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PubMed1998

Chondromyxoid fibroma of the distal phalanx of the great toe: a tumor with unusual histological findings.

Chondromyxoid fibroma (CMF) rarely arises in the distal phalanx of the foot and less than 20 cases have been reported in the literature. It has also been known to show a wide spectrum of histology mimicking other primary bone tumors. An unusual case of CMF arising in the distal phalanx of the left great toe is reported because of its unique anatomic site of origin and histology. A 53-year-old female presented with a slow growing, painful great toe of the left foot which she had had for 3 years. She had first noticed the mass 25 years ago. On admission, plain X-ray revealed an osteolytic mass with a sclerotic margin expanding to the distal phalanx of the great toe. Interestingly, the lesion was microscopically composed of hypercellular chondromyxoid lobules separated by hypocellular fibrous tissue, which is in contrast to the typical histology of CMF. In addition, the lesion showed an aggregate of tumor cells with pleomorphic multinucleate or giant nuclei within the chondromyxoid matrix, which were not similar to the osteoclast-like type. Perhaps these unusual histological findings may be associated with its long duration and presenting location.

Biomarkers, Tumor↗

PubMed2004

Inherited accessory nail of the fifth toe cured by surgical matricectomy.

BACKGROUND: The inherited accessory nail of the fifth toe is a common condition in the Chinese population. OBJECTIVE: The objective was to demonstrate three lesions in two cases of inherited accessory nail of the fifth toe successfully treated with surgical matricectomy. METHODS: Under local anesthesia and use of tourniquet, the proximal nail fold was incised and the matrix of the accessory nail was exposed and then excised by scalpel surgery. The skin defect left after removal of the lesion was repaired with a rotation flap. RESULTS: Histopathologic examination of the surgical specimens revealed that the matrices of the accessory nails were completely extirpated. No recurrence was found 2 years after operation. CONCLUSION: The inherited accessory nail of the fifth toe was cured by surgical matricectomy.

Adult↗

PubMed1994

Extra-toes (Xt) homozygous mutant mice demonstrate a role for the Gli-3 gene in the development of the forebrain.

The development of the forebrain in homozygous extra-toes mutants (Xt/Xt) was examined histologically from day 11.5 to day 16.5 of gestation. It is shown that until day 16.5 of gestation, the forebrains of Xt/Xt mutant embryos develop neither an olfactory bulb nor a choroid plexus in the lateral ventricles, and do not exhibit lamination in the cerebral cortex. Glial fibrillary acidic protein (GFAP)-expressing glial cells are detected in the prospective cerebral cortex of Xt/Xt animals, indicating that differentiation to glial cells is not disturbed. Upon comparison with a Splotch mutant, it is demonstrated that delayed closure of the anterior neuropore cannot account for the extra-toes specific defect in the developing cerebral cortex. It is, therefore, suggested that the forebrain phenotype in Xt/Xt mutant embryos is caused by the direct action of the mutation on the forebrain. As the zinc finger gene Gli-3 is deleted in extra-toes mutants, these observations suggest that the proper expression of the Gli-3 gene in the forebrain is a prerequisite for the normal development of the telencephalon and later of the cerebral cortex.

Animals↗

PubMed2000

Total contact casting and Keller arthoplasty for diabetic great toe ulceration under the interphalangeal joint.

Interphalangeal (IP) ulcerations of the great toe are frequently encountered in neuropathic diabetic feet. While total contact casting is usually effective as a first line treatment, recalcitrant ulcers continue to present substantial management challenges. The authors retrospectively reviewed the results of Keller arthroplasty employed to accelerate ulcer resolution with total contact casting in fourteen patients with neuropathic ulcers under the great toe interphalangeal (IP) joint that were resistant to casting alone. These data were compared to a group of similar patients whose ulcers were successfully treated by non-operative measures. No operative complications were observed, and all ulcers healed within twenty-four days with no recurrence documented at an average follow-up of 26 weeks. In cases of resistant great toe IP plantar ulcers associated with hallux rigidus that have failed casting trials, this treatment method can be effective.

