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PubMedDate not supplied

Microvascular second toe to finger transfer: a statistical analysis of 55 transfers.

A series of 55 second toe to long finger transfers in 42 patients are reviewed. The mean age is 17 years. The mean follow-up is more than 4 years. Two-point discrimination averages 8 mm. The sensibility is influenced by age, amputation score, ischaemic time, number of arteries, level of amputation, mobility, compensation injury and sensory re-education. The mean mobility is 33 degrees of flexion with a mean extension lack of 34.5 degrees. The mobility is influenced by dominance, amputation score, ischaemic time, number of arteries, level of amputation and compensation injury. There are four failures (7.2%). This rate of complication is influenced by tobacco, age, number of arteries and level of vascular anastomosis.

Adolescent↗
PubMed1995

Secondary procedures to improve function after toe-to-hand transfers.

From August 1990 to December 1992, 139 toe-to-hand transfers were performed on 99 patients. Crush, avulsion, and combined crush and avulsion were the mechanisms of injury in 92.8% of the cases. Average duration of follow-up was 17 months (1 to 40 months). 133 transfers were successful, an overall survival rate of 95.7%. 19 transfers (14.3%) required secondary procedures for functional improvement. The incidence of secondary procedure on tendon, bone, joint and soft tissue was 9.0%, 1.5%, 2.3% and 3.0% respectively. Flexor tenolysis was the single most common secondary procedure (6.8%). The results of secondary procedures were satisfactory in all but one instance. Transient neurapraxia of an ulnar digital nerve after tenolysis was the only complication of the secondary procedures.

Adolescent↗
PubMed1994

Differentiation between finger, toe and tongue movement in man based on 40 Hz EEG.

Movements of right and left index fingers, right toe and tongue were studied by EEG measurement in the alpha and gamma (30-40 Hz) bands. The EEG was recorded with a 56-electrode array over pre- and postcentral areas. For each movement the average power decrease, as a measurement of the event-related desynchronization or power increase in narrow frequency bands, was calculated. Single-trial data from 8 electrodes, 3 frequency bands and 4 time points within a 1 sec window were subject to a classification task. It was found that, based on single EEG trials, the data from the 4 movements could be differentiated with an accuracy of 70% when alpha and gamma band activity were used but only with 58% in the case of the alpha band activity alone. This shows that the gamma band activity or 40 Hz EEG is strongly related to planning of a specific movement and therefore, improves the accuracy of classification significantly.

Brain↗
PubMed1987

The influence of running velocity and midsole hardness on external impact forces in heel-toe running.

The purpose of this study was to investigate the influence of midsole hardness and running velocity on external impact forces in heel-toe running. Fourteen subjects were assessed with a force platform and high speed film while running at speeds of 3, 4, 5 and 6 m s-1. The result showed that running velocity does influence external impact force peaks (linear connection) and that midsole hardness does not influence magnitude and loading rate of the external vertical impact forces. Changes in kinematic and kinetic data can be used to explain this result mechanically. However, the neuromuscular control mechanisms to keep external impact forces constant are not known.

Biomechanical Phenomena↗
PubMed1992

Mechanical analysis of the landing phase in heel-toe running.

Results of mechanical analyses of running may be helpful in the search for the etiology of running injuries. In this study a mechanical analysis was made of the landing phase of three trained heel-toe runners, running at their preferred speed and style. The body was modeled as a system of seven linked rigid segments, and the positions of markers defining these segments were monitored using 200 Hz video analysis. Information about the ground reaction force vector was collected using a force plate. Segment kinematics were combined with ground reaction force data for calculation of the net intersegmental forces and moments. The vertical component of the ground reaction force vector Fz was found to reach a first peak approximately 25 ms after touch-down. This peak occurs because, in the support leg, the vertical acceleration of the knee joint is not reduced relative to that of the ankle joint by rotation of the lower leg, so that the support leg segments collide with the floor. Rotation of the support upper leg, however, reduces the vertical acceleration of the hip joint relative to that of the knee joint, and thereby plays an important role in limiting the vertical forces during the first 40 ms. Between 40 and 100 ms after touch-down, the vertical forces are mainly limited by rotation of the support lower leg. At the instant that Fz reaches its first peak, net moments about ankle, knee and hip joints of the support leg are virtually zero. The net moment about the knee joint changed from -100 Nm (flexion) at touch-down to +200 Nm (extension) 50 ms after touch-down. These changes are too rapid to be explained by variations in the muscle activation levels and were ascribed to spring-like behavior of pre-activated knee flexor and knee extensor muscles. These results imply that the runners investigated had no opportunity to control the rotations of body segments during the first part of the contact phase, other than by selecting a certain geometry of the body and muscular (co-)activation levels prior to touch-down.

