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PubMed2006

Clinical features of scleroderma patients with contracture of phalanges.

Contracture of phalanges (CP) is a frequent complication of patients with systemic sclerosis (SSc). The objective of this study was to examine the prevalance of CP in patients with SSc and investigate the clinical and laboratory features of SSc patients with CP. Three hundred and fifty patients with SSc were examined. CP was found in 164 of the 350 patients (47%) with SSc. The prevalence of oesophageal involvement, pulmonary fibrosis or heart involvement was significantly greater in the patients with CP than that in those without CP. Our study suggested that the presence of CP may be a marker of oesophageal involvement, pulmonary fibrosis and heart involvement.

Adult↗
PubMedDate not supplied

Hemiphalangectomy and syndactylization for treatment of osteoarthritis and dislocation of the second metatarsal phalangeal joint: an outcome study.

End-stage osteoarthritis or severe dislocation at the second metatarsophalangeal joint typically presents with chronic pain and is often unrelieved by conservative treatment. The aim of this article is to review the preliminary outcomes of surgery involving resection of the base of the second proximal phalanx with syndactylization to the third toe for stability. Thirteen patients (13 feet) with second metatarsophalangeal osteoarthritis and 15 patients (15 feet) with a dislocated second toe underwent the procedure and were reviewed after a mean 12.4 months (range, 5-25 months). Patients were evaluated preoperatively and postoperatively with the American Orthopedic Foot and Ankle Society's scoring system and clinical review. A patient questionnaire was devised to yield information regarding toe alignment, cosmesis, and reflection on the procedure. Pain and activities were significantly improved in both subgroups (P < .01). Eighty-two percent were very satisfied or satisfied with the reduction in symptoms, with 11% satisfied with reservations and 7% not satisfied. Seventy-nine percent were very satisfied or satisfied with the appearance. Thirty-nine percent stated the outcome was better than expected, 14% as expected, and 14% felt the result was worse than expected. Twenty-three patients (82%) had no postoperative cosmetic concerns, and 7 patients (25%) felt there was a moderate or severe difference in the alignment with respect to the other toes. In conclusion, syndactylization can significantly improve pain and activity levels and was found to be cosmetically acceptable.

Activities of Daily Living↗
PubMed1977

Hair patterns of the lower limb in Central Indian males.

The distribution of hair of the right lower limb has been studied in a random sample of 220 healthy Central Indian males 17 to 45 years of age. The common hair patterns observed are the proximal phalangeal hair in all toes in 55.45%, the middle phalangeal hair in the third toe in 8.18%, the tibial on the dorsum of foot in 69.55%, and the pedo-cruro-femoral in the lower limb in 70.00% subjects. Comparison of these findings with those of the right upper limb shows that hairiness of the two limbs is correlated, that the dorsum of foot is less hairy than the dorsum of hand, and that the third and second toes are comparable with the fourth and third fingers, respectively, as regards their middle phalangeal hair. Comparison with the available literature shows that the Central Indian males resemble the Whites in having greater frequency of middle phalangeal hair than those of the Negroes, that the dorsum of feet of this population is less hairy than the White and more hairy than the Negroes, and that the general hairiness of the lower limb is more or less equal in the three groups of persons.

Adolescent↗
PubMed1999

[Hallux valgus treated by Scarf osteotomy of the first metatarsus and the first phalanx associated with an adductor plasty. Apropos of 50 cases with a 2-year follow up].

PURPOSE OF THE STUDY: Fifty hallux-valgus were treated with Scarf Osteotomy of the first metatarsal, associated to a phalangeal varisation or shortening osteotomy and an adductor plasty. Patients were evaluated with a minimum follow-up of two years. MATERIAL AND METHODS: Forty five females and two males were operated with an average age of fifty years. The pre operative metatarsus varus was of 15 degrees 8. Mean alignment of metatarsal bar was 31 degrees 4. The cuneo-metatarsal joint was twenty two times spheric and twenty eight times plane. The average metatarso-phalangeal great toe valgus was 39 degrees 8. RESULTS: They were appreciated with a minimal follow-up of two years, according to the 3 Groulier's criteria: correction of deformation, statics troubles, functional activity. The metatarsus varus improved with an average of 10 degrees 4, as well as the alignment of the metatarsal bar (25 degrees). The post operative average phalangeal valgus was 22 degrees 7. These results were statistically significant. Cuneo-metatarsal joint type did not influenced final result. Articular joint line was normal in 64% of cases. Global result was excellent or good in 70%, passable in 22%, and bad in 8% of cases. DISCUSSION: Scarf Osteotomy of the first metatarsal allows complete correction of metatarsus varus. The surgical approach can be proposed at every age. There are no vascular trouble or arthrosis worsening. It must be completed with a phalangeal varisation or shortening osteotomy and adductor plasty.

