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PubMed1989

Plantarflexory base wedge osteotomy in the treatment of functional and structural metatarsus primus elevatus.

Plantarflexory base wedge osteotomy has proven to be a viable, rewarding treatment, where first metatarsal phalangeal joint pathology, as a result of metatarsus primus elevatus, is predicted or in its earliest forms. Although this topic was first addressed by Lambrinudi in 1938, it has received little notice in the literature, and its relevance is probably underestimated. In fact, the diagnosis of metatarsus primus elevatus with associated advancing degenerative joint disease is probably being missed in a significant number of patients. The early signs of this condition are often disregarded even by professionals and the patient frequently is told there is nothing wrong. Not until hallux limitus or hallux rigidus develops is concern demonstrated, at which point a joint preservation procedure is no longer viable. The recovery from plantarflexory base wedge osteotomy does require a longer time period before return to weight bearing as compared with more commonly performed foot surgeries. This must, however, be weighed against the consideration of a patient needing joint resection surgery at a later date, not infrequently in their late 30s or 40s. In fact, a significant patient population in the 35 to 45 age group exists, in whom one prefers to do neither an implant surgery nor a joint destructive surgery, but in whom the joint has been significantly damaged. Performing plantarflexory base wedge osteotomy in appropriately selected patients will re-establish normal function and preserve the first metatarsal phalangeal joint articular cartilage. This approach offers the benefit of arresting the joint destructive process and avoiding the need for a joint destructive procedure in a younger patient.

Humans↗
PubMed1988

Geometry of the first metatarsophalangeal joint.

This study aimed to define the articular geometry of the metatarsophalangeal (MTP) joint of the great toe. Embedded in resin blocks, five pairs of cadaveric first MTP joints (all from men) were sequentially cut in the sagittal plane with a milling machine, removing 0.5 mm of bone in each cut. The photographed cartilaginous outline of each cut was digitized against reference markers, which enabled a computer system to superimpose each outline in three dimensions. The intersesamoidal ridge was found to be parallel to the lateral shaft. The peak of the ridge was just lateral to the midline of the MT head. The articular outline, through the ridge of each sample, was circular; however, other surface contours were noncircular. The undulating plantar aspect of the MTP head formed by the intersesamoidal ridge and related grooves was found to have symmetric relationships to the sesamoid bones and a consistent orientation to the shaft. The rounded distal dorsal aspect of the MTP head showed consistent differences to the concavity formed by the phalangeal base. The sample size is too small for the sizing of prostheses but it is adequate to study the geometry of the MTP joint. More data are needed for the accurate replication of a resurfacing prosthesis and understanding of joint kinematics.

Cartilage, Articular↗
PubMed1987

Treatment of preaxial polydactyly of the foot.

Fourteen patients with preaxial polydactyly are classified into four types according to their morphologic configuration: type 1--ray duplication; type 2--completely duplicated phalanges; type 3--incompletely duplicated metatarsals; and type 4--incompletely duplicated phalanges. The surgical treatment and timing thereof appropriate for each group are discussed. Three cases of congenital hallux varus deformity are analyzed, focusing on the pathomechanism of this disorder. Based on our experience, two main factors are noticed in the etiology of congenital hallux varus deformity: inadequacy of the adductor hallucis and tightening of the fibrous band pulling the big toe into the varus.

Abnormalities, Multiple↗
PubMed1981

Surgery of the rheumatoid foot: preferable procedures.

Management of patients who have rheumatoid arthritis is best accomplished by a team approach utilizing the help of the family physician, the rheumatologist, the physical therapist and the orthopaedist. Such an approach insures careful screening and proper selection of those who can be helped by surgical procedures. Those who have painful feet welcome surgical intervention if nonoperative methods do not furnish relief. The forefoot is often involved and severe deformities of the metatarsophalangeal joints with painful plantar calluses are frequent. The deformities can be corrected and the calluses prevented or relieved by an operation that does not shorten the metatarsals. Such preserves and restores better function of the foot. After tenotomy of the extensor tendons and resection of the proximal portion of the proximal phalanges the plantar condyles of the metatarsals are excised and the remainder of the head is smoothed but not excised. The distance of the heel to metatarsal head strike during standing and walking is not shortened by this procedure. In some rheumatoid patients who have severe hallus valgus but minimal involvement of the interphalangeal joint the push off function of the great toe that is so important when walking can be preserved by arthrodesis in the correct position of the metatarsophalangeal joint. Arthrodesis of the talonavicular joint before fixed deformities develop in the hindfoot is a procedure that relieves pain and prevents progressive valgus deformity of the hindfoot. Other arthrodesing procedures are indicated occasionally. It must be remembered by the surgeon and thoroughly explained to the patient that activity of the rheumatoid process militates against the results from surgery and that corrected deformities and pain may recur if the disease progresses.