Acceleration↗
PubMed1995

Direct dynamics simulation of the impact phase in heel-toe running.

The influence of muscle activation, position and velocities of body segments at touchdown and surface properties on impact forces during heel-toe running was investigated using a direct dynamics simulation technique. The runner was represented by a two-dimensional four- (rigid body) segment musculo-skeletal model. Incorporated into the muscle model were activation dynamics, force-length and force-velocity characteristics of seven major muscle groups of the lower extremities: mm. glutei, hamstrings, m. rectus femoris, mm. vasti, m. gastrocnemius, m. soleus and m. tibialis anterior. The vertical force-deformation characteristics of heel, shoe and ground were modeled by a non-linear visco-elastic element. The maximum of a typical simulated impact force was 1.6 times body weight. The influence of muscle activation was examined by generating muscle stimulation combinations which produce the same (experimentally determined) resultant joint moments at heelstrike. Simulated impact peak forces with these different combinations of muscle stimulation levels varied less than 10%. Without this restriction on initial joint moments, muscle activation had potentially a much larger effect on impact force. Impact peak force was to a great extent influenced by plantar flexion (85 N per degree of change in foot angle) and vertical velocity of the heel (212 N per 0.1 m s-1 change in velocity) at touchdown. Initial knee flexion (68 N per degree of change in leg angle) also played a role in the absorption of impact. Increased surface stiffness resulted in higher impact peak forces (60 N mm-1 decrease in deformation).(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle Joint↗
PubMed1987

Systematic misidentification of toes in normal adults.

This note reports a previously unreported phenomenon: when subjects are asked to indicate subjective correspondence between fingers and toes, there is a remarkably systematic miscorrespondence, consistent across subjects. No satisfactory explanation for these findings has been found.

Adult↗
PubMed1990

The antibacterial efficacy of econazole nitrate in interdigital toe web infections.

Twenty-four patients with severe interdigital toe web infections and no evidence of dermatophyte colonization received randomized treatment with either econazole nitrate (Spectazole) or its vehicle. Of the patients treated with econazole nitrate, 88% had good to excellent responses, whereas no patient treated with the vehicle showed improvement. The total aerobic flora in the econazole group decreased 93%, with decreases in the large-colony diphtheroids, lipophilic diphtheroids, and gram-negative bacteria. The results of this study demonstrate that the antibacterial activity of econazole nitrate makes it an effective agent for the treatment of severe interdigital bacterial infections uncomplicated by dermatophyte colonization.

Adult↗
PubMed1991

Reconstruction of the distal phalanx of the fingers by free toe-to-hand transfer.

Anatomical examination of the blood-vessels in the distal phalanges of the foot show that the arteries and veins of this region are thick enough to be anastomosed by microsurgical means. This makes it possible to perform free toe-to-hand transfer, reconstructing defects of the distal phalanx and suturing arteries and veins at the level of the middle or even distal phalanxes. Eleven distal parts of the fingers have been reconstructed. All the transfers were successful, and good cosmetic and functional results were obtained.

Adolescent↗
PubMed1994

The psychological impact of microvascular free toe transfer for children and their parents.

This paper is based on a prospective study of microvascular toe transfers which examined psychosocial, functional and aesthetic outcome for children with congenital hand anomalies and their parents. 14 families were assessed both pre-operatively and 2 years post-operatively. There were five boys and nine girls. Their ages ranged from 6 months to 13 years (mean age = 5.08 years). The parents were assessed on the basis of a parental adjustment measure, a detailed semi-structured interview and a measure of anxiety and depression. The children were assessed on the basis of behaviour and social competence, social experience, self-consciousness about the hand and the perceptions of their own functional competence. Both parents and children were asked to rate their satisfaction with the hand. In addition, function and appearance was assessed using an independent professional panel. It was found that parental adjustment to the hand was an important independent variable in determining psychosocial outcome. The children of poorly-adjusted parents had more social and psychological problems prior to surgery, and showed an increase in behavioural problems after surgery. Their parents were less anxious and happier after surgery and it was of particular benefit to them. The children of well-adjusted parents had fewer pre-operative problems and showed a general slight improvement after surgery. For all the children, there was a significant improvement in both function and appearance of the hands after surgery.

