digital JA measured radiographically and from kinematics, which could be related to cutaneous displacement. Heel elevation induced elbow flexion, whereas a slight extension was observed with toe elevation. These movements, even slight (mean elbow angle amplitude: 3.6 +/- 1.3 degrees), may have consequences upon flexor tendon tension.

Analysis of Variance↗
PubMed2001

Three-dimensional kinematics of the proximal interphalangeal joint: effects of raising the heels or the toe.

The proximal interphalangeal joint (PIPJ) has always been considered as a low-motion joint with an almost constant angle during loading of the limb. Until very recently, its motion was not taken into account in kinematic studies in vivo. Recent in vivo studies yielded surprisingly high ranges of motion in this joint. The aim of this study was to measure, in terms of the 3 possible rotations (flexion/extension, collateromotion and axial rotation), the movements of the PIPJ in vitro during limb loading in a neutral position (500-6000 N) and after the addition of heel and toe wedges (6 degrees and 12 degrees). The joint coordinate system, as it was recently described for use in the horse, was used to compute the 3 components of rotation. With the hoof in neutral position, low-amplitude flexion movements (7.9 degrees) were observed. They were not associated with collateromotion or axial rotation. The flexion of the joint increased exponentially with load suggesting that, during the midstance phase, heavy loads are necessary to evoke substantial flexion. Raising the heels induced an early flexion of the joint with an increase of its total amplitude. Raising the toe produced an extension at 500 N, beyond which the amount of flexion was reduced. These results show that PIPJ flexion/extension during in vitro loading remains substantially smaller than suggested by in vivo studies based on skin markers. Raising the toe or heel directly affects the behaviour of this joint, but does not induce motion outside the sagittal plane. Hoof wedges are commonly used in clinical practice for purposes other than affecting PIPJ motion. In these cases, their biomechanical effects on this joint should be taken into account.

Animals↗
PubMed1978

The effects of position and skin temperature on the capillary pressures in the fingers and toes.

1. Direct measurements of the capillary pressure (P(c)) were made in capillaries at the base of the nails of the fingers and toes of two subjects (the authors of this paper).2. With the hand or foot at heart level, P(c) varied over the range of 7-70 cm H(2)O with mean values of 43 cm H(2)O in both the fingers and the toes. P(c) was higher in the arterial limb (mean 49 cm H(2)O) than in the venous limb (mean 34 cm H(2)O) of the capillary loops. The plasma colloid osmotic pressures for the two subjects were 33 and 34 cm H(2)O.3. For capillaries at heart level there was a strong positive correlation between P(c) and skin temperature when the latter was varied over the range 23-36 degrees C.4. When the hand or foot was lowered, P(c) increased less than the local arterial (P(a)) and venous pressures (P(v)). Furthermore the variation in P(c) was reduced. In fourteen measurements of P(c) made on capillaries in the toes of standing subjects, P(c) was no more than 10 cm H(2)O greater than P(v). It is argued that the increase in the ratio (P(a) - P(c))/(P(c) - P(v)) with hydrostatic load represents an increase in the ratio of pre- to post-capillary resistance.5. When P(v) was increased by inflating a sphygmomanometer cuff around the upper arm, (P(a) - P(c))/(P(c) - P(v)) increased in the hand held at heart level. These changes were similar to those seen with changes in position.6. The implications of the results are discussed with respect to fluid balance between the blood and tissues. It is argued that since P(c) in the warm hand was never less than the plasma colloid osmotic pressure, fluid is not reabsorbed from the tissues into the capillaries of the warm skin of the hand even at heart level. Compensatory changes in the circulation appear to minimise the filtration of fluid into the feet of the standing subject but the mechanism of these changes remains obscure.

Blood Pressure↗
PubMed2000

A comparison of lactate concentration in plasma collected from the toe, ear, and fingertip after a simulated rowing exercise.

OBJECTIVE: To examine the validity of using blood taken from the toe for the assessment of plasma lactate concentration in rowers. To achieve this, values were compared with those taken from the fingertip and earlobe. METHODS: Nine subjects exercised at two separate submaximum workloads on the Concept II rowing ergometer. The loads, each lasting four minutes, elicited mean (SD) heart rate responses of 160.1 (8.5) and 180.1 (5.7) beats/min, which corresponded to 76.4 (6.1)% and 91.9 (4.7)% of the estimated heart rate maximum of the subjects. Blood was simultaneously removed after the cessation of exercise by three experimenters and was analysed for plasma lactate concentration. RESULTS: At 76.4% of estimated heart rate maximum, the mean (SD) plasma lactate concentrations sampled from the fingertip, toe, and earlobe were 6.36 (1.58), 5.81 (1.11), and 5.29 (1.24) mmol/l respectively. At 91.9% of estimated heart rate maximum, respective values were 8.81 (2.30), 8.53 (1.37), and 8.41 (2.35) mmol/l. No significant differences (p > 0.05) were found between any of the sites at either work intensity. CONCLUSIONS: The toe may offer a practical alternative for assessing the concentration of lactate during rowing, having the advantage that repeated blood samples can be removed without interruption of the rowing action.