Adult↗

PubMed1981

Amputation of the great toe.

Four patients who had undergone reimplantation of the great toe to create a thumb were studied. The follow-up period ranged from 29 to 62 months. In all cases, the great toe was disarticulated at the metatarsophalangeal joint. The patients felt their feet functioned at approximately 85% of normal, and none had any significant complaint of metatarsalgia. The one patient who participated in sports after the surgery noted that it was difficult to "push off" moving away from the involved foot. X-ray examination demonstrated retraction of the sesamoids, which accounted for the increased plantar flexion of the first metatarsal shaft. The second metatarsophalanageal joint drifted into varus an average of 8 degrees. The Harris mat demonstrated that there was an increase in weightbearing beneath the second and third metatarsal heads. It appears as though, on the basis of this study, the loss of the great toe in this manner does not significantly affect the normal everyday function of an individual's foot.

Amputation, Surgical↗

PubMed1992

Stabilization of the interphalangeal joint of the big toe: comparison of three methods.

Three methods of stabilizing the IP of the big toe were compared. In group A, 10 patients underwent tenodesis of the extensor hallucis longus to the extensor digitorum brevis tendon. All of them developed a toe-drop; two patients had significant symptoms that required IP fusion. In group B, 19 patients underwent IP fusion using smooth or threaded intramedullary Kirschner wire fixation. There were nine nonunions, three requiring refusion. In group C, 32 patients underwent IP fusion using intramedullary screw fixation. There was one nonunion with screw failure that required revision. Although none of our patients considered the toe-drop after extensor hallucis longus tenodesis cosmetically unacceptable, this may not be so in other cultures. All complications following IP fusion with screw fixation were technical and are avoidable. When stabilization of IP is required, we recommend fusion of IP with screw fixation.

Adolescent↗

PubMed2002

Correction of hammer toe with an extended release of the metatarsophalangeal joint.

Between March 1995 and January 2000 we reviewed retrospectively 84 patients with hammer-toe deformity (99 feet; 179 toes) who had undergone metatarsophalangeal soft-tissue release and proximal interphalangeal arthroplasty. The median follow-up was 28 months. Patients were assessed by the American Orthopaedic Foot and Ankle Society Scores (AOFAS) and reviewed by independent assessors. The median AOFAS score was 83, with 87% of patients having a score of more than 60 points; 83% were satisfied and 17% were dissatisfied with the procedure. Pain at the metatarsophalangeal joint was the commonest cause of dissatisfaction, with 14% having moderate or severe pain. Only 2.5% had instability and 9% had formation of callus. There was no statistical difference for the age and gender of the patients, the number of toes operated on, associated surgery for hallux valgus or length of follow-up. Our study was based on an anatomical model and shows good results with no recurrence of deformity.

Adult↗

PubMedDate not supplied

Reconstruction of the great toe ski-slope, sunken-nail deformity with a buried adipofascial flap.

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient's persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity.

Adult↗

PubMed2001

[New varieties of lateral metatarsophalangeal dislocations of the great toe].