Adolescent↗
PubMed1991

The anatomy of a human foot with missing toes and reduplication of the hallux.

Detailed dissection of a malformed human foot was performed so that the skeletal and soft tissue anomalies in the foot could be compared and contrasted with those found in three previous specimens that we have dissected. The specimen described here consisted of a foot with a reduplicated hallux and two missing toes. Study of the bones revealed a wide medial metatarsal that articulated with a reduplicated hallux. There were two complete lateral toes with normal bones. Two toes and their metatarsals were missing with no remnants. The arterial pattern was similar to those seen previously by us. The dorsalis pedis artery was absent and the plantar arch was abnormal in that it did not terminate with a dorsal anastomosis. There was an extra lateral branch of the medial plantar artery. The digital arteries to the missing toes were also missing. The nerves of the foot were normal with the exception of an extra lateral branch from the medial plantar nerve. As with the arteries, the nerves to the missing toes were also missing. The muscles and tendons on the dorsal surface of the foot were all present but several of the tendons were inserted in abnormal locations in apparent response to the abnormal bone pattern. Most of the muscles and tendons of the plantar surface were present with the exception of the flexor hallucis longus and brevis muscles. Several of the remaining tendons apparently were influenced by the abnormal skeletal pattern and the missing muscles to become inserted on or near the replicated phalanges of the hallux. The anatomy of this specimen suggests that the teratogenic event occurred when specification of the limb bud mesoderm cells had progressed to the level of the distal tarsus and was located in the region that normally would have formed the metatarsals and phalanges of Toes 2 and 3. Further, we propose that the association between skeletal anomalies and arterial deficiencies has aetiological significance. We hypothesise that the abnormal arterial pattern put the limb at risk of teratogenic damage by reducing the number of collateral blood supply routes and that some event, such as extravasation of blood or embolisation, compromised the blood flow in the remaining blood vessels. These events could have resulted in both general shortening of the limb and the specific defects observed in this foot.

Arteries↗
PubMed2007

Morphometric study of the human metatarsals and phalanges.

Mathematical relation between metatarsals and between phalanges in terms of their lengths and widths in themselves is considered to be significant with respect to its functional and aesthetic roles. The objective of this study is to conduct measurements for determining lengths and widths of metatarsals and phalanges on the foot radiographs and to determine possible mathematical correlations between metatarsals themselves and between phalanges themselves in terms of their lengths and widths. Anteroposterior right and left foot radiographs were taken from 100 volunteers (50 men and 50 women). Lengths and widths of the metatarsals and phalanges were measured in millimeter on radiographs. The mean, minimum and maximum values, and standard deviations of each bone's length and width were studied and data were put into formulation. The results were evaluated by Regression statistical test, and the relation between metatarsals and between phalanges in terms of their lengths and widths was studied. As a result of the measurements, we found fixed proportions between metatarsals in themselves and between phalanges in themselves in terms of their lengths and widths. Knowing these morphometric relations may be useful for performing any surgical procedures designed to manage any defects or imperfections of the foot, chief among them is shortness.

Adult↗
PubMedDate not supplied

The effect of temperature elevation during discontinuous use of rotatory burrs in the correction of hallux valgus.

