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At least 523 records · Page 29Linked to original sources
PubMed1995

The two-boned fifth toe: clinical implications.

Eighty operations on the fifth toe in 59 patients were retrospectively reviewed to determine the effect of skeletal variation on the occurrence of pathological conditions requiring surgery. The two-boned fifth toe occurred in 60% of the operated group. This is statistically significant (P < .05) as compared with 45% in our prospective control group. Our results support the theory that the stiffer two-boned fifth toe predisposes it to increased pathology, which includes hammertoes, interdigital and dorsal corns, and clawtoes.

Adult↗
PubMed1995

Kirschner wire breakage after surgery of the lesser toes.

A retrospective review was made of all patients operated on by the two senior authors from January 1985 to January 1993 for problems with Kirschner wire breakage following forefoot surgery. Thirty-three broken K-wires in 27 patients were encountered. All of these were 0.045-inch K-wires that had been placed across the metatarsophalangeal (MTP) joint of the lesser toes. In no case was there breakage of a K-wire that was larger than 0.045 inches or that did not cross the MTP joint. The medical records and radiographs of 565 consecutive patients having fixation with 0.045-inch K-wires that crossed the MTP joints of the lesser toes were then reviewed. A total of 1002 K-wires were used with an overall failure rate of 3.2% (4.8% of the patients). All of these K-wires failed just proximal to the point of entry into the metatarsal head. No intra-articular retained fragments were noted. Twenty-five of the retained fragments were completely within the metatarsal head and shaft, and eight of these fragments pierced the cortex of the metatarsal proximally. Twenty-three patients with retained fragments were examined in follow-up and in no case could the retained fragment be palpated or directly related to postoperative symptoms. Of the three patients who complained of persistent pain, two had mild pain with persistent MTP synovitis and one had severe pain due to lateral deviation of the toe after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Osteoid osteoma of the phalanx: enlargement of the toe--two case reports.

After a review of the literature, two cases of osteoid osteoma involving phalanges of the toes are reported. Physical findings of osteoid osteoma vary with the site of the tumor; in the foot, particularly the toes, it presents various atypical and characteristic features. Its more frequent cancellous and subperiosteal localization in the small bones of hand and foot, showing atypical roentgenographic findings, poses particular problems in diagnosis. In the osteoid osteoma of the phalanges, characteristic enlargement of the toe or finger seems to be frequent and with a typical clinical history may be considered a reliable sign of suspected osteoid osteoma. Specialized imaging techniques may hasten diagnosis, but only an accurate clinical history and the characteristic findings with a high index of suspicion can allow for a proper diagnosis.

Adult↗
PubMed1999

Results of flexor-to-extensor and extensor brevis tendon transfer for correction of the crossover second toe deformity.

Between 1990 and 1995, 38 patients (42 feet) underwent repair for crossover toe deformity, 31 (35 feet) of whom returned for final examination at an average of 51.6 months (range, 24-81 months). Causes included trauma, iatrogenic, and unknown. Presenting complaints included dorsal pain with either metatarsalgia or joint pain, isolated metatarsophalangeal (MP) joint pain, metatarsalgia, painful plantar callus, metatarsalgia and joint pain, and painful dorsal callus. All patients were treated with one of two operative techniques, either the flexor-to-extensor tendon transfer or the extensor brevis tendon transfer. Choice of procedure depended on the stage of preoperative deformity. Twenty-four patients were completely satisfied with the surgical correction, 6 were satisfied with reservations, and 1 was dissatisfied. The average postoperative AOFAS score for all patients was 85 points (range, 54-100 points), which correlated strongly with patient satisfaction. Twenty-two patients stated that they had no postoperative pain, 8 reported some pain, and 1 had frequent pain at the corrected toe. In 30 feet, there was no recurrence; three patients had mild residual crossover toe deformity, and two patients had recurrent deformity, although all MP joints were stable. Follow-up radiographs demonstrated substantial reduction in MP joint angles in both the AP (from 7 degrees to -1 degree) and lateral (from 45 degrees to 25 degrees) projections. This article reviews the surgical technique of both procedures, proposes specific indications for each, and presents outcomes. Based on our findings, the extensor brevis tendon transfer is appropriate for stage 1, stage 2, and flexible stage 3 deformities. Flexor-to-extensor tendon transfer is appropriate for rigid stage 3 and stage 4 deformities and for all patients with a symptomatic neuroma of the second web space (where the extensor brevis transfer is not possible). Stiffness of the MP joint is a potential problem with the flexor-to-extensor tendon transfer.