PURPOSE OF THE STUDY: We report seven cases of traumatic dislocation of the great toe, detailing the anatomy, the mechanism of injury and the radiographic diagnosis. We propose an additional classification based on three hereto unreported cases. MATERIAL AND METHODS: Between october 1994 and october 1997, we treated seven patients with traumatic dislocation of the first metatarso-phalangeal joint of the great toe. There were six men and one woman, mean age 35 years (range 24 - 44 years). Dislocation was caused by motor vehicle accidents in four cases and by falls in three. Diagnosis was made on anteroposterior, lateral and medial oblique radiographs. According to Jahss' classification, there was one type I and three type IIB dislocations. There was also one open lateral dislocation and two dorsomedial dislocations. Only these dorsomedial dislocations required open reduction, done via a dorsal approach. Mean follow-up was 17.5 months (range 9 - 24 months) in six cases. One patient was lost to follow-up. The outcome was good in six cases and poor in one (dorsomedial dislocation). DISCUSSION: Dislocation of the first metatarso-phalangeal joint of the great toe is an uncommon injury. In 1980, Jahss reported two cases and reviewed three others described in the literature. He proposed three types of dislocation based on the feasibility of closed reduction (type I, II and IIB). In 1991, Copeland and Kanat reported a unique case in which there was an association of IIA and IIB lesions. They proposed an addition to the classification (type IIC). In 1994, Garcia Mata et al. reported another case which had not been described by Jahss and proposed another addition. All dislocations reported to date have been sagittal dislocations. Pathological alteration of the collateral ligaments has not been previously reported. In our experience, we have seen one case of open lateral dislocation due, at surgical exploration, to medial ligament rupture and two cases of dorsomedial dislocation due, at surgical exploration, to lateral ligament rupture. CONCLUSION: We propose another additional classification with pure lateral dislocation (type III) and dorso-lateral dislocation (type IL or IIL+), which are related to the formerly described variants.

Accidental Falls↗

PubMedDate not supplied

External rotation contracture of the extended hip. A common phenomenon of infancy obscuring femoral neck anteversion and the most frequent cause of out-toeing gait in children.

External rotation contracture of the extended hip is common in young infants, decreasing progressively with growth so that it appears to be present in less than 5 per cent of the children over age 18 months. Persistence of the external rotation contracture was the main cause of toeing-out gait in this study. Femoral neck anteversion, as a cause of internal rotation posturing of the limb, does not become clinically recognizable until complete resolution of the external rotation contracture of the hip has occurred, that is, usually after 18 months of age. Femoral neck retroversion was not present clinically in any of the patients examined, and so appears to be quite rare. Approximately 80 per cent of children under 18 months of age who toe-in have internal tibiofibular torsion; most of these also have significant talar neck adductus! Approximately 70 per cent of children over age 2 years who toe-in have excess femoral neck anteversion as the cause. Approximately 75 per cent of the children with metatarsus adductus deformity have coexistent internal tibial torsion and talar neck adductus; only 25 per cent of children with internal tibial torsion have coexistent metatarsus adductus deformity. Physiologic genu varum usually occurs prior to 2 years of age and physiologic genus valgum usually occurs after 2 years of age.

Bone Diseases↗

PubMed2006

Early transoesophageal echocardiography (TOE) in cardiac arrest: a case study.

We describe a case of abrupt cardiac arrest in an 80 year old woman. Emergent transoesophageal echocardiography (TOE) helped clarify the diagnosis of pulmonary embolism, and guide management and ongoing resuscitation. This case highlights the utility of TOE in the peri-arrest setting and in the diagnosis of massive pulmonary embolism. TOE can also be useful in providing prognostic information and determining the choice of therapeutic drug treatment and vasopressor support.

Aged, 80 and over↗

PubMed1991

[Possibilities of therapy of hallux valgus et rigidus in a private hospital (Swanson great toe implant)].

In 1983 we decided to use Swanson's great toe implants in selected cases after previous clinical examinations and X-ray tests, especially the stemmed or the stemmed hinge great toe implant based on Swanson/Weil and the Swanson silastic HP double stemmed flexible hinge toe implant. Thus 97 patients were operated between 1983 and 1989. Of these patients 82 were recently examined once again. In 80.5% of all cases good to very good results were achieved concerning functional or cosmetic aspects, X-ray tests and the patient's well-being.

Hallux Valgus↗

PubMed1984

A case of "trigger toe".

"Triggering" of the toes, in which local tendon hypertrophy prevents the smooth movement of the tendon, has been described as a problem more theoretical than real and only three cases have been reported. The authors report a case of partial tethering of the flexor hallucis longus tendon just distal to the medial malleolus in a 28-year-old jogger who had painful triggering of the great toe on plantar flexion of the ankle and great toe. Division of the flexor hallucis longus tendon pulley distal and posterior to the medial malleolus cured the patient.

