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Intercalary non-vascularised toe phalanx transplantation for short finger-type symbrachydactyly.

A two-year-old boy with short finger-type symbrachydactyly involving the index, middle, and ring fingers was treated with intercalary nonvascularised toe phalanx transplantation into the middle finger to obtain stability of the middle finger before syndactyly release. He underwent syndactyly release one year after the transplantation. Two years after the transplantation, the clinical result was satisfactory, although X-ray showed fibrous union between the transplanted phalanx and the host phalanx. Intercalary nonvascularised toe phalanx transplantation is one of the way of stabilising a finger after syndactyly release.

Fingers↗

Toe-to-hand transfer in symbrachydactyly.

Symbrachydactyly, or central atypical cleft, is classified as a failure of formation. For the adactylous or monodactylous forms, free toe transfer is the treatment of choice. We present 18 free toe transfers in 13 patients for symbrachydactyly. Despite abnormal anatomy, the functional building blocks have always been available and transfer technically possible. The result has been improved function and high levels of parental satisfaction.

Child↗

Blue toe syndrome: treatment with anticoagulants and delayed percutaneous transluminal angioplasty.

The spontaneous onset of a painful unilateral blue toe is usually caused by fibrinoplatelet microemboli arising from an upstream stenotic or occlusive lesion of the iliac or femoral artery. This constellation of findings is referred to as the blue toe syndrome (BTS). In 12 patients who experienced 14 spontaneous episodes of BTS, angiography demonstrated 15 proximal atherosclerotic arterial lesions, which were presumed to be the source of the microemboli. Fourteen of the 15 lesions were short-segment stenoses or occlusions distal to the aortic bifurcation. Six lesions were treated with antiplatelet or anticoagulant drugs followed by delayed percutaneous transluminal angioplasty (PTA) 6-12 weeks later. Three lesions were treated with surgical bypass, three with long-term anticoagulation, and one with transcatheter clot aspiration and immediate PTA. Two were treated with immediate thrombolytic therapy and had embolic complications. Antiplatelet and anticoagulant therapy followed by delayed PTA may be an effective alternative to surgery for treating BTS.

Adult↗

Recurrent intravascular papillary endothelial hyperplasia of the toes.

We report on the rare case of a 50-year-old male with intravascular papillary endothelial hyperplasia (IPEP) in the left toes. The patient noticed a small tender mass in the left toes and underwent surgery in November 1997. The tumor recurred twice after surgery. Histopathological examination revealed a pure form of IPEP without underlying benign vascular lesions.

Endothelium, Vascular↗

Reversal of gangrenous lesions in the blue toe syndrome with lovastatin--a case report.

A seventy-six-year-old man with ischemic heart disease, peripheral vascular disease, and chronic renal failure developed bilateral cyanotic toes, which upon muscle biopsy, were shown to be caused by atheromatous emboli. The probable source was atheromatosis of the abdominal aorta. The toes became gangrenous, but surgical therapy was deferred because the patient was considered a high risk. With lovastatin therapy there was complete healing and except for transient cyanosis related to temporary cessation of therapy, there has been no recurrence for the past thirty months. The possible role of lovastatin in the conservative treatment of this disorder is discussed.

Aged↗

Force patterns of heel strike and toe off on different heel heights in normal walking.

This study investigated the changes of force patterns of the heel strike and toe off phases at different heel heights during normal walking. Ten healthy female college students wore running shoes, flat leather shoes and high heeled shoes while walking on a Kistler force platform at their self-comfortable paces. It was found that the high heeled shoes and the leather shoes generated significantly greater vertical impact forces and anterior-posterior forces in the toe off phase than those in the heel strike phase. Accumulated impulses did not show significant increase while the heel heights increased and total support time while wearing the high heeled shoes was significantly longer than while wearing the running shoes.

Adult↗

Surgical correction of crossover deformity of the second toe: a technique for tenodesis.

Twenty-seven patients with 30 crossover toe (COT) deformities of the second toe were evaluated. This deformity in the transverse and sagittal planes at the second metatarsophalangeal joint may be caused by hindfoot pronation. Compression of the lateral plantar nerve may produce incompetence of the second dorsal interosseous muscle and an increased extension-adduction pull by the lumbrical and first dorsal interosseous muscles. A surgical procedure for tenodesis is described to correct these deformities and restore the extrinsic-intrinsic musculotendinous balance at the second MTP joint. Our results are encouraging, with 83% good or excellent results. There was one recurrence.

Aged↗

Total joint prosthetic arthroplasty of the great toe--a 12-year experience.

This report describes the use of a double-stemmed flexible hinge silicone elastomer implant for use as a total joint replacement for the metatarsophalangeal joint of the great toe. Experience with this prosthesis has been since 1971 with 103 prostheses implanted in 71 patients with a minimum follow-up of 12 months and an average follow-up of 7.4 years. Of the 71 patients, 40 had osteoarthritis with 64 joints replaced, 22 had rheumatoid arthritis with 29 joints replaced, four patients were revised from a failed excisional hemiarthroplasty, three patients with four joints involved were revised from a failed silicone implant hemiarthroplasty, and two patients had a surgically arthrodesed metatarsophalangeal joint taken down and revised to a total joint arthroplasty. Of the total number of patients involved, eight were men, 63 were women, and the average age per joint was 56 years. The results were graded as excellent, good, fair, and poor on two bases: relief of pain and the cosmetic result. Overall results were good. On the basis of these results over a 12-year period, it was concluded that there is a place for total joint prosthetic replacement in the surgical reconstruction of the painful, destroyed metatarsophalangeal joint of the great toe.

Arthritis, Rheumatoid↗

Diaphyseal lengthening for shortness of the toe.