The purpose of this study was 2-fold: to measure temperature elevation during exostectomy and osteotomies of the metatarsal head and the proximal phalanx in 78 patients (94 feet) with hallux valgus undergoing distal first metatarsal and proximal phalangeal osteotomies by minimal incision surgery; and to assess whether there was a relationship between working temperatures at operation and the overall thickness of the forefoot. The procedure included the use of rotary wedge burrs in discontinuous cutting bursts of less than 20 seconds for removal of the exostois, and the use of rotary triflute burrs used in discontinuous cutting bursts of less than 10 seconds for each osteotomy. The temperature of the bone surface was measured with a thermocouple and, when 38 degrees C was exceeded, the field was irrigated with saline solution. The temperature generated during the procedure was found to be significantly associated with the amount of bone removed from the metatarsal (Pearson's correlation coefficient, r = -0.101, P = .05). At the 6-week visit, thickness of the first metatarsal was greater in the group with temperature elevations > or =47 degrees C compared with the group with temperatures <47 degrees C. The Reverdin-Isham procedure by minimal incision surgery using rotatory triflute burs in discontinuous cutting bursts is an effective, reliable, and technically simple procedure for treating hallux valgus deformity. At follow-up, thickness of the foot at the level of the head of the first metatarsal was associated with heat generated during the use of rotary burs.

Adult↗
PubMed2006

Radiographic angles in hallux valgus: differences between measurements made manually and with a computerized program.

BACKGROUND: The objective of this study was to compare angular measurements in the evaluation of hallux valgus deformities using a goniometer and a computerized program to assess degree of concordance between the two methods and determine the reliability of manual measurements. METHODS: Angles measured included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), and the proximal phalangeal articular angle (PPAA), also called the hallux valgus interphalangeus angle or interphalangeal angle. Measurements were made on preoperative weightbearing radiographs in 176 patients with symptomatic hallux valgus. Manual measurements were made with a goniometer by an orthopaedic surgeon. An independent experienced technician used digitized images to perform angular measurements with the Autocad software program (Autodesk Inc., San Rafael, CA). RESULTS: HVA values obtained with the two techniques were similar. However, significantly higher mean values were obtained with the Autocad for the IMA and PPAA measurements, and higher mean values were obtained for the DMAA measurement with the manual technique. Whereas differences were more or less randomly distributed for the HVA, in the remaining patients, measurements were clearly related to the measurement technique, i.e., for the DMAA, the manual technique had a tendency to show higher values, and for the IMA and PPAA the manual technique showed lower values than the computer. Correlations between both techniques for the different angular measurements were as follows: HVA, -0.179 (p = 0.018); DMMA, -0.294 (p < 0.001); PPAA, -0.876 (p < 0.001); and IMA, -0.661 (p < 0.001). The intraclass correlation coefficient (ICC) showed that the concordance between manual and Autocad angular measurements was excellent for the HVA (ICC = 0.89) and DMAA (ICC = 0.80) and very poor for the PPAA (ICC = 0.11) and IMA (ICC = 0.42). CONCLUSIONS: Angular measurements made on weightbearing radiographs with the Autocad in patients with hallux valgus deformities were more reliable than those made with a goniometer. Although for large angles, such as HVA and DMAA, results obtained with both measurement techniques were similar. Manual measurements, however, may underestimate the true values of the smaller IMA and PPAA angles.

Hallux Valgus↗
PubMed2005

Pedal symphalangism in modern American and Japanese skeletons.

Pedal symphalangism is a surprisingly common heritable trait of the human foot. In individuals exhibiting the trait, the joint between the intermediate and distal phalanges of one or more lateral toes never develops, resulting in toes with two phalanges rather than three. This study was undertaken to explore variation in the frequency of pedal symphalangism among groups with widely different geographic ancestry, and to consider the applicability of this trait to skeletal biological distance studies. A total of 460 Euro-American, 191 African-American and 99 Japanese skeletons were examined for presence of pedal symphalangism. The American individuals date to the first half of the 20th c, while the Japanese individuals date to the late 19th and early 20th c. Although the country of ancestry is unknown for most of the American individuals, the Euro-Americans appear to be largely northern European, with roots in Germany, Ireland and Scandinavia, while the African-Americans are primarily descendants of slaves with roots in west African countries such as Nigeria, Benin, Togo, Ghana and Sierra Leone. Frequencies of fifth toe pedal symphalangism were calculated and compared among all three samples and found to be significantly higher in modern Japanese (83.7%) than in either Euro-Americans (46.4%) or African-Americans (44.0%). The Euro- and African-American frequencies were statistically indistinguishable for symphalangism of the fifth toe. In the fourth toe, however, the opposite result was found. The African-American frequency (7.9%) was significantly higher than the Euro-American frequency (2.6%), while no difference was found between the African-Americans and Japanese (11.7%). Since fourth toe pedal symphalangism has never been observed in the absence of fifth toe involvement, some of the same genes are clearly involved in producing the trait in both toes. However, differences in the pattern of fourth and fifth toe expression among the three groups identified in this study suggest that additional genetic or developmental factors may play a role in expression of pedal symphalangism in each of the toes.