Adult↗

PubMed1981

Deformities of the great toe in Apert's syndrome.

Complex syndactyly of the hands and feet is a major deformity seen in children with Apert's syndrome. Also observed in the three patients presented in this paper was severe hallux valgus, which caused significant shoeing difficulties in two patients, for whom surgical correction was necessary. The two operative plans were based on the different underlying osseous abnormalities: (1) removal of the great toe with transposition of the second toe; (2) resection of the second ray with realignment of the great toe. Both procedures were successful from a functional and aesthetic viewpoint. When confronted with a child with Apert's syndrome who is having shoeing difficulty, assessment of the underlying osseous pathology is a mandatory step in the preoperative planning of surgical intervention.

Acrocephalosyndactylia↗

PubMed1994

MRI findings of acute turf toe. A case report and review of anatomy.

Normal anatomy of the metatarsophalangeal joint of the hallux has been well described. However, the pathologic anatomy of turf toe, a common injury among football and rugby players, has not been documented in detail. Magnetic resonance images (MRI) of a classic case of turf toe were examined and the findings were compared with MRI of a normal specimen and correlated with known features of gross anatomy. MRI findings confirmed that turf toe involves a sprain or tear of the plantar metatarsophalangeal joint capsule.

Adult↗

PubMed1993

[The painful leg and moving toe syndrome].

The paper reports a case of painful-legs-and-moving-toes syndrome in a 75-year-old woman who developed it after a paralytic ischias attack at the age of 70. The syndrome was characterized by persistent pains in distal parts of the legs and feet and constant involuntary flexion-extension wave-like toe movements. SSEP studies revealed a defect of conduction in high-speed myelinated fibers of the lumbo-sacral radices of both sides. A cortical motor potential corresponding to the toe hyperkinetic movement was present. It the base of the hyperkinesis a reflectory mechanism may underlie initiated from radiculo-spinal nociceptive systems disinhibited in consequence of the deficiency of inhibitory control from high speed rear column afferents. Neurophysiological data suggest participation of cerebral mechanisms in realization of the hyperkinesis.

Action Potentials↗

PubMed1996

[Arthrodesis of the metatarsophalangeal joint of the large toe].

Arthrodesis of the first metatarsophalangeal joint is the procedure of choice in hallux rigidus with advanced destruction of the joint surfaces. It is also indicated after failed resection arthroplasty in hallux valgus. A dorsal skin incision is used. Flat osteotomy surfaces are created at the first metatarsal head and at the proximal phalanx with a saw. The angle between the great toe and the bottom of the foot should be ten to 15 degrees of dorsal extension. The great toe should be aligned in ten degrees of valgus relative to the first metatarsal bone, and in neutral rotation. Fixation with a dorsal one-third or one-quarter tubular plate and an interfragmentary lag screw is most stable. Interposition of a bone graft may be necessary in cases of undue shortening of the great toe, as in revision surgery following resection arthroplasty. Full weightbearing in a postoperative shoe with a rigid sole is allowed immediately postoperatively. Results with this technique are good and excellent in approximately 80 percent. The incidence of pseudarthroses is between three and 13 percent, depending on the operative technique. Symptomatic degeneration of the interphalangeal joint occurs in approximately 10 percent of patients at long-term follow-up.

Adult↗

PubMed2004

[Lesser toe deformities].

Lesser toe deformities often lead to painful calluses and metatarsalgia. Depending on the different underlying etiologies it is mandatory to perform a meticulous clinical assessment including the whole foot and the entire lower limb. Prior to any surgical interventions it is necessary to evaluate the deformity at all three joint levels. The metatarsophalangeal joint acts as a key joint. Any dorsal subluxation or dislocation has to be addressed first. This may include various soft tissue procedures and shortening osteotomies of the metatarsals. After successful realignment contractures of the distal joints have to be corrected. Since function of the lesser toes mainly depends on stability of the distal joints arthrodeses of the proximal and distal interphalangeal joints are superior to any resection arthroplasties.

Arthrodesis↗