Arthritis, Rheumatoid↗
PubMed2002

Free phalangeal transfer: donor-site outcome.

The role of non-vascularised free proximal phalangeal transfer in digital reconstruction in children remains controversial. Significant cosmetic and functional deficits can result in the donor foot. We compare the donor-site outcome following a new technique of reconstruction using a cylindrical iliac-crest bone graft (n = 11) with the outcome following the technique previously described by Buck-Gramcko (n = 18). We have found better preservation of toe stability and length following the bone-graft technique.

Bone Transplantation↗
PubMed2005

Congenital brachydactyly and nail hypoplasia: clue to bone-dependent nail formation.

Congenital hyponychia and anonychia are rare malformations which may form part of syndromes such as nail-patella syndrome, ectodermal dysplasias and brachydactylies, or may occur as an isolated finding. Congenital hyponychia and anonychia are frequently accompanied by underlying skeletal abnormalities. A 20-year-old woman showed congenital bilateral hypoplasia or aplasia of the second, third and fourth toenails with corresponding phalanx dysplasia or aplasia of the affected toes. Malformations of the hands or other congenital defects were absent. The findings in this patient do not exactly fit any known entities. Our clinical observation prompted us to review the literature on congenital hyponychia/anonychia and to summarize recent advances in understanding molecular events in nail development. In conclusion, the association of nail anomalies with aplasia and/or hypoplasia of corresponding middle and/or distal phalanges supports the hypothesis of bone-dependent nail formation.

Adult↗
PubMed1989

Osteosclerosis of the phalanges in Werner syndrome.

Werner syndrome is an autosomal-recessive disease characterized by premature aging, shortness of stature, scleroderma-like skin changes, endocrine abnormalities, and cataracts. Although radiographic findings have been well documented, the presence of distinctive osteosclerotic changes in the phalanges of the hands and feet has not been emphasized in previous publications. The authors' review of radiographs of both hands in nine patients and of both feet in six patients with Werner syndrome documented the frequent occurrence of phalangeal sclerosis related predominantly to endosteal thickening. In the hand, sclerosis was present in every patient, was generally symmetric in distribution, predominated in the distal phalanges, and demonstrated an ulnar predilection. Similar changes in the phalanges of the feet were demonstrated in only two patients. The presence of osteosclerosis in the phalanges of the hand alone or both the hand and foot, when combined with osteoporosis and periarticular calcification, suggests the diagnosis of Werner syndrome.

Adult↗
PubMed1994

Idiopathic phalangeal osteolysis.

BACKGROUND: The acro-osteolytic diseases are a heterogeneous group of bone disorders characterized by bone resorption. Acquired and genetic forms have been well described. As hand abnormalities are frequently encountered in dermatologic practice, bone resorptive states, with particular reference to the idiopathic osteolytic disorders, are discussed. OBSERVATIONS: Asymptomatic terminal phalangeal osteolysis has been investigated in two unrelated young adults with no other bony or systemic abnormalities. The nails of the attenuated bulbous fingers were dystrophic, and pigmentary changes were present in the affected areas. The skin was otherwise normal, and there was minimal soft-tissue loss. Roentgenograms of the hands and feet showed varying stages of phalangeal osteolysis. CONCLUSIONS: Both cases represent primary idiopathic acro-osteolysis, as the bony changes are limited to the distal phalanges of the hands and feet. There were no features in the history or clinical evaluation to support a diagnosis of secondary acro-osteolysis.

Adult↗
PubMed2004

Multiple congenital brachymetatarsia. A one-stage combined shortening and lengthening procedure without iliac bone graft.

We performed nine metatarsal and three proximal phalangeal lengthenings in five patients with congenital brachymetatarsia of the first and one or two other metatarsal bones, by a one-stage combined shortening and lengthening procedure using intercalcary autogenous bone grafts from adjacent shortened metatarsal bones. Instead of the isolated lengthening of the first and the other metatarsal bones, we shortened the adjacent normal metatarsal and used the excised bone to lengthen the short toes, except for the great toe, to restore the normal parabola. One skin incision was used. All the operations were performed bilaterally and the patients were followed up for a mean period of 69.5 months (29 to 107). They all regained a nearly normal parabola and were satisfied with the cosmetic results. Our technique is straightforward and produces good cosmetic results. Satisfactory, bony union is achieved, morbidity is low, and no additional surgery is required for the removal of metal implants.

Adolescent↗
PubMed1986

A radiographic characterization of toe length disparity and its relation to nutrition and structural unsoundness in boars, barrows and sows.

