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PubMed1987

Cockup deformity of the great toe hallux extensus.

Cockup of the great toe is characterized by persistent extension of the first metatarsophalangeal joint; the interphalangeal joint also may be involved. The syndrome has many causes, all easily diagnosed. Surgery is indicated in nearly every instance and will produce a corrected or improved result. The type of surgery--whether reefing, lengthening, or transposition of tendons, implant arthroplasty, or arthrodesis--is tailored to the underlying cause.

Arthrodesis↗
PubMed1983

Implants for lesser toes.

The use of a double-stemmed hinged implant in conjunction with an arthroplasty has been found to be advantageous for the correction of hammertoes of the lesser digits. Active toe mobility has been obtained and no bone reactions have occurred from the use of implants.

Adolescent↗
PubMed1978

Overlapping fifth toe: a new surgical approach.

The authors introduce a new method of correction for overlapping fifth digits. With the advent of newer types of precision power surgical instrumentation, performance of an exacting wedge osteotomy is possible on small bones. Combining an abductory wedge osteotomy with previously described soft tissue revisions can now realign a common deformity--the overlapping fifth toe.

Adult↗
PubMed1994

Making the diagnosis when the patient has 'blue toes'.

Painful "blue toes" describes a physical sign whose meaning may be discovered through a carefully taken history, physical, and laboratory evaluation. Accurate diagnosis is important, because therapy for one specific condition may be contraindicated for another. When embolism is suspected, ultrasound examination of the heart, aorta, and periphery may be useful prior to angiography in order to avoid exacerbation of cholesterol crystal embolization. Transesophageal echocardiography or MRI may be needed to exclude a thoracic aortic source. The differential diagnosis can be divided into three categories: emboli from the cardiac and arterial system, acquired hypercoagulability disorders, and syndromes that lead to peripheral vascular pathology. A clinical approach to the evaluation of patients is presented, with case reports.

Aged↗
PubMed1996

Correction of crossover second toe deformity.

Crossover second toe deformity is a common, but quite difficult, condition to treat. Its causes are multifactoral but resultant clinical findings are fairly constant. An aggressive surgical approach is mandatory to produce permanent correction. This involves a combination of soft-tissue and appropriate osseous reconstruction.

Follow-Up Studies↗
PubMed1996

Craniosynostosis, Philadelphia type: a new autosomal dominant syndrome with sagittal craniosynostosis and syndactyly of the fingers and toes.

The acrocephalosyndactyly syndromes (ACS) are a group of clinically similar disorders that share the manifestations of craniosynostosis and a variety of hand and foot anomalies. Here we report on a 5-generation kindred segregating sagittal craniosynostosis and syndactyly of the fingers and the toes in an autosomal dominant manner. The anomalies seen in this kindred comprise a syndrome distinct from other craniosynostosis syndromes. For this novel syndrome, we propose the name craniosynostosis, Philadelphia type.

Acrocephalosyndactylia↗
PubMed1976

The fine structure of the digital corpuscle of the mouse toe pad, with special reference to nerve fibers.

Digital corpuscles in the dermal papillae of the mouse toe pad have been studied using light and electron microscopy of serial thick and thin sections, and silver impregnations of frozen sections. These corpuscles are ellipsoid in shape and approximately 10-30 mum in diameter. They consist of one to three lamellar cells, nerve fibers and a capsule. These digital corpuscles are regarded as small Meissner corpuscles. The capsule is perineural epithelium. One or two myelinated nerve fibers and occasionally an unmyelinated nerve fiber enter the corpuscle. The axon terminals contain many mitochondria and a variable population of vesicular profiles. These terminals are ellipsoid or discoid in shape with the long axis parallel to the skin surface. The cytoplasmic plates (or lamellae) of the lamellar cells are arranged parallel to the skin surface, as is the cleft between the bilaterally symmetrical stacks of lamellae. Small processes extend from the expanded terminal of the neurite into the cleft between the lamellae. The relationship of the neurite terminal and associated lamellar cells resembles in some respects the organization of the inner core of Pacinian corpuscles. Intraepidermal fibers derived from myelinated neurites of the corpuscle may extend to the superficial epidermis. Intraepidermal fibers derived from unmyelinated neurites usually terminate in the basal regions of the epidermis.

Animals↗
PubMed1995

Synpolydactyly (type II syndactyly) with aplasia/hypoplasia of the middle phalanges of the toes: report on a family with eight affected members in four generations.

We describe a new family with synpolydactyly (syndactyly type II) with 8 affected members in 4 generations. Aplasia/hypoplasia of the middle phalanges of the toes was also noted. In our opinion, this anomaly represents a frequent manifestation of synpolydactyly. No other major skeletal or extraskeletal malformations were present.

Adult↗
PubMed1995

Anophthalmos-syndactyly (Waardenburg) syndrome without oligodactyly of toes.

We report on 2 brothers from a consanguineous family from a small city of southeast Turkey. Both have bilateral anophthalmia, soft tissue syndactyly of the feet, bilateral partial synostosis of metatarsals IV and V, and basal synostosis of the fourth and fifth toes on the right in the older sib only, thus differing from all previously reported cases of anophthalmos-syndactyly syndrome.

Child↗
PubMed2005

Carpal and tarsal synostoses and transverse reduction defects of the toes in two brothers heterozygous for a double de novo NOGGIN mutation.