Adult↗
PubMedDate not supplied

Angioplasty with stenting is effective in treating blue toe syndrome.

Blue toe syndrome is a manifestation of distal embolization associated with significant pain and risk of tissue loss. The recommended treatment options for this problem include endarterectomy or bypass with exclusion of the source of emboli. Although focal arterial stenosis can be effectively treated with angioplasty,it is unclear whether performing angioplasty in a lesion suspected of causing distal embolization might actually worsen the condition or what long-term effects this would have in preventing future embolization. The purpose of this study was to evaluate the treatment and outcome of a series of patients with unilateral blue toe syndrome treated with percutaneous angioplasty and stenting. During a 5-year period, a total of 8 patients were identified with unilateral blue toe syndrome. Ankle/brachial indices (ABIs) were obtained, followed by arteriography. The study group included 4 men and 4 women with an age range of 35 to 83 years. Their atherosclerotic risk factors included smoking (8), hypertension (5), diabetes mellitus (3), and hypercholesterolemia (1). One patient had a history of illicit drug use. The patients were followed up by repeat clinical examinations and vascular laboratory studies. Arteriography typically demonstrated a focal preocclusive lesion with thrombus at the distal end of the lesion. Angioplasty and stent placement was technically successful in all cases. The ABIs increased following angioplasty (before 0.81 +/- 0.05; after 1.02 +/-.05). The symptoms resolved in all 8 patients over the ensuing month, and there were no recurrences with a mean follow-up of 18.5 months (range 4 to 36 months). There was 1 death at 4 months associated with preexisting colon carcinoma. Unilateral arterial to arterial emboli were found in association with focal preocclusive lesions. Despite the presence of thrombus in some of the lesions, these patients were not acutely worse following angioplasty. There was good initial angiographic success in all cases. There was also hemodynamic improvement as shown by the increased ankle/brachial indices. Although long-term follow-up is not available, these intermediate results suggest that angioplasty and stenting should be considered a reasonable alternative to standard operative approaches for patients with blue to syndrome associated with embolization from a focal stenosis.

Adult↗
PubMed2000

Activation of supplementary motor area during imaginary movement of phantom toes.

To evaluate changes in the human cerebral cortex after lower limb amputation, we studied repetitive toe movements using functional magnetic resonance imaging. The subject did not experience any phantom pain but had a vivid sensation of the phantom limb's presence and was able to imagine the movement of her phantom toes and ankle. Actual movement of her normal limb activated the contralateral supplementary motor area (SMA), the primary motor cortex (M1), and the primary somatosensory cortex (S1). Movement of her phantom limb activated the contralateral SMA and the M1. Imaginary movement of her normal toes without actual movement activated the contralateral SMA. The slice level that was activated by the movement of the phantom limb was shifted 8 mm caudally, suggesting that cortical reorganization had occurred after the lower limb amputation.

Adult↗
PubMedDate not supplied

A vitamin K antagonist rapidly reverses a blue toe syndrome in a patient with lupus anticoagulant and antiprothrombin antibodies.

