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A prosthesis has been designed with which to resurface the painful, degenerated first metatarsophalangeal joint. Clinical evaluation thus far has indicated satisfactory results in 16 of 18 instances. This procedure will probably give the best results in the older patient with hallux rigidus, but the length of follow-up is as yet too short to allow firm opinions to be formed.
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This paper will present a review of the literature on hallux limitus, including etiology, clinical findings, radiographic findings, and surgical treatment. Criteria for the treatment of this problem will also be presented.
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We reviewed the results of reconstruction of the fore part of the foot in rheumatoid patients by arthrodesis of the first metatarsophalangeal joint. The follow-up averaged 4.1 years (range, 2.0 to 7.25 years). Eighteen feet in eleven women were operated on. Twelve feet underwent total reconstruction of the fore part: arthrodesis of the first metatarsophalangeal joint and excision of all of the lesser metatarsophalangeal joints. Six feet underwent subtotal reconstruction, which included arthrodesis of the first metatarsophalangeal joint. The results were classified as excellent in fourteen feet, good in two, and fair in two. There were no poor results. Metatarsophalangeal bone fusion was achieved in all but one foot (fusion rate, 94 per cent). The one fibrous ankylosis was painless, with satisfactory function. Interphalangeal degenerative joint disease was a radiographic but not a clinical sequela. Arthrodesis of the first metatarsophalangeal joint provided stability that permanently corrected deformity, permitted the patients to wear ordinary shoes, and, in combination with excisional arthroplasty of involved lesser metatarsophalangeal joints, relieved disabling pain in the fore part of the foot.
The secure diagnosis "psoriasis arthropathica" must always be the result of a clinical examination, paraclinical and radiological findings. In 150 patients with arthropathic psoriasis X-ray examinations of peripheral joints, of the sacroiliac joints and of the spine were performed. As a result of subtle evaluations of the findings X-ray-morphological criteria on the skeleton of hand and foot, on the sacroiliac joints and on the spine may be derived. On the basis of the experiences gathered recommendations for the practice in form of radiographic objects of an X-ray-diagnostic basic programme in primary diagnostics and in repeated examinations are proposed. An optimum diagnostics of the arthropathic psoriasis can be achieved only ba close co-operation and by constant mutual informations between rheumatologists, dermatologists and radiologists.
Of 50 patients in whom Morton's metatarsalgia was diagnosed during an 18-year period, 12 (24%) had rheumatoid arthritis at the time of presentation. After conservative management had failed, 20 patients had subtotal excision of the intermetatarsophalangeal bursa and associated digital nerve; in two patients, only the nerve was excised. During the follow-up period ranging from two months to 15 years, an additional eight patients developed sero-positive rheumatoid arthritis. Thus, a total of 20 patients (40%) presenting with Morton's metatarsalgia had rheumatoid disease at initial presentation or later developed this disease. Histological changes in the intermetatarsophalangeal bursa consistent with rheumatoid arthritis were found in ten patients. Of these, two were known already to have rheumatoid arthritis, three subsequently developed rheumatoid arthritis, and five do not yet have other evidence of the disease. The evidence suggests that Morton's metatarsalgia is associated with rheumatoid arthritis and is the basic etiology in a significant number of patients.
Calcinosis circumscripta, usually associated with scleroderma, Raynaud's phenomenon, and telangiectasia, usually affects middle aged persons and is more common in females than males in a ratio of 6 to 1. The etiology is unknown, and onset of the lesion is slow and insidious. It occurs in the periarticular area as a painful mass with surrounding erythema and edema. It is visible in x-rays as localized, scattered calcification.
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Toe-to-hand vascularized joint transfers in four children were reviewed 6 to 8 years after operation (average, 6.6 years). Two children had vascularized metatarsophalangeal (MTP) joints. Both children have near normal active range of motion. The transferred epiphyses have provided a major contribution to digital growth. The other two children had second toe proximal interphalangeal (PIP) joints transferred to damaged hand joints. Active PIP joint extension has been disappointing, and the overall growth contribution of the transferred epiphysis has been small. We conclude that MTP to metacarpophalangeal vascularized joint transfer can provide painless, functional, stable motion, with near normal growth potential, and the usefulness of toe PIP to hand PIP joint transfer is limited by the inability to achieve good active extension and limited growth potential.
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.
OBJECTIVE: Our aim was to compare the prevalence and severity of foot deformities and the development of ulcerations in patients after a great toe amputations. RESEARCH DESIGN AND METHODS: We evaluated the presence of deformities of the toes and metatarsophalangeal joints (MTPJs) in patients with a great toe amputation who had an intact unamputated contralateral foot. The contralateral foot served as the patient's own control. We used a binomial test for paired data to compare the presence of deformity and ulcer formation and Fisher's exact test to compare joint flexibility in toes and MTPJs with foot deformities. RESULTS: There were more deformities of the second (P = 0.012) and third (P = 0.002) toes and lesser MTPJs (P < 0.05) and more rigid deformities of the second (P = 0.002) and third (P = 0.016) toes and second MTPJs (P = 0.035) in feet with great toe amputations. New ulcers were more common in feet that had an amputation (P = 0.002). CONCLUSIONS: We concluded that amputation of the great toe contributes to the development of deformities of the second and third toes and lesser MTPJs and new ulcer formation in patients with diabetes. When deformities were present, the second and third toes and second MTPJ were more severe in feet with a great toe amputation.
A prospective analysis of 60 patients with gout was undertaken to evaluate the radiographic spectrum of gouty arthritis in patients treated in the era of hypouricemic therapy. Twenty-two of these patients were clinically tophaceous; 36 were considered to have radiographic findings diagnostic of gouty arthritis by strict radiographic criteria. Up to 24% of the patients denied symptoms in joints with radiographic changes of gout; 42% with no evidence of tophi on clinical examination had radiographic changes characteristic of gout. Radiographic assessment can be extremely helpful in the management of gout by documenting the degree and extent of bony involvement, particularly in patients with limited symptoms or without clinical tophi.
We describe the vascularised transfer of a second metatarsophalangeal joint to the hand to correct a congenital deformity in a thirteen-year-old boy. Technical refinements are described, allowing inversion of the joint to the optimal position for subsequent mobility and retention of a large overlying dorsalis pedis flap to provide adequate cover.
Basing on x-ray and clinical examinations, the authors report on the incidence, distribution according to sex and age, and lateral localisation of arthrosis occurring in the first segment of the foot. The bilateral type of arthrosis mostly occurs as a result of hallux valgus and is seen in women. Furthermore, degnerative changes and structural modifications of the dislocated sesamoids are also frequent. Arthrosis associated with hallux rigidus is a degenerative process mainly found in men, which is exclusively unilateral. This degenerative process shows the classical clinical and x-ray signs pertaining to arthrosis