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PubMed1994

Sex-Tac-Toe.

With sexually transmitted diseases (STDs) increasingly present in the nation's adolescent population, health educators need innovative strategies for addressing cognitive, affective, and behavioral issues related to sexuality. Learning in a game format offers students a safe and entertaining opportunity to explore sexuality issues and discuss their concerns in a non-threatening environment. Sex-Tac-Toe, which is based on the traditional game of tick-tack-toe, is played by two teams that compete to earn three squares in a row by answering multiple-choice, true-false, and short-answer questions dealing with such topics as STDs, AIDS, contraception, and how to talk about sexuality issues. The game has been used in a college setting by both health educators and trained peer educators in residence hall and campus programs. It can be easily adapted for younger groups by changing squares or questions to meet the developmental level of the audience.

Condoms↗
PubMed1987

Toe-touch test. A measure of its validity.

The primary purpose of this study was to investigate the relationships between the vertical fingertip-floor distance (FFD) and the hip and vertebral components of trunk flexion during the toe-touch test. Measurements were taken from lateral photographs of each subject standing in the erect and maximally flexed positions. The subjects were healthy young men (n = 16) and women (n = 17). The mean FFD was 3 cm below floor level (-3 cm) with a standard deviation of 8 cm. Reliability of this measure was indicated by a test-retest correlation coefficient of .97. The FFD was a measure of both trunk (r = -.85) and hip flexion (r = -.79), but not of vertebral flexion (r = .10). At maximum trunk flexion, therefore, FFD is mainly a measure of the extensibility of the hamstring muscles that limit hip flexion when the knees remain extended. The toe-touch test was determined to be unsuitable for monitoring the effect of a treatment regimen to improve vertebral mobility because the partial correlation coefficient between vertebral flexion and FFD was -.64 (p less than .01), with the effect of hip flexion held constant. Although this correlation is significant, it means that less than half of the variation in FFD can be explained by changes in vertebral mobility. For this group of young adults, no significant correlations existed between the FFD and limb length and abdominal girth at maximum trunk flexion.

Adult↗
PubMed2002

Retrograde-flow medial plantar island flap reconstruction of distal forefoot, toe, and webspace defects.

Plantar forefoot defects have been reconstructed using a wide variety of techniques, including skin grafts, local flaps, and free tissue transfer. The distally based, retrograde-flow medial plantar island flap provides coverage with durable plantar skin from the nonweight-bearing instep area to reconstruct defects at the metatarsal heads. This technique requires careful flap dissection, and the anterior reach of the flap is limited by its pedicle length and vascular pivot point location. The authors describe two cases using this flap for reconstruction of tumor resection defects (5 x 6 cm and 5 x 8 cm) involving the distal forefoot, toes, and webspaces. One case required venous supercharging of a congested flap with an interpositional vein graft. Technical aspects of the design, elevation, and inset of the flap that enhance its versatility and reliability are presented. The reverse-flow medial plantar fasciocutaneous island flap should be considered an option for forefoot defects that extend anteriorly onto the metatarsal heads, including defects involving the toes and webspaces.

Aged↗
PubMed1986

Functional, mechanical, and biochemical assessment of ultrasound therapy on tendon healing in the chicken toe.

We studied the therapeutic effect of ultrasound treatment on the functional recovery of surgically repaired profundus tendon in the right third toe of mature White Leghorn hens. Ultrasound treatment was given daily for 5 minutes for a total of 20 treatment days, starting immediately after 4 weeks immobilization. Ultrasound (frequency 3.0 mHz; intensity 0.75 W/cm2) was delivered to the right leg by a 5-cm2 probe through distilled water in a bath kept at 35 degrees C. The flexion of the toe was measured preoperatively for 4 consecutive days and daily for 6 weeks after the start of ultrasound treatment for the calculation of percent of functional recovery of the flexor tendon. The non-ultrasound-treated group of birds went through the same manipulations except that no ultrasound was given when the right leg was immersed in the water bath. Ultrasound treatment significantly (p less than 0.01) improved the functional recovery of the repaired tendons (less than 5-mm gap) starting on the third week of treatment (94 +/- 2 percent) compared with the non-ultrasound-treated group (79 +/- 4 percent). Ultrasound treatment had no effect on gap formation or breaking (tensile) strength of the repaired tendons. It is concluded that ultrasound enhanced functional return of repaired flexor tendons in the hen, and the clinical implication is discussed.