We describe two siblings with carpal and tarsal synostoses associated with transverse deficiencies of the toes. Mutation analysis of the NOG gene revealed a double missense mutation in both boys resulting in Pro42Ala and Pro50Arg. The parents were clinically unaffected, and these two mutations were not detected in their white blood cells or buccal mucosa. This indicates the presence of gonadal mosaicism or a low level of somatic mosaicism in one of the parents.

Abnormalities, Multiple↗
PubMed1998

Somatotopical organization of striatal activation during finger and toe movement: a 3-T functional magnetic resonance imaging study.

The present study aimed at determining the distribution and somatotopical organization of striatal activation during performance of simple motor tasks. Ten right-handed healthy volunteers were studied by using a 3-T whole-body magnetic resonance unit and echo planar imaging. The tasks consisted of self-paced flexion/extension of the right fingers or toes. Motor activation was found mainly in the putamen posterior to the anterior commissure (10 of 10 subjects) and the globus pallidus (6 subjects), whereas the caudate nucleus was activated in only 3 subjects, and in a smaller area. Thus, performance of a simple motor task activated the sensorimotor territory of the basal ganglia. Within the putamen, there was a somatotopical organization of the foot and hand areas similar to that observed in nonhuman primates. These data suggest that functional magnetic resonance imaging can be used to study normal function of the basal ganglia and should therefore also allow investigation of patients with movement disorders.

Adult↗
PubMed2004

Actin fiber patterns detected by Alexafluor 488 phalloidin suggest similar cell migration in regenerating and nonregenerating rodent toes.

Although mammals do not regenerate most appendages, they are able to regenerate toetips if the amputation occurs through the nail bed. The reasons for different outcomes following amputation at different levels are not understood. It is possible that cells at regenerating and nonregenerating sites migrate from fundamentally different tissues. If so, different migratory pathways could be detected. To identify putative migrating cells, microscope slides were made from both regenerating and nonregenerating toes of rats and mice on successive days after amputation. Fluorescent-labeled phalloidin, which binds polymerized f-actin, was used to identify actin filaments and fibers. Cells containing prominent actin bundles were distinguishable from those containing diffuse fibrils and those in which visible fibers were absent. Phalloidin labeling was similar in regenerating and nonregenerating digits after amputation. As early as 2 days after amputation at either proximal or distal levels, many cells of the hypodermis adjacent to the wound became labeled with phalloidin. The number and intensity of labeled hypodermal cells containing stress fiber-like bundles increased rapidly with time, and at successive times cells were seen progressively further distally. By approximately 7 days, they occupied the wound site immediately distal to bone of both regenerating and nonregenerating digits. Most dermal cells were unlabeled and endosteal and marrow cells contained only fibrillar actin. Phalloidin labeling does not support the concept of migration from different tissues in regenerating and nonregenerating amputation sites.

Actins↗
PubMed2003

Interphalangeal sesamoid bones of the great toe: an anatomic variant demanding careful scrutiny of radiographs.

We describe a patient who was found to have two sesamoid bones at the interphalangeal joint of the right great toe after radiographs for dislocation of the joint. Recognition of the sesamoids required careful scrutiny of the films. Interphalangeal sesamoids may cause painful callosities plantar to the joint or may become incarcerated in a dislocated joint. Our patient made a good recovery. The presence of sesamoid bones on the medial and lateral sides of the joint was unusual.

Adult↗
PubMed2005

Gross anatomy of the interphalangeal joint of the great toe: implications for excision of plantar capsular accessory ossicles.

Bony or cartilaginous ossicles occur at the plantar aspect of the interphalangeal joint of the great toe. The variation in pattern, prevalence, and anatomic relationships of these structures is not clearly established in the literature, especially in a Caucasian population. Without this knowledge, pathology at this joint may be underestimated and surgical approaches may be poorly planned particularly as radiographs underestimate the incidence of ossicles at this joint. The aims of this study were to determine the incidence and pattern of ossicles at this joint and to establish their anatomic relationships to aid planning the approach for their excision. The interphalangeal joint of the left hallux was dissected in 40 British Caucasian cadavers and the pattern of nodules and their anatomic relationships were established. In 27.5% of subjects, there was no identifiable ossicle and, in these specimens, the tendon of flexor hallucis longus was adherent to the joint capsule. In the remaining specimens (72.5%), a bursa separated the tendon of flexor hallucis longus from the plantar joint capsule and nodules were found embedded within the joint capsule. More than half (52.5%) of the specimens had a single nodule located centrally within the plantar capsule and the remaining 20% had two nodules lying within the capsule. This study shows that a large proportion of the population have either one or two bony or cartilaginous ossicles at this joint. It has also shown that, when present, these structures do not lie within the tendon of flexor hallucis longus and may be most safely excised from a medial approach.

Adult↗
PubMed2006

Painless legs moving toes in a patient with Wilson's disease.

We describe and present a video of a 20-year-old woman with Wilson's disease (WD) who developed the painless variant of painful legs and moving toes (PLMT) syndrome. The symptoms appeared during a subsequent minor exacerbation of her extrapyramidal symptomatology, only to gradually disappear 3 to 4 months later. We suggest that, in our case, a structural central nervous system lesion caused by WD may have been associated with the development of PLMT.

Adult↗
PubMed1998

Unilateral painful legs and moving toes syndrome with moving fingers--evidence for distinct oscillators.

This case report presents a patient with painful legs and moving toes on the right side followed by the development of involuntary movements in his right hand. The frequencies of the semirhythmic muscle activities in both extremities were different. This finding excludes one central pacemaker for both and supports the notion that separate oscillators in the segmental interneuron pool of different spinal areas may drive the individual movements in this case.

Electromyography↗