A 30-year old male was admitted to the hospital with extremely painful blueish discoloration of his toes. After clinical and laboratory evaluation the diagnosis of a blue toe syndrome due to primary antiphospholipid syndrome (APS) was made. Complete resolution of the blue toe syndrome occurred within 72 hours following 9 mg phenprocoumon. APS consists of the association of lupus anticoagulant or antiphospholipid antibodies with arterial or venous thrombosis, thrombocytopenia, and spontaneous abortion. The exact pathways leading to thrombosis are still unknown. Our group has previously proposed that membrane-associated immune complexes contribute towards clinical symptoms in the antiphospholipid syndrome. The case presented strengthens that concept.

Adult↗
PubMed1997

Lengthening of short great toes by callus distraction.

We lengthened seven first metatarsals in four patients with short great toes by callus distraction using an external fixator. Good clinical and cosmetic results were obtained. Bone lengthening is effective in patients with short great toes not only for cosmesis, but also to relieve pain and callosities on the plantar aspect of the second and third metatarsal heads. Excessive lengthening of the first metatarsal resulted in limitation of the range of movement of the metatarsophalangeal joint of the great toe. To prevent this the amount of lengthening should not exceed 40% of the preoperative length of the metatarsal.

Adult↗
PubMed2003

Toe tourniquet syndrome in association with maternal hair loss.

Increased hair loss a few months after delivering an infant is a common postpartum condition known as telogen effluvium. A much less common condition involving young infants is the hair-thread tourniquet syndrome, or toe tourniquet syndrome, which involves hair or thread becoming so tightly wrapped around an appendage that pain, injury, and sometimes loss of the appendage result. This case report is the first known description of the hair-thread tourniquet syndrome in association with maternal telogen effluvium. A literature review shows that accidental cases involving human hair almost always involve the toes, and usually occur at the age when mothers are experiencing excessive hair loss. This association is significant in that anticipatory guidance of new parents experiencing rapid hair loss may prevent cases of the toe tourniquet syndrome and its associated morbidity.

Female↗
PubMed2000

Treatment of extrinsic flexion deformity of the toes associated with previous removal of a vascularized fibular graft.

BACKGROUND: Complications from vascularized fibular bone-grafting are infrequent. We saw six patients who had a painful flexion deformity of the great and lesser toes after a free vascularized fibular graft had been obtained from the ipsilateral leg. In this report, we discuss our management of these patients. METHODS: Painful flexion deformity of the toes that had developed in six adults after removal of a free vascularized fibular graft was treated by cutting of the flexor hallucis longus alone in three patients, by lengthening of the flexor hallucis longus alone in one, and by cutting of both the flexor hallucis longus and the flexor digitorum longus in two. RESULTS: After an average duration of follow-up of six years and eleven months, the flexion deformity of the great and lesser toes had decreased or disappeared, leading to improved or full extension of the digits. Preoperative and postoperative measurements of muscle strength for plantar flexion of the interphalangeal joints did not change appreciably. CONCLUSIONS: Cutting or lengthening of the flexor hallucis longus behind the ankle provides an adequate release of digital flexion deformities that occur after removal of a vascularized fibular bone graft.

Adult↗
PubMed1995

Foot agility and toe gnosis/graphaesthesia as potential indicators of integrity of the medial cerebral surface: normative data and comparison with clinical populations.

A protocol was designed to identify quantitative indicators of the function of the medial surfaces of the cerebral hemispheres. Normative data were collected from 40 volunteers for foot agility, toe gnosis, and toe graphaesthesia. A total of 100 patients (most of whom had been referred for possible closed-head injuries) completed thorough neuropsychological and cognitive assessments. Deficits for toe graphaesthesia were most consistently correlated with general brain impairment and with scores for tasks whose normal performance requires the integrity of structures within the dorsal half of the medial cerebral hemispheres.

Adolescent↗
PubMed1992

Transfer of the second toe for reconstruction of the hand after trauma.

Twenty-six transfers of second toe to hand have been carried out in 25 cases. On 25 occasions the toe was anastomosed to the stump of the thumb, and in one to a metacarpal hand. Revascularization failed in five cases, but the remaining 21 healed with bony union occurring within six weeks in all cases. The mean follow up period was 52 months, range 14-81, and the results in 19 thumb cases were classified as excellent and in one as good by the Tamai score. We conclude that the microsurgical technique of transferring the second toe to the hand is challenging, but if revascularization is successful the functional results are good. Morbidity at the donor site is minimal.

