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[Insertable orthopedic devices in the treatment of flatness of the anterior section of the foot and valgus deviation of the great toe].

The article draws attention to the urgency of the problem of orthopaedic provision of patients with flatness of anterior section of foot and valgus deviation of the first toe for conservative treatment as well as after surgical intervention. Based on clinical and biomechanical peculiarities of foot, in the institute have been developed insertable orthopaedic devices for mass-produced footwear for mentioned pathology: corrective device with unloading element and curative insole. Orthopaedic articles ensure complex influence upon the foot deforming components, improve redressing effect on the first toe. Mass production is planned for 1991.

Evaluation Studies as Topic↗

Great toe sesamoid injuries in the athlete.

Rare, but potentially debilitating, injuries in the athlete may originate from trauma to the sesamoid bones of the great toe. Controlled studies comparing conservative versus surgical treatment outcomes are lacking owing to the limited number of suspected and proven cases of sesamoid stress fracture or sesamoiditis, a nondescript, painful condition involving the sesamoid. Thus, familiarity with the anatomy and congenital variations of the sesamoid is necessary to identify possible pathology in this area. Existing studies of surgical and nonsurgical treatment of athletes with great toe sesamoid injuries are reviewed.

Athletic Injuries↗

[Aseptic osteonecrosis of the internal sesamoid bone of the large toe, apropos of 3 case reports in adults].

Idiopathic aseptic necrosis of the sesamoid bone of the big toe in teenagers and young adults has been described by Renander (1952). We reported three incidents of this condition in adults. The first case was secondary to trauma, whereas repeated trauma could have been responsible for the second. The third case was associated with gout and a multifocal osteo-necrosis. We favor the opinion that idiopathic aseptic necrosis of the sesamoid one of the big toe in adults is seldom a primary condition and that other predisposing factors should be taken into consideration.

Aged↗

Non-joint destructive procedure for long great toe with abductus deformity (a retrospective study).

Excessive great toe length may be attributed to an unusually long first metatarsal, proximal phalanx, distal phalanx, or a combination of two or all three components. The procedure proposed here is not recommended for deformity existing in conjunction with a long first metatarsal or a pathologic first metatarsophalangeal joint. It has been used in mild to moderate hallux abductus or abductovalgus associated with intact first metatarsophalangeal joint cartilage and a long great toe.

Follow-Up Studies↗

[Psoriatic onycho-pachydermo-periostitis of the big toe. Anatomo-clinical study and physiopathogenic approach apropos of 4 cases].

The authors report 4 cases of rheumatoid psoriasis in which involvement of the great toe, associating psoriatic onychosis, thickening of the distal soft tissues and osteo-periostitis of the distal phalanx without lesions of the interphalangeal joint, is the result of a direct repercussion of the ungual lesion on the distal phalanx. This is explained by very close anatomic links between nail and distal phalanx. They advocate the term of psoriatic onycho-pachydermo-periostitis of the great toe or OP3GT, when referring to this radio-clinical syndrome highly evocative of rheumatoid psoriasis.

Adult↗

[Bilateral stenosing tenosynovitis of the long flexors of the great toe in a dancer. Apropos of a bilateral case].

The aim of this article is to draw attention to an uncommon lesion associated with classical Spanish ballet dancing - an activity with both artistic and competitive sporting influences. The lesion is characterised by a clicking great toe and pain in the region posterior to the medial malleolus, together with inability to point the toes. An analysis is made of the literature and of the treatment used in a bilateral case.

Adolescent↗

Anterior transfer of the long toe flexors for the treatment of spastic equinovarus and equinus foot in cerebral palsy.

Anterior transfer of the long toe flexors combined with the Baker procedure, or heel cord lengthening was used to correct equinus foot deformity in 21 patients with cerebral palsy. In more than two-thirds of the cases, heel-to-ball gait became possible. There were no significant recurrences that required re-operation. There were no complications caused by loss of original function in the long toe flexors even in younger patients. Excellent and good results were seen in 57.1% of the patients according to the overall results.

Adolescent↗

Transcutaneous Doppler ultrasound in the prediction of healing and the selection of surgical level for dysvascular lesions of the toes and forefoot.