Adult↗
PubMed1997

Toe agnosia in Gerstmann syndrome.

The following case report presents a patient exhibiting Gerstmann syndrome accompanied by toe agnosia. A 72 year old right handed woman had a focal lesion in the angular gyrus of the left hemisphere which was caused by a glioblastoma multiforme. The first symptom she had complained of was severe headache. Standardised neuropsychological tests of intelligence, memory, attention, fluency, apraxia, and language functions as well as tests for the assessment of agraphia, acalculia, right-left disorientation, and digit agnosia were performed. The patient displayed all four symptoms of the Gerstmann syndrome--namely, agraphia, acalculia, right-left disorientation, and finger agnosia. The patient did not display aphasia, constructional apraxia, or any other neuropsychological impairment. In addition to the four symptoms of the Gerstmann syndrome an agnosia of the toes was found. Further studies should determine whether finger agnosia in Gerstmann syndrome is usually accompanied by toe agnosia. Finger agnosia in the context of this syndrome may be better named digit agnosia.

Aged↗
PubMed1989

Blue toe syndrome: treatment with percutaneous atherectomy.

"Blue toe syndrome" refers to digital ischemia of the foot in the presence of palpable or Doppler audible pedal pulses. This clinical syndrome is caused by microembolization to small vessels from a proximal source. The use of percutaneous transluminal atherectomy is described in the treatment of embologenic superficial femoral artery lesions in seven patients. All seven had prompt healing of the ischemic toes, and none required surgical revascularization or amputation. One patient developed a recurrent stenosis at the atherectomy site and had a second episode of digital ischemia, which was treated by means of atherectomy with a larger device. Histologic study of atherectomy specimens suggests that emboli arise from adherent fibrinoplatelet aggregates or thrombus and less often from cholesterol-rich atheromatous plaque. Although either percutaneous transluminal angioplasty or atherectomy can be used to treat the underlying stenosis, percutaneous atherectomy offers the advantage of nonsurgical removal of embologenic material and provides material for histologic study. Percutaneous atherectomy is an effective method of treating embologenic superficial femoral stenoses in patients with ipsilateral blue toe syndrome.

Adult↗
PubMedDate not supplied

Assessment of toe blood pressure is an effective screening method to identify diabetes patients with lower extremity arterial disease.

The authors evaluated a screening program for lower extremity arterial disease (LEAD) in diabetic patients and focused on the value of toe blood pressure assessment. They recruited 437 subjects, ages 30-70 years (134 healthy controls, 166 type 1 and 137 type 2 diabetic patients; control [Ctr], DM1, and DM2) with no previous history of LEAD. They were enrolled in a longitudinal study with a planned follow-up of 10 years. Patients were consecutively enrolled from outpatient diabetes units of 2 university hospitals. Subjects were screened with respect to peripheral circulation by use of established noninvasive techniques. These included arm, ankle (AP), and toe (TP) blood pressure measurements; evaluation of peripheral neuropathy; and a standardized physical examination. Results from the baseline examination are presented in this report. The number of patients who presented peripheral pressures or indices below normal (< mean -2 SD for controls) was higher among diabetic patients; 24% of DM1 and 31% of DM2, as compared to 6% of Ctr, had at least 1 lower limb with a low TP, AP, toe/arm index (TI), or ankle/arm index (AI), and these subjects were mainly identified by using the toe/arm index. TI was independently and negatively associated with fasting blood glucose in both patient groups, and with smoking, age, and diabetes duration in DM1. The mean AP was higher in the DM1 and DM2 groups compared to Ctr, whereas overall TP, TI, and AI were similar in the groups. It was also shown that abnormally low TI was significantly more common than low AI among diabetics (p<0.001), and this was true for TP vs AP as well (p<0.05). It is beneficial to include assessment of toe blood pressure and toe/arm blood pressure index to detect early LEAD in diabetic patients. Ankle blood pressure and indices alone are less efficient, owing probably to medial sclerosis in diabetic patients. Up to 30% of diabetic patients with no ischemic symptoms may have signs of impaired arterial circulation.

Adult↗
PubMed1978

Ischemia of toes as a presenting symptom in primary thrombosis: a case report.

