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Toe transplantation provides a means of restoring a thumb or finger in a single microsurgical procedure with tissues anatomically similar to those lost or absent. Although formidable, these toe transplantation procedures can be accomplished by experienced teams of microsurgeons with a high rate of success.
Congenital short tendo calcaneus is seen in children as partial or complete walking on the toes, and may represent a major disturbance for normal motor development and coordination. This clinical finding may indicate a more serious, underlying disease (cerebral paresis, childhood psychosis or a neuromuscular disorder). If the patient, apart from walking on the toes exhibits normal clinical findings, the diagnosis of congenital short tendo calcaneus may be justified. The disease may be inherited. The diagnosis should be made by an orthopaedist, and the treatment is either conservative with aggressive physical therapy, or surgery. The prognosis is good after early diagnosis and special treatment. A review of the literature, with emphasis on diagnosis and treatment, is presented, together with a brief review of five patients operated by the authors.
We reported a 68-year-old man of dural arteriovenous fistula at the cranio-cervical junction with dysesthesia ascending from his both toes. He recognized dysesthesia at his both toes 10 months previously. Thereafter dysesthesia ascended to his girdle which was stronger as far as his girdle and gait disturbance developed. Somatosensory evoked potential (SEP) revealed delayed central conduction time. Cervical MRI showed a swelling of the spinal cord and intramedullary hyperintense lesion from the C2 to C7 level on the T2-weighted image. Moreover flow void behind the mudulla oblongata on the T2-weighted MRI was outstanding. Angiogram through right ascending pharyngeal artery revealed enlarged and tortuous anterior and posterior spinal veins at the early arterial phase. We diagnosed as dural arteriovenous fistula (AVF) and conducted intraarterial embolization. After treatment, the swelling and hyperintense lesion of the cervical spinal cord improved on MRI, and flow void behind medulla oblongata was extinguished. Gait disturbance also improved. We think that the valves of veins in the spinal cord are responsible for the tendency of higher venous pressure in outer circumference, which results in the symptom dominating in the lower extremities. We recommend that dural AVF at the cranio-cervical junction should be considered as a differential diagnosis in case with the similar clinical course to our case.
Myxoid cysts of fingers and toes are observed frequently on the lateral or dorsal aspects of the distal digits. They are usually solitary nodules. Both subungual localization and multiplicity are quite rare. We present a 74-year-old woman with digital subungual mucous cysts located on all toes.
This manuscript deals with use of silicone implants as part of the correction for hammer toe deformity. A brief description of the historical correction of hammer toe is presented, with emphasis placed on the development and use of silicone prostheses. The surgical procedure is discussed and an overview of the authors' long-term results are included. Analysis of an informal survey taken of several practitioners known to utilize digital implants is also presented. This manuscript primarily focuses on potential complications that may accompany the procedure. Management and prevention of these complications is also discussed.
In consecutive 50 diabetic patients hospitalized for medical education, without subjective symptoms of autonomic neuropathy (DM group), performed treadmill walking stress test and thermography, for clarify the feature of the pattern typical of diabetic autonomic neuropathy. Thermal images were collected, before, immediately after, 3, 6, 12 minutes after walking. The mean temperature of toes fell more than 1 degree C than that of baseline level and returned within 0.5 degrees C of baseline level within 6 minutes (N type) in 66% of 30 normal subjects (C group) and 24% of DM group. In 10% of C and 24% of DM, the temperature fell but not returned within 0.5 degrees C of baseline level in 6 minutes (D type). In 17% of C and 38% of DM, the temperature changed within 0.5 degrees C (F type), or rose more than 0.5 degrees C after exercise (U type) in 7% in C and 14% in DM groups. Pts D, F group, have more complications (HbA1c, nephropathy, retinopathy or somatic neuropathy), but not so in C, U type. We concluded D, F types were the typical thermographic features of the toes of pts with diabetic autonomic neuropathy.
On the basis of 193 cases of psoriatic arthropathy, the authors sought the incidence and rapidity of onset of signs suggestive of this type of rheumatic disorder when there are radiological lesions of the fingers and toes. They conclude that when such radiological lesions exist, signs suggestive of psoriatic arthropathy are frequent (90%), early (85% of cases of psoriatic arthropathy present for less than 5 years) and predominantly involve the distal parts of the fingers and toes (85.5%). The authors consider that the signs which distinguish psoriatic arthropathy from rheumatoid arthritis are due to an extrasynovial process of enthesopathic origin.
The presence of accessory muscles and other organs on the lower limbs of some individuals have variously been reported in the literature. We report an unusual muscle located on the plantar surface of the left foot of a cadaver, which had not been previously described. This muscle originated from the tendon of tibialis posterior and inserted into the middle phalanx of the fifth toe. It differed from the 'expansions' of the tibialis posterior tendon, which usually pass from its insertion on the navicular bone to other tarsal bones and are ligamentous in nature. The muscle produced flexion of the fifth toe and is innervated by the medial plantar nerve. Awareness of this is important to Anatomists and surgeons, especially those working on the foot.