Adult↗
PubMed2000

Are triphalangeal thumb-polysyndactyly syndrome (TPTPS) and tibial hemimelia-polysyndactyly-triphalangeal thumb syndrome (THPTTS) identical? A father with TPTPS and his daughter with THPTTS in a Thai family.

We report on a Thai man who had triphalangeal thumb-polysyndactyly syndrome (TPTPS, MIM *190605) and his daughter who had tibial hemimelia-polysyndactyly-triphalangeal thumb syndrome (THPTTS, MIM *188770). The father had polysyndactyly of triphalangeal thumbs, syndactyly of fingers, duplicated distal phalanx of the left great toe, brachymesophalangy of toes, and the absence of middle phalanges of some toes. He was diagnosed as having TPTPS. His daughter was more severely affected, having complete syndactyly of five-fingered hands in rosebud fashion (Haas-type syndactyly), hypoplastic tibiae, absent patellae, thick and displaced fibulae, preaxial polysyndactyly of triphalangeal toes, and cutaneous syndactyly of some toes, the manifestations being consistent with THPTTS. Having two different syndromes in the same family suggests that they are actually the same disorder. A literature survey showed that there have been several families where THPTTS occurred with TPTPS or Haas-type syndactyly (and/or preaxial polydactyly type 2, PPD2). In addition, all loci for TPTPS, THPTTS, and PPD2 (and/or PPD3) have been assigned to chromosome band 7q36. These findings support our conclusion that TPTPS, PPD2 (and/or PPD3), and Haas-type syndactyly are a single genetic en-tity (THPTTS). We propose to call the condition "tibial hemimelia-polysyndactyly-triphalangeal thumbs syndrome."

Adult↗
PubMed1995

Autosomal recessive Melnick-Needles syndrome or ter Haar syndrome? Report of a patient and reappraisal of an earlier report.

We report on a patient with congenital glaucoma, brachycephaly with flat occiput, large anterior fontanel, hypertelorism, anteverted nostrils, thoracolumbar kyphosis, prominent coccyx with skin fold, short hands and feet, flexion deformity of fingers, and clubfeet. He had a double-outlet right ventricle with ventricular septal defect, and severe tricuspid insufficiency. Mild skeletal changes included short tubular bones, absence of distal phalanges of toes, caliber variation of ribs, and scalloping of the anterior surface of vertebrae. The patient died at age 21 months. He belongs to the same extended family as 3 similarly affected patients, previously described by ter Haar et al. [1982: Am J Med Genet 13:469-477] as representing an autosomal recessive form of Melnick-Needles syndrome. We believe this diagnosis is no longer tenable. After having reviewed the relevant literature, we conclude that most probably we are dealing with a new autosomal recessive syndrome. We propose to name this entity ter Haar syndrome.

Diagnosis, Differential↗
PubMed2003

A new syndrome of symphalangism, multiple frenula, postaxial polydactyly, dysplastic ears, dental anomalies, and exclusion of NOG and GDF5.

A Thai girl with a unique combination of limb and craniofacial anomalies is reported. Manifestations include blepharoptosis; prominent nose; hypodontia; multiple, hyperplastic frenula; and dysplastic ears. Limb anomalies include short stature, postaxial polydactyly of both hands and the left foot, proximal and distal symphalangism of fingers, and congenital absence of the distal phalanges of toes 2-5. Mutation analyses of NOG and GDF5, the genes responsible for symphalangism-related syndromes, were negative.

Bone Morphogenetic Proteins↗
PubMed2006

Yunis Varon syndrome.

In this communication is reported a neonate with Yunis Varon syndrome, a rare autosomal recessive disorder, born to a consanguineously married couple who had microcephaly, wide cranial sutures, prominent eyes, hypertelorism, dysplastic ears, sparse hairs, cupid bow like upper lip with median pseudocleft and labio-gingival retraction. Bilateral hypoplasia of thumbs, absent great toes, short phalanges were other features. Additional features in this case included median pseudocleft unreported earlier and C.T. findings of underdeveloped gyri, ischemic changes in temperoparietal region and bilateral lacunar infarcts in middle cerebral artery territory.

