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PubMed1977

Structure and position of receptors within scales bordering the toes of gekkonids.

In gekkonids, the scales bordering the toes or the adjacent tissue possess suberpidermal and intraepithelial receptors in addition to setae-bearing organs. The position of subepidermal lamellated corpuscles seems to be correlated with the size of the species. The larger the adult animal the more frequently is this type of receptor found laterally in the toe. This can be explained in connection with the vibration-sensitive function of lamellated receptors. Intraepithelial axon terminals were found close to the setae-bearing sensilla in one species only. They are surrounded by numerous tonofibrils and may function as receptors for mechanical (pressure)-stimuli.

Animals↗
PubMed1997

Ft1, a novel gene related to ubiquitin-conjugating enzymes, is deleted in the Fused toes mouse mutation.

The dominant mouse mutation Fused toes is characterized by partial syndactyly of the limbs and thymic hyperplasia. Both morphological abnormalities were shown to be related to impaired regulation of programmed cell death. Ft/Ft embryos die in midgestation showing severe malformations of fore- and midbrain as well as randomized situs. In Ft mice a large chromosomal deletion (about 300 kb) occurred after insertional mutagenesis. In this report we describe the identification of the first gene that has been mutated by Fused toes. The expression of the novel gene Ft1 is reduced in Ft/+ mice and completely absent in Ft/Ft embryos. Analysis of the Ft1 cDNA revealed an open reading frame that could code for a 32-kDa protein with similarities to ubiquitin-conjugating enzymes. Ft1 transcripts with alternative 5' UTR sequences as well as differential usage of polyadenylation sites were found. Interestingly, the 3' parts of the longest Ft1 transcripts are identical to the reverse complement of the 3'-most sequences of the Rb-related p130 gene. Both genes are transcribed in opposite directions and overlap in their 3' UTRs. Despite the close linkage, p130 expression appeared not to be affected by the Ft mutation. In wild type mice, Ft1 expression levels were found to be high in brain, kidney, and testes and detectable in all other adult organs and throughout embryonic development. Finally, we show that Ft1 is conserved among mammals and identify the human homolog.

Abnormalities, Multiple↗
PubMed1998

Follow-up results 17 years after resection arthroplasty of the great toe.

Resection arthroplasty of the first metatarsophalangeal joint is a well-known operation. The follow-up results more than 17 years after arthroplasty for hallux valgus are reported and discussed. Between 1971 and 1980, 335 resection arthroplasties were performed on 205 patients. The sole indication for resection arthroplasty of the great toe in this study was hallux valgus. The technique involved removal of the proximal one-third of the phalanx with interposition of a capsular flap, occasionally including temporary Kirschner wire fixation. After 17.6 years on average, 102 patients were re-examined clinically and radiographically. Questionnaire assessment revealed a significantly prolonged walking distance, and 70% of the patients were pain-free at follow-up investigation, whereas 67% suffered from severe pain before the operation. Clinical evaluation showed diminished weight-bearing of the great toe during walking and a reduced range of motion of the resected first metatarsophalangeal joint. Radiographic shortening of the proximal phalanx was 37%. The average hallux valgus angle was 23 degrees at follow-up and 34 degrees prior to surgery. The unacceptably high rate of hallux valgus relapse, especially due to a high intermetatarsal angle, emphasizes the unsatisfactory long-term results of the resection arthroplasty. We now recommend this operation for older patients only, and a differentiated approach using reconstructive procedures according to the clinical and radiographical situation for younger patients.

Adolescent↗
PubMed2006

A modified Hohmann method for hallux valgus and telescoping osteotomy for lesser toe deformities in patients with rheumatoid arthritis.

To preserve the function of metatarsophalangeal joints and to ensure forefoot stability in patients with rheumatoid arthritis (RA), we performed a modified Hohmann method for hallux valgus (HV) and telescoping osteotomy of lesser toe deformities instead of fusion of HV or resection of all metatarsal heads. From October 1995 through March 2001, 47 RA patients (90 feet) with severe HV and forefoot deformities were examined. The indication for the procedure in all the patients was disabling foot pain secondary to intractable plantar callosities below the lesser metatarsal heads, painful HV deformities, and the severe deviation of the sesamoid complex diagnosed by the basis of X-ray images. The HV and intermetatarsal (M1M2 and M1M5) angles and sesamoid complex were measured on the preoperative and postoperative roentgenograms. According to the results of a questionnaire survey, the patients were divided into three groups using the visual analogue scale; group 1: satisfied, group 2: fair and or no pain, group 3: dissatisfied. HV and M1M2 angles significantly improved compared between pre- and postoperative or preoperative and the follow-up periods. Out of the 47 patients, 78.9% were satisfied with the results of the operation and 8.9% were dissatisfied. Of these patients, 12.2% reported fair results. There were several complications, such as painful callosity, which was recurrent in seven feet, and delayed wound healing was observed in two out of 90 feet. A modified Hohmann method and abductor hallucis correction are effective in relieving pain and ensuring the bony union of the great toe in spite of severe osteoporosis.