The front and hind feet from a total of 64 boars, 86 sows and 107 barrows were radiographed after necropsy to study the nature of inequalities in digits and their relation to nutrition and structural unsoundness in swine. Boars were fed ad libitum or 75% ad libitum with 100 or 150% of 1979 NRC recommended vitamin-mineral levels, whereas, sows were fed the same two levels of energy with 100 or 150% of NRC recommended calcium-phosphorus (Ca-P) levels during the growing-finishing period. Barrows were fed two sources of phosphorus with increasing levels of sodium. Radiographs of metacarpals, metatarsals and associated phalanges were measured for length and deviations of proximal and distal extremities. The length of both medial and lateral bones were longer (P less than .05) in boars fed 75% ad libitum than in the ad libitum-fed group, which was probably due to age (285 +/- 8.7 vs 240 +/- 8.4 d). Dietary energy and Ca-P level did not influence the bone lengths in sows. Similarly, dietary phosphorus source or sodium level had no influence on bone lengths or deviations in barrows. The incidence of inequality in digits with a smaller medial digit was 90.9% in boars, 96.7% in sows and 87.6% in barrows. In boars and sows, the inequality in digits of front feet was due to lower positioning of proximal extremities of lateral bones because the total lengths of both medial and lateral bones were approximately equal. In hind feet, this inequality was more due to longer lateral bones because the proximal extremities of metatarsals were positioned at approximately an equal level.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Nutritional Physiological Phenomena↗
PubMedDate not supplied

Duplicated longitudinal bracketed epiphysis "kissing delta phalanx" in Rubinstein-Taybi syndrome.

A duplicated longitudinal bracketed epiphysis or the "kissing delta" phalanx is not well recognized in the world literature. This represents complex double-delta bones with a longitudinal epiphyseal bracket. This complex is composed of a back-to-back fusion of adjacent delta bones enclosed in a bracket. The convex side of each delta phalanx faces the other; hence the term kissing-delta bone. These delta bones have a very bizarre appearance and are associated with the Rubinstein-Taybi syndrome. We have seen a total of 36 kissing-delta phalanges in the foot. We discuss the natural history and treatment options of this very rare congenital anomaly. This is not a surgical-outcome study, but surgical treatment is observed.

Child↗
PubMed2005

Development and growth of long bones in European water frogs (Amphibia: Anura: Ranidae), with remarks on age determination.

Differentiation and development of long bones were studied in European water frogs: Rana lessonae, R. ridibunda, and R. esculenta. The study included premetamorphic larvae (Gosner Stage 40) to frogs that were 5 years old. Femora, metatarsal bones, and proximal phalanges of the hindlimb exhibit the same pattern of periosteal bone differentiation and the same pattern of growth. Longitudinal and radial growth of these bones was studied by examination of the diaphyses and epiphyses, particularly where the edge of periosteal bone is inserted into the epiphysis. The periosteum seems to be responsible for both longitudinal and radial growth. Investigation of the formation, length, and arrangement of lines of arrested growth reveals that the first line is present only in the middle 25-35% of the length of the diaphysis of an adult bone; therefore, only the central portion of the diaphysis should be used for age estimation in skeletochronological studies. Comparison of the shapes and histological structures of epiphyses in the femur, metatarsal bones, and phalanges revealed that epiphyseal cartilages are composed of an inner and outer part. The inner metaphyseal cartilage has distinct zones and plugs the end of the periosteal bone cylinder; its role in longitudinal growth is questioned. The outer epiphyseal cartilage is composed of articular cartilages proper, in addition to lateral articular cartilages. Differences in the symmetry of the lateral articular cartilages of distal epiphyses of the femur and toes may reflect adaptations to different kinds of movements at the knee and in the foot.

Age Determination by Skeleton↗
PubMedDate not supplied

[Differential diagnosis of osteoarthropathia hypertrophicans].

PURPOSE: Chief clinical symptoms of HOA are bone and joint plain, nearly always coupled with finger and toe clubbing. The classification of HOA distinguishes between a very seldom primary (PHOA) and the more frequent secondary hypertrophic osteoarthropathy (SHOA). The pathogenesis of the disease is as yet not wholly understood, but there is a tendency that it may be a bony manifestation of a paraneoplastic syndrome. RESULTS: By means of two cases, one a 72-year old patient with pulmonary carcinoma, the second a 48-year-old patient with a long standing history of COPD, we demonstrate and discuss typical clinical, laboratory, radiographic, and scintigraphic findings associated with SHOA. Primarily the patients consulted an orthopaedic surgeon due to persisting, localised osseous pain. Clubbing of fingers and toes as well as soft tissue swelling usually remain asymptomatic. Characteristically a symmetrical diaphyseal accumulation of periosteal calcification in the vicinity of short and long cortical bones becomes radiographically apparent. Early diagnosis is best facilitated by means of a bone scan, where the symmetrical increase in bone activity and the typical "double stripe sign" can be observed. CONCLUSION: In patients in whom unexplained periosteal reaction is found and phalangeal clubbing becomes evident, the diagnosis of SHOA should be contemplated and further tests performed, so as to rule out a paraneoplastic syndrome.

Aged↗