Animals↗
PubMed1993

Double fillet of foot free flaps for emergency leg and hand coverage with ultimate great toe to thumb transfer.

A 42-year-old woman presented with avulsion amputation of her right leg 14 cm below the knee joint and a hemihand amputation of the opposite hand. Two free flaps, taken from the amputated foot, were used to cover the injured extremities. The sole fillet flap was used to preserve length and cover the injured leg, while the dorsal fillet flap covered the injured hand and provided ectopic storage for the great toe. The great toe was later transferred on a pedicle for thumb reconstruction. Spare parts surgery is now a well-accepted technique. This case demonstrates maximum utilization of amputated parts for functional and aesthetic reconstruction.

Adult↗
PubMed1997

The "Tic-Tac-Toe" classification system for mutilating injuries of the hand.

Several classifications of mutilating hand injuries exist in the literature. Unfortunately, each of these provides a categorization that is arbitrarily grouped according to the part of the hand predominantly involved. It is imperative that a comprehensive classification system incorporate the degree and precise location of soft-tissue and/or bony destruction and the vascular integrity in addition to the predominantly involved part of the hand. We therefore devised a new classification system for mutilating injuries of the hand which categorizes them into seven types: (I) dorsal mutilation, (II) palmer mutilation, (III) ulnar mutilation, (IV) radial mutilation, (V) transverse amputations, (VI) degloving injuries, and (VII) combination injuries. These types are subcategorized into three subtypes: (A) soft-tissue loss, (B) bony loss, and (C) combined tissue loss. Vascular integrity is recorded with subscript notation: (0) vascularization intact or (1) devascularization. The hand is then systematically divided into nine numerical zones in "tic-tac-toe" fashion with radial, central, and ulnar columns and proximal, central, and distal rows. The "Tic-Tac-Toe" classification system allows the examining surgeon to describe precisely any mutilating injury of the hand. This system permits accurate assessment of each hand injury by assignment of the appropriate classification type, subtype, vascular status, and zone involvement. Clinical examples illustrate the user-friendliness and practicality of this new classification system.

Adolescent↗
PubMed1996

Intermittent therapy with terbinafine for dermatophyte toe-onychomycosis: a new approach.

Terbinafine, an orally active antifungal agent of the allylamine class, is effective in the treatment of dermatophyte onycomycosis. Its pharmacologic and pharmacokinetic properties give strong support to the possibility that intermittent treatment courses may be equally effective in onychomycosis in general. The present randomized and controlled study was carried out to determine whether intermittent therapy with terbinafine was effective in dermatophyte toe-onychomycosis. Sixty patients with mycologically proven toenail dermatophyte onychomycosis were included in the study. Patients were equally allocated to treatment groups in a random manner. Group 1 was given 250 mg/day of terbinafine for 3 months. Group 2 was given 500 mg/day of terbinafine for 7 days during the first week of each month for 3 months. Nails were examined clinically and mycologically at monthly intervals. All patients were followed up for 48 weeks after starting the treatment. Of the patients who entered the study, 24 in Group I and 23 in Group 2 were evaluable for efficacy. At the end of the follow-up period, the cure rate (negative microscopy and culture) was 79.2% in Group 1 and 73.9% in Group 2; this difference was not significant (p: 0.79). The results indicate that intermittent therapy with terbinafine is as effective as 3-month treatment in dermatophyte toe-onychomycosis.

Adult↗
PubMed1996

A 12-week treatment for dermatophyte toe onychomycosis: terbinafine 250 mg/day vs. itraconazole 200 mg/day--a double-blind comparative trial.