Adult↗
PubMed1987

Problems with the use of the toe-spreading reflex in rats as an assay in nerve regeneration studies.

Stages in the return of the toe-spreading reflex after sciatic nerve injury were examined using the rat. It was found that the earliest stages in the return of the reflex do not indicate nerve regeneration, but rather reflect the development of adrenalin sensitivity in denervated muscles. Probably systemic adrenalin released during the reflex-testing procedure causes muscle contractions which imitate a nerve-induced toe-spread reflex.

Adrenergic alpha-Antagonists↗
PubMed2005

Homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients.

Diabetic ulcers located in the plantar surface of the great toe resist conservative treatment modalities including skin grafts and usually require flap coverage for a stable reconstruction. Free tissue transfer is not feasible in these patients, because these defects are closely associated with peripheral vascular disease and local flap alternatives are extremely limited in this region. Reported here is the use of homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients with encouraging results.

Aged↗
PubMed1985

Toe-to-hand transfer based on the medial plantar artery.

Two patients had toe-to-hand transfers based on the medial plantar artery system. The dorsalis pedis and first dorsal metatarsal arteries were absent in both cases. Although the procedure is slightly more complicated than currently described techniques for toe-to-hand transfers based on the dorsal system, the procedure was performed in both cases without complication.

Adult↗
PubMed1987

Preoperative and postoperative gait analyses of patients undergoing great toe-to-thumb transfer.

Microvascular transfer of the great toe is a reliable method of thumb reconstruction for many patients, but the precise deficit incurred by elective amputation of the great toe has not been fully defined. Twelve patients who had this procedure were evaluated with preoperative and postoperative gait analyses and clinical examinations. The mean age was 29.3 years, with a mean clinical follow-up of 30.3 months, and a comparative follow-up gait study at a mean of 21.1 months postoperatively. Only one patient exhibited a significant motion change postoperatively, which was a reduction in ankle plantar-flexion at weight release of the operated foot (push-off). The average velocity, cadence, step length of the foot that had surgery performed, single and double limb stance times of each foot, and step width did not significantly change. There was only a slight average reduction in stride length at 4.6% (p less than 0.05), which resulted from a decrease in step length of the foot that did not have surgery 7.6% (p less than 0.02). Nine patients had no clinical complaints, two had occasional mild discomfort near the second and third metatarsal heads, and one had intolerance to cold.

Adolescent↗
PubMed2002

The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain.

This study tested whether the peak external knee adduction moments during walking in subjects with knee osteoarthritis (OA) were correlated with the mechanical axis of the leg, radiographic measures of OA severity, toe out angle or clinical assessments of pain, stiffness or function. Gait analysis was performed on 62 subjects with knee OA and 49 asymptomatic control subjects (normal subjects). The subjects with OA walked with a greater than normal peak adduction moment during early stance (p = 0.027). In the OA group, the mechanical axis was the best single predictor of the peak adduction moment during both early and late stance (R = 0.74, p < 0.001). The radiographic measures of OA severity in the medial compartment were also predictive of both peak adduction moments (R = 0.43 to 0.48, p < 0.001) along with the sum of the WOMAC subscales (R = -0.33 to -0.31, p < 0.017). The toe out angle was predictive of the peak adduction moment only during late stance (R = -0.45, p < 0.001). Once mechanical axis was accounted for, other factors only increased the ability to predict the peak knee adduction moments by 10 18%. While the mechanical axis was indicative of the peak adduction moments, it only accounted for about 50% of its variation, emphasizing the need for a dynamic evaluation of the knee joint loading environment. Understanding which clinical measures of OA are most closely associated with the dynamic knee joint loads may ultimately result in a better understanding of the disease process and the development of therapeutic interventions.

Aged↗
PubMedDate not supplied

The Biomet Total Toe System utilizing the Koenig score: a five-year review.

The two-component, durable first metatarsophalangeal joint implant has a 5-year history of clinical use. Unique for having plantar condyles, the Total Toe System is fully weightbearing, thus functional. A new scoring system, the Koenig Score, is introduced and applied to the Biomet Total Toe System to demonstrate the success of this implant postoperatively.

Adult↗
PubMed1984

Genetic and environmental variation of ridge-counts on fingers, palms, soles and toes: a twin study.