Dysvascular lesions of the toes and forefoot are divided into 5 grades and matched with appropriate treatment programs. Patients with diabetes mellitus and arterosclerosis obliterans make up the greatest number presenting with such problems. Transcutaneous Doppler ultrasound has been added to clinical criteria as an aid in the prediction of healing. Systolic blood pressures are taken at the thigh, knee, calf, ankle, foot and toes using transcutaneous Doppler ultrasound as a sensitive stethoscope. Systolic blood pressure taken at the antecubital fossa is divided into the lower extremity pressures to obtain an ischemic index. Healing can be predicted with 90% or better accuracy where the ischemic index is above 0.35 in the arteriosclerotic foot and above 0.45 in the diabetic foot.

Amputation, Surgical↗

Treatment of resistant ulcers on the plantar surface of the great toe in diabetics.

Six diabetic patients with a large, resistant ulcer on the plantar surface of the great toe were treated by resection of the proximal one-half of the proximal phalanx of the great toe through a dorsal median incision followed by a split-thickness skin graft onto the ulcer bed. Each of these ulcers had failed to heal with conservative measures which included debridement, split-thickness skin grafts, and extra-depth shoes with molded insoles. Preoperatively each patient had a complete vascular evaluation and appropriate antibiotic treatment. Postoperatively the ulcers healed promptly, and no ulcers had recurred at follow-up after two to five years. The only complication was delayed healing of the incision in one patient. At follow-up no obvious functional impairment of gait was evident, and each patient had regained his or her original functional status.

Adult↗

[Feedback therapy for improving heel contact and toe off motion during ambulation (author's transl)].

The postural defects of cerebral palsy children arising at heel contact during ambulation result, in many cases, in considerable initial vertical loads. These, in turn, lead to unfavorable motor patterns, a high degree of joint load, and undesirable spinal movements. An acoustic feedback system aimed at improving the motor process was developed; this turns vertical loads arising during ambulation into sounds, enabling thus to control a motor learning process. A KISTLER measuring platform was used as measuring instrument; this instrument translates vertical forces into a sequence of tones via a tone generator. In a series of experiments, the children with motor disorders learned to perform consciously a heel contact and toe off pattern which is checked and controlled through the use of tones and acoustic feedback. The aim is to achieve a slow increase in power at heel contact, a graduated power peak, and a well defined floor contact phase. The computation of the test using a 2 x 3 x 3 factor variance analysis showed a highly significant reduction in load increase not only in children with hemiplegia but also in those with diplegia. The most important findings was the fact that all the children were capable of practising a complex motor process controlled by an external feedback system and to compensate accordingly. In addition, at the end of the test, the children were in a position to reproduce alternatively the various motor patterns, and were thus able to distinguish between joint-loading and joint-relieving heel contact and toe off pattern. Moreover, the children's considerable motivation to practise on the 'sound plate' represented a substantial therapeutic aid.

Acoustic Stimulation↗

Turf toe injury.

Long term morbidity secondary to previous first MP injury has been reported by Coker and associates and involved persistent pain with athletic activities and restricted range of motion. Clanton and coworkers noted hallux valgus and early hallux rigidus as specific long term sequelae. Clanton and Seifert have reviewed 20 athletes with prior turf toe injury with greater than 5 year follow-up noting a 50% incidence of persistent symptoms. Further study is needed regarding the long term effect of turf toe injury, but it is clearly a significant athletic injury that requires appropriate treatment tailored to the severity of the injury.

Athletic Injuries↗

Nursing or chiropody? Nurses' attitudes to toe nail trimming.

1. Trimmed toe nails make an important contribution to the rehabilitation of patients recovering from orthopaedic treatment by eliminating a source of discomfort. 2. Twenty-two nurses in orthopaedic care completed questionnaires about their attitudes toward this aspect of patient hygiene. 3. The majority felt it was part of the work of podiatrists but could be done by nurses in special circumstances. 4. The main deterrents to nurses undertaking toe nail trimming were fear of causing damage to patients' feet and lack of confidence about technique.