Abnormalities, Multiple↗
PubMed2006

Epidermal inclusion cyst of phalanx: a case report and review of the literature.

Epidermal cyst within a toe phalanx is an extremely rare condition. It is important to differentiate this benign lesion, which can be easily treated by curettage, from other benign and malignant lesions of the bone with a similar clinical presentation, and which may require amputation of the toe. This report describes one such lesion in the mid-phalanx of the fourth toe in a 48-year-old woman, and which was successfully identified by intra-operative frozen diagnosis and treated by curettage.

Bone Diseases↗
PubMed2006

Individualizing characteristics of footprints in Gujjars of North India--forensic aspects.

Careful examination of foot impressions can provide important evidences and clues in a crime scene investigation. The present study is conducted on a cross-sectional sample of 1040 adult male Gujjars inhabiting the sub-Himalayan region of North India. The study describes the utility of individualizing characteristics of footprints in forensic examinations. Various features of the toes, humps in the toe line, phalange marks, flatfoot condition, pits, cracks, corns, etc., were studied. Frequency of some of these characters has also been recorded. The frequency of the tibialis-type foot is the highest, followed by fibularis-type, then intermediate-type and midularis-type is found to be least frequent among the sample. Three humps have been found most often in footprints, followed by two humps, four humps, and then five humps and one hump are found to be least frequent. Flatfoot condition is found to be present in 1.54% of the sample population and the trait also shows bilateral variation. Phalange marks, crease marks, pits, deformity, etc., are also demonstrated with suitable examples in the present population. These characteristic features can provide useful clues to establish personal identity whenever complete or partial footprints are recovered at the crime scene and can help in including or excluding the possible presence of individual at the scene of crime.

Adolescent↗
PubMed2006

Vascularized bone blocks from the toe phalanx to solve complex intercalated defects in the fingers.

PURPOSE: Vascularized bone transplants resist infection and allow rapid healing but keeping small bony segments vascularized, as needed for a finger defect, is a challenge. The purpose of this article is to present a cohort of patients with traumatic intercalated compound bony defects in the fingers that were reconstructed by a vascularized toe phalanx (or part of a phalanx) in a single stage. METHODS: Eight patients were treated with an intercalary vascularized bone graft that included a part of the proximal phalanx (3 patients), most of the middle phalanx (4 patients), or a portion of each phalanx (1 patient) of a second toe (totaling 9 bone blocks). There was an associated soft-tissue defect in each patient, an infection in 6 patients, and cartilage loss in 4 patients. The toes were pedicled on the proper digital artery (6 patients) or a segment of the first dorsal metatarsal artery (2 patients). A mean length of 12 mm of vascularized bone was transferred. The associated skin island varied from a minimum of 2 x 1 cm to a maximum of 5 x 3 cm. Bleeding from all of the bone surfaces was evidenced once the clamps were released. The homolateral digital nerve and the contralateral neurovascular pedicle of the toe were kept in place. The toe defect was treated by soft-tissue arthroplasty or arthrodesis. No toe was amputated. RESULTS: Radiologic bony union was evident at 4 to 6 weeks, except in 1 patient with an acute infection whose distal union failed to unite at 6 weeks because the infection recurred. Finger length loss averaged 3 mm. All patients returned to their preoperative occupation. CONCLUSIONS: In this group of patients the toe phalanx reliably maintained its vascularization, allowing us to solve compound osteocutaneous defects in the fingers in a single stage. Donor site morbidity was minimal.

Adult↗
PubMed2005

[Phalengeal actinomycosis: a rare disease].

INTRODUCTION: Bone involvement in actinomycosis is rare. EXEGESIS: We report a case of a 38 year-old woman with foot bone actinomycosis. The clinical symptoms were non-specific and the diagnosis was difficult. An X-ray revealed an osteolysis and a sclerosis of the proximal phalanx of the big toe. A phalengiectomy was carried out after the failure of antistaphylococcic antibiotherapy. The diagnosis of actinomycosis was substantiated by a histological examination. The clinical outcome was good after six-month treatment by penicillin G substitutes for cotrimoxazol. The patient completely recovered and was feeling well. The mean follow up was fifteen months. CONCLUSION: Clinical and therapeutic aspects of this rare localization are reviewed.

Actinomycosis↗