Spontaneous arterial dissection in peripheral arteries of the extremities is an extremely rare event. We report a case of a spontaneous dissection of a nonaneurysmal popliteal artery in an otherwise healthy 36-year-old man that came to clinical attention as an acute blue toe syndrome. The diagnosis was primarily made by high-resolution duplex ultrasound that revealed a dissection flap (length: 15.5 mm; thickness: 0.4 mm) together with the partially thrombosed false lumen at the dorsal wall of the left popliteal artery (degree of local diameter reduction: 56%). Further work-up by means of contrast-enhanced MR-A and conventional DSA confirmed a moderate stenosis of the popliteal artery compatible with focal dissection and excluded other causes such as popliteal artery entrapment syndrome. Under full-dose intravenous anticoagulation with unfractionated heparin that was switched to oral anticoagulation with vitamin K antagonists (target INR: 2-3) and conservative management of the blue toe the patient made a gradual, but eventually complete clinical recovery over 8 weeks.
A case of Abrikossof tumor in a 33 year old patient presenting a progressive growth of a toe without associated pain or inflamation. There was an important hypertrophy of the affected toe with hyperkeratosis and pseudoelephantiasis. The histologic examination showed a massive infiltration of granular cells in the dermis. The exceptional localisation of the tumor in this case is emphasized.
Eighteen free second toe were used for pollicization other than the conventional method. From the first and second plantar metatarsal arteries junction of the both digital arteries of the second toe were dissected retrogradely and anastomosed to the deep of superficial palmar arch or terminal branch of the radial artery. The venous return was established between the dorsal venous arch and cephalic vein. These vessels were found to have much bigger diameters and less anatomical variation than those used by conventional methods. Seventeen transplantation were considered successful both functionally and cosmetically. One cases had persistent spasmodic contraction of the recipient arteries, so the transplant was salvaged by subclavicular pedicle including the sutured nerves and the attached soft tissues as introduced by Lu in 1964. Our method for reconstruction of the thumb or finger can avoid frequent anatomical variation and smaller diameter of the anastomosed vessels.
Mucinous pseudocysts are dome-shaped, fluctuant lesions that may affect the dorsal aspects of the toes. Although synovial involvement cannot usually be demonstrated by histologic examination of biopsy specimens, joint involvement is a causative factor. Arthroplasty of the intermediate phalangeal head is advocated along with excision of the pseudocyst and its underlying pedicle. Conservative approaches rarely provide a permanent cure for mucinous pseudocysts of the toes.
V-Y plasty has been used for greater than 35 years for correction of the varus fifth toe. During this time, there has been no study of the results of this operation on children with long-term follow-up. We report the results of 20 operations in 16 children. The short-term results were good in 70%. However, postoperative review at a mean time of 2 years 1 month showed marked deterioration, with only 30% good results. V-Y plasty is not recommended for correction of the varus fifth toe.
Six patients with no hemodynamically significant atherosclerotic lesions of the lower limb arteries but with ischemic changes of the feet or toes were studied and diagnosed as having atherothrombotic microembolism. All patients were non claudicators and had peripheral Doppler examinations on admission. Five patients experienced more than one separate episode of microembolization involving both extremities. None presented with a history of heart disease or diabetes. Biplanar arteriograms revealed in every case atherosclerotic degeneration of the aorta without any obstructing lesions and anatomical arterial continuity between the aorta and the site of distal embolization. Three patients who refused operation, were treated conservatively, with a combination of dipyridamole plus aspirin. Three other patients had surgical repair of their atheromatous infrarenal aorta: in two cases thromboendarterectomy was performed, and in the other a Dacron bifurcated graft interposition. No amputations resulted in the patients treated medically, but one of the surgical group lost one toe. This study confirms that atherothrombotic microembolism from an ulcerated atherosclerotic aorta is a potential threat to the extremities and indicates that the optimal therapy for this syndrome has yet to be found.
Since 1979, 30 fingers of 28 cases defect were reconstructed with revascularized free second toe transplantation. Of these 30 fingers, 22 thumbs, 4 index, 3 middle and 1 ring fingers were reconstructed. Twenty-nine fingers in 27 cases succeeded with satisfactory results and 1 finger in 1 case failed. In this paper, experiences of revascularized free second toe transplantation are presented.
The pathogenesis, etiology, diagnostic features, and treatment of the crossover second toe deformity are discussed in this manuscript. The crossover second toe deformity is an undescribed entity in podiatric literature. Two cases are presented by the authors to illustrate the deformity and surgical correction.
When "sausage-like" swelling of the toes occurs in the absence of clinical Reiter's disease or psoriasis, definite classification is hardly possible. Nine patients with isolated "sausage toes" (dactylitis) and minor involvement of other joints are described. The relationship between this syndrome and HLA B27 permits better classification and more rational treatment.
A report on the use of 130 double-stemmed flexible hinge silicone elastomer implants as total joint replacements for the metatarsophalangeal (MTP) joint of the great toe in 98 patients since 1971. Of the total number of patients involved, 11 were men and 87 were women; the average age per joint was 57 years. The report is based on a minimum follow-up of 12 months, an average follow-up of 9.4 years, and a maximum follow-up of 16 years. Seven patients (10 joints) were lost to follow-up. In the 57 patients with osteoarthritis, 81 joints were replaced; in the 30 patients with rheumatoid arthritis, 37 joints were replaced. Five patients were revised from a failed excisional hemiarthroplasty, and four patients (with five joints involved) were revised from a failed silicone implant hemiarthroplasty. Two patients had a surgically arthrodesed MTP joint taken down and revised to a total joint arthroplasty. The results were graded excellent, good, fair, or poor based on relief of pain and cosmesis. The overall results were good. On the basis of these findings, the author concludes that there is a place for total joint prosthetic replacement with this device in the surgical reconstruction of the painful, destroyed MTP joint of the great toe.