Attitude of Health Personnel↗

Arthrodesis of the metatarsophalangeal joint of the great toe with Herbert screws: a clinical analysis of 27 cases.

A clinical analysis of 27 cases of arthrodesis of the great toe with Herbert screws, which include 5 male and 22 female patients with an average age of 60.2 years and an average follow-up period of of 14.1 months was accomplished. The data reveals an average reduction of the first metatarsophalangeal angle from 31.4 degrees to 17.5 degrees (a 44.3% reduction). The first intermetatarsal angle decreased from 11.9 degrees to 8 degrees (a 32.8% reduction). Lateral subluxation of the sesamoids changed from 6.2 to 4.6 mm. (a 25.8% reduction). Distance between the centers of the first and fifth metatarsal heads changed from 73.6 to 68.2 mm. (a 7.3% reduction of ball width), with an average postoperative dorsiflexion of the first metatarsophalangeal joint of 22.0 degrees. The evaluation includes 25 cases (92.6%) of satisfactory results and 2 cases (7.4%) of unsatisfactory results. Unsatisfactory cases were caused by technical errors, which produced insufficient dorsiflexion and excessive lateral deviation of the great toe. No incidence of nonunion was encountered in this series.

Adolescent↗

Hallux limitus/rigidus deformity: a new great toe implant.

The authors present a new alternative to the problem of hallux limitus/rigidus deformity. The new Bioaction great toe implant (Orthopaedic Biosystems, LTD, Scottsdale, Arizona) appears to be superior to the popular hinged implant, since it is comprised of two separate components and therefore appears to be more resilient to implant breakage/failure. This manuscript will examine the etiologic factors contributing to this deformity, a brief retrospective review of traditional surgical treatment and a case presentation utilizing the Bioaction great toe implant.

Arthroplasty↗

A double-blind, randomized study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe-nail onychomycosis.

In this multicentre, double-blind, parallel group study, we evaluated the efficacy and safety of continuous treatment with itraconazole, 200 mg daily for 3 months, in comparison with itraconazole pulse therapy, 400 mg daily 1 week per month for 3 months, in the treatment of toe-nail onychomycosis. The study included 129 patients with distal subungual onychomycosis of the toe-nails, confirmed by microscopy and positive for dermatophyte culture; 65 received continuous treatment and 64 received pulse therapy. Patients were followed up for 9 months after treatment. After 12 months, there were 62 evaluable patients in the continuous group and 59 evaluable patients in the pulse group. The clinical response (i.e. the size of the affected area and the progress of the infection) and mycological cure (i.e. negative results on microscopy and culture) were the main outcome measures. A clinical response was defined as a cure or a marked improvement. Clinical response rates were 69%, in the continuous group, and 81% in the pulse group at month 12; the corresponding mycological cure rates were 66 and 69%. A better improvement in signs and symptoms was noted in the pulse group. Six patients were withdrawn from treatment because of adverse events, not all of which were thought to be drug-related. There were no clinically relevant laboratory abnormalities. We conclude that both regimens are effective, safe and well tolerated. The superiority of one treatment over the other was not established, but the results tended to favour pulse therapy. Equivalence testing confirmed that pulse therapy was at least equivalent to continuous treatment.

Adolescent↗

Congenital crossover fifth toe correction with soft tissue release and cutaneous Z-plasty.

Congenital overriding of the fifth toe causes symptoms in approximately half of all patients. The results of three patients treated with a simpler procedure involving metatarsal phalangeal capsular release dorsally and medially, oblique lengthening of the extensor tendon, and Z-plasty of the skin is reported. At an average of 33 month follow-up, no recurrence is noted with this simple procedure.

Adolescent↗

Lesser toe abnormalities.

Lesser toe abnormalities, which can result in significant pain and discomfort, are caused by several intrinsic or extrinsic factors including inflammatory arthritis, trauma, congenital abnormalities, neuromuscular disorders, or poorly fitting shoe wear. Identification of the etiology of the deformity is necessary to determine whether conservative or surgical treatment is warranted and to possibly halt progression of the deformity.

Callosities↗