Lamisil (terbinafine) 250 mg daily and itraconazole 200 mg daily were compared in the treatment of dermatophyte toe onychomycosis over 12 weeks in a double-blind randomized clinical trial. At the end of follow-up (week 48) treatment with Lamisil led to negative mycology in 73% of patients compared with 45.8% in the itraconazole group (P < 0.0001). Globally the clinical symptoms of the target nail improved, a response which was in favour of Lamisil (P = 0.001). The percentages of patients who were clinically totally cured or who presented with only minimal symptoms were 76.3% for the Lamisil-treated group compared with 58.1% in the itraconazole group. The unaffected nail length for big toes was significantly higher in the Lamisil-treated group (9.1 mm vs. 7.7 mm; P = 0.0298). Onycholysis was also less in the Lamisil group (P = 0.001). We conclude that 12 weeks' continuous oral therapy leads to higher cure rates with Lamisil than with itraconazole and that both drugs are equally well tolerated.

Administration, Oral↗
PubMed2005

Subungual exostosis following toe nail removal--case report.

Removal of toe nail is a minor procedure that can be under ring block with no significant complications. We report the case of a young lady who developed a rapidly growing subungual exostosis on her right great toe following nail removal. Inadvertent iatrogenic injury to the nail bed and underlying phalangeal periosteum during nail removal might have triggered off rapid bone growth resulting in the large exostosis. To our knowledge, this aetiology for subungual exostosis formation has not been reported before.

Adult↗
PubMed2003

Application of a probabilistic microstructural model to determine reference length and toe-to-linear region transition in fibrous connective tissue.

This study shows how a probabilistic microstructural model for fibrous connective tissue behavior can be used to objectively describe soft tissue low-load behavior. More specifically, methods to determine tissue reference length and the transition from the strain-stiffening "toe-region" to the more linear region of the stress-strain curve of fibrous connective tissues are presented. According to a microstructural model for uniaxially loaded collagenous tissues, increasingly more fibers are recruited and bear load with increased tissue elongation. Fiber recruitment is represented statistically according to a Weibull probability density function (PDF). The Weibull PDF location parameter in this formulation corresponds to the stretch at which the first fibers begin to bear load and provides a convenient method of determining reference length. The toe-to-linear region transition is defined by utilizing the Weibull cumulative distribution function (CDF) which relates the fraction of loaded fibers to the tissue elongation. These techniques are illustrated using representative tendon and ligament data from the literature, and are shown to be applicable retrospectively to data from specimens that are not heavily preloaded. The reference length resulting from this technique provides an objective datum from which to calculate stretch, strain, and tangent modulus, while the Weibull CDF provides an objective parameter with which to characterize the limits of low-load behavior.

Animals↗
PubMed2004

Unusual stress fractures of the proximal phalanx of the great toe: a report of two cases.

Stress fractures of the toes are rare. Most reported fractures of the proximal phalanx of the great toe have been associated with halux valgus deformity. Two cases are presented that illustrate several unique features of this rare injury which have not been reported before. One of the cases went on to non-union, requiring bone grafting and internal fixation.

Adolescent↗
PubMed1987

The neurological assault on the great toe (1893-1911).

The late 19th/early 20th century heralded a period in neurology when there was claim and counter claim about the founders of new reflex movements of the great toe. The cutaneous plantar reflex is undoubtedly one of the most important signs in clinical neurology, and there have been several methods described of eliciting this sign, each with its own eponymous name. This article reviews the background to these claims and the contribution of the various authors, to the discovery, clinical relevance and ease of eliciting reflex movements of the great toe.

Germany↗
PubMed2003

Stress fractures of the medial great toe sesamoids in athletes.