Although thrombotic occlusion of small vessels in thrombocytosis is allegedly well recognized, it has been reported only rarely. We treated 4 patients with primary thrombocytosis in whom ischemic toe lesions with normal peripheral pulses were the presenting and only symptoms. The symptoms preceded diagnosis by 5 years, 3 years, 1 year, and 1 month respectively. Treatment of the hematologic disorder resulted in disappearance of the toe lesions. Thrombocytosis should be routinely searched for in patients with ischemic toes and normal peripheral pulses.

Aged↗
PubMed2004

Relationship between stress fractures of the proximal phalanx of the great toe and hallux valgus.

PURPOSE: To clarify the relationship between stress fractures of the great toe and hallux valgus. METHODS: Ten cases of this fracture were analyzed for their alignment of the great toe. RESULTS: Nine of them had hallux valgus. DISCUSSION: The continuous bowstring effect of the extensor hallux longus and shearing stress on the hallux valgus that occur during specific exercises such as sprinting, jumping, and standing on tiptoe, could cause these stress fractures. CONCLUSION: The hallux valgus could play a role in the cause of stress fractures of the proximal phalanx of the great toe.

Adolescent↗
PubMedDate not supplied

Evaluation of claw toe deformity, weakness of the foot intrinsics, and posteromedial shin pain.

Posteromedial middle one-third tibial pain and tenderness associated with stressful activities has been previously recognized as occurring at the origin of the flexor digitorum longus muscle. Seventeen running athletes with this clinical syndrome were evaluated with regard to second toe range of motion and foot intrinsic muscle strength. The results were compared to results obtained from a comparable group of asymptomatic athletes. Statistical analysis of the results of the evaluation indicated a significant displacement of the arc of motion of the second toe in the symptomatic athletes toward extension of the metatarsophalangeal joint and a decrease in flexion. Weakness or dysfunction of the intrinsic muscles in the symptomatic athletes was also found to be significant. This analysis supports the hypothesis that posteromedial middle one-third tibial stress symptoms may be related to overuse of the flexor digitorum longus muscle associated with mild claw toe deformity.

Adolescent↗
PubMed2006

Flexor hallucis longus tendon transfer for hallux claw toe deformity and vertical instability of the metatarsophalangeal joint.

BACKGROUND: Historically, operative treatment of hallux claw toe deformity has been the Jones procedure or one of its modifications. Review of the literature confirms its ability to maintain alignment and achieve patient satisfaction; however, several complications have been reported. Many of these are related to altered biomechanics across the metatarsophalangeal (MTP) joint. A similar approach to this clinical problem involves restoration of the flexion moment across the MTP joint without an interphalangeal (IP) joint arthrodesis. METHODS: We conducted a retrospective review of 10 patients who had a flexor hallucis longus (FHL) tendon transfer to the proximal phalanx of the great toe for hallux claw toe deformity, as well as for symptomatic vertical instability. Four patients had a positive drawer test indicating vertical instability without static deformity. Two patients with vertical instability were found to have a dynamic deformity. Mean followup was 24 (SD 15.2) months. RESULTS: All deformities were corrected and alignment was maintained at the time of followup. Pain under the first metatarsal head was reliably improved in symptomatic patients (p < 0.05). Patient satisfaction also was assessed. All six patients treated for hallux claw deformity were satisfied with their outcomes. Two of the four patients treated for vertical instability were satisfied. The other two patients expressed dissatisfaction because of persistent pain that occurred during strenuous exercise. Their symptoms during routine activity were improved, however. CONCLUSION: Based on initial results, the FHL transfer to the proximal phalanx appears to be a viable treatment option for hallux claw deformity in terms of deformity correction, pain relief, and patient satisfaction. Further evaluation is warranted regarding the indication of vertical instability.

Adolescent↗
PubMed1981

Chronic and recurrent dislocations of the fifth toe.

Ten cases of chronic and recurrent dislocations of the fifth toe were reviewed. The history consisted of forceful abduction by catching the toe on a piece of furniture while walking barefoot. In every case the pathology was overlooked by the treating physician or the patient failed to seek medical care. All of the patients were seen years after the initial injury. The clinical patterns revealed a relatively fixed abduction deformity at the proximal interphalangeal level or a recurrent dislocation occurring on weightbearing at either the proximal interphalangeal or metatarsophalangeal level. Treatment consisted of resection of the head and neck of the proximal phalanx and/or syndactyly to the fourth toe. Results were uniformly excellent.

Female↗
PubMed1991

Traumatic boutonnière deformity as a cause of acute hammer toe: a case report.

Traumatic boutonnière deformity, well-described when occurring in the fingers, can occur in a lesser toe. The deformity mimics that of a hammer toe, but the onset is acute, and develops immediately after trauma. Open repair of the central slip rupture and recentralization of the displaced lateral bands of the extensor mechanism with temporary pinning of the toe can give an excellent result.

Acute Disease↗