A method of bone lengthening for bilateral shortness of the fourth toe in a 23-year-old woman is described. The symptomatic short fourth toes were successfully treated by metatarsal and phalangeal diaphyseal lengthenings with metatarsophalangeal joint preservation.

Adult↗

Irreducible dorsal dislocation of the great toe interphalangeal joint: case report and literature review.

Irreducible dorsal dislocation of the interphalangeal joint of the great toe is rare. Few case reports can be found in the literature. Most cases have been treated with operative exploration of the joint and reduction through a dorsal midline incision. We present a case where a medial approach was used under local block anesthesia to treat an irreducible complex dislocation of the interphalangeal joint of the great toe.

Adolescent↗

Interphalangeal dislocation of the fourth toe with avulsion-fracture in a child: report of a case.

Phalangeal dislocations of toes are extremely rare in childhood and usually can be treated by closed reduction. We present a proximal interphalangeal dislocation of the fourth toe with an irreducible avulsion fracture of the middle phalanx requiring open reduction. To our knowledge concomitant avulsion fractures in this condition have not been reported thus far in pediatric patients. The pathological mechanism of this injury is discussed, and the significance of the plantar plate for joint stability is emphasized.

Child↗

Lipoma of the toe.

Lipoma is a common benign soft tissue tumor. It may arise in any location, but most frequently it is located on the trunk, chest, upper thigh, upper arm, and shoulder. Reports of a lipoma in the foot exist, but the occurrence of the tumor in this location is very rare. Lipomas of the toe have only been reported in children, some imitating or having associated gigantism. We present a benign lipoma occurring on the plantar aspect of the second toe in an adult.

Child↗

Cholesterol emboli following percutaneous transluminal coronary angioplasty as speculated by toe skin biopsy.

A 55-year-old man required hemodialysis for acute renal failure 3 days after repeat percutaneous transluminal coronary angioplasty (PTCA). Bilateral acrocyanosis and necrotic lesions of the toes occurred 10 days after PTCA. Skin biopsy samples revealed needle-shaped cholesterol crystals of the intraluminal clefts in his small arteries. He was diagnosed with cholesterol emboli presenting as blue toe syndrome. The conditions improved with anticoagulation and vasodilation, but improvement in renal function was temporary. He later required maintenance hemodialysis. Cholesterol emboli following PTCA are life threatening because they are difficult to diagnose and can cause severe complications.

Angioplasty, Balloon, Coronary↗

Results of blood inflammatory markers are associated more strongly with toe-brachial index than with ankle-brachial index in patients with type 2 diabetes.

OBJECTIVE: Three blood markers of inflammation (high-sensitivity C-reactive protein [hsCRP], interleukin [IL]-6, and fibrinogen) were compared with markers of atherosclerotic cardiovascular disease (CVD) (history of stroke or cardiac ischemia and measured toe-brachial index [TBI]) to determine whether inflammatory markers are associated with atherosclerosis in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Of 103 patients with type 2 diabetes, 26 had CVD. TBI was plethysmographically determined in both great toes. Serum hsCRP was immunonephelometrically determined. Plasma IL-6 was measured by an enzyme immunoassay. RESULTS: Both ABI and TBI were lower in diabetic patients with CVD than in those without CVD (1.05 +/- 0.19 vs. 1.14 +/- 0.09, P < 0.05, and 0.75 +/- 0.20 vs. 0.95 +/- 0.21, P < 0.001, respectively). By linear regression, right TBI but not right ABI showed a significant negative correlation with serum hsCRP (r = -0.372, P < 0.01) and plasma fibrinogen (r = -0.224, P < 0.05). Serum hsCRP was also negatively correlated with lower TBI, but not lower ABI. We found no significant correlation between plasma IL-6 and ABI or TBI. CONCLUSIONS: TBI was strongly associated with CVD, serum hsCRP, and plasma fibrinogen. Of these inflammatory markers, serum hsCRP may be the most promising marker for vascular inflammation.

Aged↗

Toe graphaesthesia as a discriminator of brain impairment: the outstanding feet for neuropsychology.

Because of the vulnerability of the medial surfaces of the cerebral hemispheres to the consequences of shear forces, we hypothesized that quantitative sensori-motor deficits for the feet would be strong indicators of general brain dysfunction. On the basis of the Halstead-Reitan Impairment Index, 28 adults who had received closed head injuries were assigned to perfectly normal, normal, or (mildly to severely) impaired groups. Foot tap and finger tap as well as agnosia and graphaesthesia for the fingers and toes were measured. Deficits in toe graphaesthesia were the most powerful group discriminator. Potential usefulness of haptic/motor, finger/toe comparisons for recording the progress of degenerative diseases, such as AIDS, is also suggested.

Adult↗

Resection for macrodactylism of toes. Report of three cases.

Three cases of macrodactylism of toes were operated on with a V-shaped resection: the toe, approximately two thirds of the metatarsals, and part of the adjacent interosseous muscles were resected. The cosmetic and functional results were good.

Child, Preschool↗

Vascularized toe-to-finger joint transplantation. 11 patients followed for 4 years.

Since 1983, we have transplanted 11 free vascularized joints in 8 men and 3 women, mean age 32 years. The causes of joint involvement were trauma in 9 cases and infection in 2. One MP and 10 PIP joints of the second toe were transplanted to 3 MP and 8 PIP joints of the fingers. After a mean postoperative follow-up period of 4 years, the mean postoperative range of motion was 31 degrees compared with 16 degrees preoperatively. Radiographs showed destruction of 4 PIP joints, probably caused by vascular failure in 2 joints and infection in 2. In spite of no evidence of arthrosis, some of the joints had gradually undergone a loss of extension. Although there are some problems that should be overcome, we advocate a free vascularized toe-joint transplantation for severe finger-joint destruction without extensive surrounding soft-tissue damage.

Adolescent↗