Adolescent↗
PubMed1997

Late toe-to-hand transfer for the reconstruction of congenital defects of the long fingers.

Toe-to-hand transfer is a well established procedure and is one of the best ways of reconstructing the missing fingers or parts of fingers. In congenital deformities of fingers and hands such as absence of digits, second toe transfer may create the grip function and is superior to all other procedures. We present three cases of four second toe transfer to reconstruct long finger defects after congenital malformations of the long fingers. The aim of this paper is to discuss some aspects of the procedure and to evaluate achieved results. All our four patients were operated on when they were over 10 years of age.

Adolescent↗
PubMed1997

Blue toe syndrome associated with rapidly progressive glomerulonephritis: ultimately revealed essential mixed cryoglobulinemia.

The blue toe syndrome is a rare presentation in a number of medical disorders. We report a 35-year-old woman who initially presented with blue toe syndrome and rapidly progressive glomerulonephritis. Essential mixed cryoglobulinemia with vasculitis and renal failure was documented by laboratory tests and renal biopsy. She was on maintenance hemodialysis as renal failure persisted after steroid and immunosuppressive agents therapy. Her gangrenous changes of bilateral toes were autoamputated symmetrically and uneventfully.

Adult↗
PubMed1992

Flexor to extensor tendon transfer for curly toes. 43 children reviewed after 8 (1-25) years.

43 children treated by flexor-to-extensor transfer for a total of 130 curly toes were retrospectively reviewed after a mean period of 8 years. According to an objective scoring system, 37 patients had a satisfactory result and 6 patients had a poor result of one or more toes. We now recommend that children with mild to moderate curly toes should be observed until the age of 6 years, by which time the majority will have had spontaneous correction. The remaining patients should be operated on at that stage because children operated on later had poor results. Attention should be paid to the surgical technique because the long flexor tendons are often bipartite.

Adolescent↗
PubMedDate not supplied

Bizarre parosteal osteochondromatous proliferation of the little toe.

A 19-year-old woman presented with pain at the lateral side of the fifth toe of her left foot, which was separated from the adjacent toe. Initial examination suggested dislocation of the fifth metatarsophalangeal joint due to a past fracture. Radiographs showed a mass arising from the proximal phalanx of the little toe, with no medullary and cortical continuity. Excisional biopsy of the mass was performed, and a histologic diagnosis of bizarre parosteal osteochondromatous proliferation of bone (Nora's lesion) was made.

Adult↗
PubMedDate not supplied

Arthroplasty of the interphalangeal joint of the great toe using costal osteochondral grafting.

Although many reports have been published on the usefulness of costal cartilage grafting in the reconstruction of interphalangeal joints of fingers, there are only a few published reports on the reconstruction of interphalangeal joints of toes. We describe a 21-year-old woman with a tissue defect of the dorsum pedis and a partial defect of the interphalangeal joint of the great toe caused by a motor-vehicle accident. We attempted arthroplasty using a free latissimus dorsi myocutaneous flap and a costal osteochondral graft. The grafted rib and cartilage survived, allowing the patient to resume functional ambulation for day-to-day activities. Arthroplasty using costal osteochondral grafts seems to be an effective means of reconstructing the interphalangeal joints of toes.

Adult↗
PubMed1975

Lumbrical muscles and contracted toes.

Dissection of fifty feet revealed a lack of correlation between absence of lumbrical muscles and the presence of contracted toe. This is at variance with assertions commonly encountered in textbooks of anatomy. Contracted toes were found in association with well developed lumbricals. Absence of lumbricals was not found to be associated with toe anomalies. These findings leave in doubt the function of lumbrical muscles of the foot.

Congenital Abnormalities↗