A multivariate procedure for estimating heritable components from twin data was applied to ridge counts obtained from the entire dermatoglyphic system. Covariance matrices of MZ and DZ within-pair differences were used to estimate genetic correlation matrices for 20 finger ridge counts, 6 palmar interdigital counts, 20 toe counts, 4 hallucal counts, and 6 sole interdigital counts. The proportion of genetic variation was found to be greater in ridge counts of patterns than in ridge counts of interdigital areas. On digits, finger counts are more highly heritable than toe counts. Each of the dermatoglyphic areas yielded several independent genetic components, ranging from general to specific. Environmental variation was found to be local and to frequently involve reciprocal interaction between twin pairs.

Dermatoglyphics↗
PubMed1998

The influence of transoesophageal echocardiography on intra-operative decision making. A European multicentre study. European Perioperative TOE Research Group.

The role of transoesophageal echocardiography (TOE) in anaesthesia remains controversial because it is a rapidly evolving technique with few proven benefits and considerable cost. Recently, the Society of Cardiovascular Anaesthesiologists has published practice guidelines for the use of peri-operative TOE. To determine the current role of transoesophageal echocardiography and the relative impact of category-based transoesophageal echocardiographic indications the present study investigated its use in seven Western European countries. The study sample was taken from a prospective cohort of 224 patients with acute or chronic haemodynamic disturbances or at risk of myocardial ischaemia. All patients were monitored with two-lead electrocardiography and radial and pulmonary artery catheters, as well as biplane or multiplane transoesophageal echocardiography. A total of 2232 clinical interventions were made in these patients. The most frequently observed intervention was the administration of a fluid bolus (45% of all interventions). Overall, transoesophageal echocardiography was the most important guiding factor in 560 (25%) interventions. It was the most important monitor in guiding the following therapeutic interventions: anti-ischaemic therapy--207 of 372 interventions (56%); fluid administration--275 of 996 (28%) interventions; vasopressor or inotrope administration--56 of 316 (16%) interventions; vasodilator therapy--six of 142 (4%) interventions and depth of anaesthesia--four of 211 (2%) interventions. We found that transoesophageal echocardiography is frequently influential in guiding clinical decision making and is used most frequently for category II indications but category I indications were associated with more frequent change in management.

Adult↗
PubMed2003

Lamellar ichthyosis associated with pseudoainhum of the toes and eye changes.

Classic lamellar ichthyosis is a rare, autosomal recessive, genetically heterogeneous skin disease caused by mutations in the transglutaminase 1 gene. Pseudoainhum is characterized by the appearance of a constricting band around a digit which may lead to spontaneous amputation. We describe a 41-year-old man with classic lamellar ichthyosis with unusual eye changes and pseudoainhum of both the fifth and the third right toes. Eye abnormalities included bilateral ectropion of the lower eyelids, chronic blepharitis, and nuclear cataract. A radiometric assay revealed greatly reduced skin transglutaminase activity. To the best of our knowledge, this report is unique as classic lamellar ichthyosis with deficient transglutaminase activity has never been associated with pseudoainhum of the toes and the early development of nuclear cataract.

Adult↗
PubMed1999

Reconstruction of the great toe in a child using the Y-V pedicle elongation technique for a medial plantar flap.

The authors report a case of reconstruction of a great toe in a young boy, following amputation proximal to the IP joint and exposure of the MP joint. A local flap was chosen for its lesser morbidity, and plantar skin was selected as optimal coverage for weight-bearing surfaces on the first ray. Very few local flaps fulfill these conditions. The Y-V technique of elongation of a vascular pedicle, first described by Martin in 1991, was used to bring a medial plantar flap to the toe, doubling its normal arc of rotation distally. Technical points are highlighted and outcome is reported at 18 months follow-up.

Amputation, Surgical↗
PubMed2001

Finger reconstruction with a free neurovascular wrap-around flap from the big toe.

From 1983 to 1998, 16 cases of finger reconstruction with a free neurovascular wrap-around flap from the big toe were treated. Fourteen cases were successful, and two cases failed. The authors reviewed these cases on the average of about 38 months after surgery. Pinch power was 51 percent of the unaffected normal hand, and two-point discrimination was 7.6 mm. The mean resorption of the grafted bone was 13 percent in width and 9 percent in length. There were no complications such as fracture of the grafted bone, nonunion, and pulp dislodgement. This procedure provided length, stability, and adequate sensibility for a functional pinch and grasp. Sensory return to the wrap-around flap on the thumb was often greater than for the same area on the opposite foot. The donor site of the wrap-around flap was acceptable, both aesthetically and functionally, and allowed the wearing of open-toed shoes by young women. Finger reconstruction with a wrap-around flap from the big toe yielded excellent cosmetic and functional results in cases involving amputation at the level of the metacarpophalangealjoints or distal to it. In addition, this procedure was an excellent choice for treatment in cases involving avulsion injuries of the fingers and reconstruction of soft-tissue defects after tumor excision.

Adolescent↗
PubMed2000

Pharmacoeconomic analysis of ciclopirox nail lacquer solution 8% and the new oral antifungal agents used to treat dermatophyte toe onychomycosis in the United States.