The purpose of this study was to determine whether specific symptoms and findings are present in patients with symptomatic stress fractures of the sesamoids of the great toe and, if so, whether partial sesamoidectomy is sufficient for successful treatment. Five consecutive athletes (five females; mean age 16.8 years [range, 13 to 22 years]) with six feet that were treated for symptomatic stress fractures of the sesamoids of the great toe were included in this study. Four athletes (five feet) performed rhythmic sports gymnastics; the fifth athlete was a long jumper. Some swelling to the forefoot and activity-related pain that increased in forced dorsiflexion, but disappeared at rest was found in all patients. While plain X-rays evidenced fragmentation of the medial sesamoid, MRI (n=2) and frontal plane CT scan (n=3) did not always confirm the diagnosis, but bone scan (n=3) and axial as well as sagittal CT scan were useful to detect the pathology. After failure of conservative treatment measures, surgical excision of the proximal fragment was successful in all patients, and there were no complications. All patients were pain free and regained full sports activity within six months (range, 2.5 to six months). At final follow-up which averaged 50.6 months (range, 20 to 110 months), the overall clinical results were graded as good/excellent in all patients, and there was only one patient with of restriction sports activities. The obtained AOFAS-Hallux-Score was 95.3 (75 to 100) points. Apparently, stress fractures occur more often at the medial sesamoid, and females are mainly involved. When a stress fracture is suspected, bone scan and CT scan are suggested as more reliable in confirming the diagnosis than other imaging methods. When conservative treatment has failed, surgical excision of the proximal fragment is recommended.

Adolescent↗
PubMed2006

Mid-term results of titanium hemi-great toe implants.

BACKGROUND: We reviewed the mid-term results of metatarsophalangeal hemiarthroplasty with titanium hemi-great toe implants. This study may help with future prosthetic design and evaluation leading to improved management and patient satisfaction. METHODS: Ten of 12 patients were contacted more than 2.5 years after surgery. Their charts were reviewed, and they were evaluated clinically and radiographically. RESULTS: All patients were improved and satisfied in the first 5 years after surgery, but subsidence and lucency in all patients and a painful fracture in one patient bring long-term implant survival into question. The ultimate longevity of the implant and its long-term functionality should be questioned. CONCLUSIONS: Metallic hemi-great toe implants have satisfactory mid-term results. Improved prosthetic design may lead to less implant subsidence and stem lucency.

Adult↗
PubMed1995

Determination of in vitro metatarsocuneiform pressure before and after surgical modification of the great toe.

In vitro contact pressures were measured at the first metatarsocuneiform joint in order to determine the effect of resectional arthroplasty and arthrodesis of the metatarsophalangeal joint of the great toe. Eight fresh cadaver feet were loaded with the Instron machine to determine the pressure seen at the first metatarsocuneiform joint. The specimens were subsequently modified by performing either an arthrodesis of the great toe metatarsophalangeal joint or an arthroplasty of this joint by removal of the proximal one third of the proximal phalanx. A second test was then performed. Pressure-sensitive film was analyzed to determine maximum pressure and total transmitted force. No significant pressure change was seen after the arthrodesis. After the resection arthroplasty, there was a significant decrease in both the maximum pressure and the total force measured at the first metatarsocuneiform joint.

Adult↗
PubMed1996

Origin and course of the dorsomedial cutaneous nerve to the great toe.

The purpose of this study was to describe the course of the dorsomedial cutaneous nerve (DMCN) to the great toe. The DMCN is a branch of the medial dorsal cutaneous nerve, which originates from the superficial peroneal nerve. Injury to the DMCN may result in a painful neuroma. Identifying and protecting the DMCN to the great toe during surgical procedures near these areas may decrease the rate of painful neuroma formation.

Cadaver↗
PubMed1998

Osteochondral lesions of the proximal phalanx of the great toe: a report of two cases.

Two cases of osteochondral lesions of the proximal phalanx of the great toe at the interphalangeal joint are presented. This condition is characterized by pain, swelling, and tenderness at the interphalangeal joint. The roentgenographic characteristics resemble osteochondritis dissecans. Curettage and bone grafting to the lesion is effective. These conditions in adolescent soccer players may be caused by chronic repetitive overloading of the interphalangeal joint using soccer shoes with soft, supple, and narrow toe boxes.

Adolescent↗