BACKGROUND: Recently a novel topical nail lacquer, ciclopirox solution 8%, has been approved for the treatment of onychomycosis. OBJECTIVE: This was undertaken to determine the most cost-effective treatment for the treatment of dermatophyte onychomycosis of the toes in the United States in 2000. METHODS: The nature of the problem was defined. The drug comparators were ciclopirox nail lacquer, terbinafine, itraconazole (pulse), itraconazole (continuous), fluconazole, and griseofulvin. A decision analytic model that reflected the manner in which pedal tinea unguium is managed was produced. Studies that have evaluated the efficacy of the nail lacquer and the oral antifungal agents for this indication were identified. Appropriate studies were used in a meta-analysis to determine the mycologic and clinical response rates when the drug comparators are used for the treatment for toe dermatophyte onychomycosis. For each drug comparator a cost of regimen analysis was carried out. This is the sum of the drug acquisition cost, the cost of medical management, and the cost of managing adverse effects. Next, the expected cost of management was calculated, disease free days were determined, and a sensitivity analysis was conducted. RESULTS: For each comparator the meta-analytic average mycologic cure (MC) rate and clinical response (CR) rates were: ciclopirox nail lacquer (MC: 52.6 +/- 4.2%, CR: 52.4 +/- 9.0%), griseofulvin (MC: 41.1 +/- 20.4%, CR: 33.7 +/- 14.1%), itraconazole (continuous) (MC: 66.3 +/- 4.2%, CR: 70.3 +/- 4.2%), itraconazole (pulse) (MC: 70.8 +/- 5.7%, CR: 73.6 +/- 4.6%), terbinafine (MC: 77.2 +/- 4.0%, CR: 75.3 +/- 2.9%), and fluconazole (MC: 65.6 +/- 7.1%, CR: 66.5 +/- 11.7%). The cost of regimen for the drug comparators was: ciclopirox nail lacquer $325.2, griseofulvin $1413.1, itraconazole (continuous) $1410.2, itraconazole (pulse) $811.7, terbinafine $890.1, and fluconazole $966.8. The cost/mycologic cure rate and expected cost/expected symptom free day were, ciclopirox nail lacquer ($618.2, 1.69), griseofulvin $3438.2, 5.3), itraconazole (continuous) ($2126.9, 3.52), itraconazole (pulse) ($1146.4, 2.01), terbinafine ($1153.0, 2.14), and fluconazole ($1473.7, 2.10). The relative cost-effectiveness was ciclopirox nail lacquer 1.00, itraconazole (pulse) 1.19, fluconazole 1.24, terbinafine 1.27, itraconazole (continuous) 2.08, and griseofulvin 3.13. Sensitivity analysis indicated that ciclopirox nail lacquer was a cost effective alternative compared with the oral regimens of terbinafine, itraconazole (continuous), and griseofulvin when clinical response rate was used as the primary efficacy parameter. CONCLUSION: Ciclopirox nail lacquer solution 8% is a recent addition to the armamentarium of therapies available to the physician and patient for the treatment of onychomycosis. The nail lacquer is a cost effective agent compared with the oral antifungal therapies, terbinafine, itraconazole, fluconazole, and griseofulvin.

Administration, Oral↗
PubMed2004

Assessing the head-to-toe physical examination skills of medical students.

Second-year medical students performed a head-to-toe screening physical examination on trained patient instructors (PIs) as a high-stakes examination before beginning clinical clerkships. PIs completed a 138-item checklist and instructed the students in the proper performance of any incorrectly executed or omitted items. To assess the accuracy of the PI ratings, 'monitor' PIs watching the encounter by video completed checklists for 11 retests of failed students in 2001 and for 28 randomly selected encounters in 2002. Checklist-level discrepancies measured by mean absolute checklist difference were 8% in 2001 and 9% in 2002. Case-level mean difference between raters in 2002 was -2.9%. The inter-rater reliability for a single rater, estimated by the intra-class correlation coefficient for total encounter scores, was 0.95. The assessment and feedback were well received by the students. The Head-to-Toe examination provides a reliable assessment of a student's ability to carry out a complete screening physical examination. Patient instructors can be trained to acceptable accuracy and reliability despite the length and complexity of the exercise, and can provide effective feedback and teaching targeted to individual student deficiencies.

Clinical Competence↗
PubMed2004

Use of a combined pedicled toe fillet flap.

We report the use of a double toe fillet flap combined with reconstruction of the joint capsule of the metatarsal proximal phalanx (MP) in a diabetic patient with a chronic persistent deep plantar ulcer and an avulsed third MP joint. Not only was the soft tissue defect dealt with, but also the stability of the MP joint was increased by the vascularised extensor tendon provided by the pedicled toe fillet flap.

Aged↗