Adolescent↗
PubMed1987

Pincer reconstruction using second toe transplantation.

Nine patients who had suffered mutilating injuries of the hand with preservation of only one digit and loss of the others at metacarpal level have been treated by transfer of the second toe onto a metacarpal stump to restore pincer grip. The transfers did not all survive but those which did gave useful function.

Adolescent↗
PubMed1989

Measurements of human pressure-pain thresholds on fingers and toes.

Pressure-pain thresholds (PPT) were measured on fingers and toes with a hand-held electronic pressure algometer in 15 males and 15 females. The pressure algometer offered easy control of pressure application rate. The intra-individual coefficient of variation, based on repeated PPT measurements with a 1 week interval was 14%. The inter-individual coefficient of variation was 28% for females and 33% for males. In the course of 10 consecutive PPT measurements with short intervals (10 and 20 sec), no significant change in PPT was observed. PPT was found to be 50% higher in males than in females (P less than 0.0001). Slightly but significantly higher PPT values were found on the dominant compared to the non-dominant side (P less than 0.005).

Adult↗
PubMed1990

Pain relief achieved by transcutaneous electrical nerve stimulation and/or vibratory stimulation in a case of painful legs and moving toes.

A patient is described with painful legs and moving toes. The pain had been occurring for more than 15 years, and a variety of therapies had been attempted with only partial, if any, success. Only morphine had succeeded in relieving the pain, but it had to be discontinued to avoid tolerance and dependence. We devised a treatment consisting of transcutaneous electrical nerve stimulation (TENS), vibratory stimulation (VS), and a combination of the two methods (TENS + VS). TENS brought about partial pain relief, but was less effective than VS; dual stimulation (TENS + VS) led to complete alleviation of the pain. Four months later, the patient was applying dual stimulation himself at home and was thus able to maintain complete relief with 3 or 4 weekly sessions. We suggest that dual stimulation results in a large-scale recruitment of large-diameter afferent fibres and may thus set up a powerful inhibitory control of nociception in our patient.

Adult↗
PubMed1993

Toe phalangeal grafts in congenital hand anomalies.

The results of 73 toe phalangeal grafts were reviewed in order to determine the effects of age and operative technique on subsequent growth of the transferred phalanx. Minimum length of follow-up care for inclusion in the study was 1 year (mean, 42 months). Physeal openness and growth of transferred phalanges were determined from standard x-ray films. Physeal openness rates were 94% for those operated on before 1 year of age, 71% for those 1-2 years of age, and 48% for those older than 2 years of age. Mean growth rates were 1.0 +/- .2 mm, 1.0 +/- 0.6 mm, and 0.5 +/- 0.5 mm per year, respectively, for these three age groups. Extraperiosteal dissection of the transferred phalanx, tendon and collateral ligament reattachment, and patient age under 12 months had a statistically beneficial effect on maintaining physeal openness.

Bone Development↗
PubMed2005

The heel-contact gait pattern of habitual toe walkers.

We used kinematic, kinetic and EMG analysis to compare the spontaneous heel-contact gait patterns of 13 children classified as habitual toe walkers (HTWs) and age-matched controls. In the HTWs, the incidence of spontaneous heel-contact strides during a single recording session ranged from 15% to 92%, with no correlation with age, passive ankle joint excursion, walking speed and trial order. Hallmarks of the heel-contact strides were premature heel-rise, reversal of the second rocker, relative shortening of the loading response and anticipation and enhancement of the electromyographic (EMG) activity normally observed in the triceps surae (TS) during the first half of the stance phase. This variant of the locomotor program is different from the walking patterns observed in normally developing toddlers and children with cerebral palsy (CP). It does not necessarily reflect a functional adaptation to changes in the rheological properties of the muscle-tendon complex.

Analysis of Variance↗
PubMed2004

Sesamoid and toe fractures.

Injuries of the toes and sesamoids of the first metatarsophalangeal joint comprise a wide spectrum of traumatic entities. Despite the fact that a majority of lesions may well respond to nonsurgical treatment and exhibit an excellent prognosis, appropriate clinical and imaging analysis is mandatory to select those injuries that require specific therapeutic and surgical measures to avoid long-term sequelae of functional disability.

Fractures, Stress↗
PubMed2005

Multi-criterion optimization for heel-toe running.

This paper presents an optimization procedure for multi-criterion analysis essential in many biomechanical studies. The optimization is illustrated with a heel-toe running analysis wherein the rate of load and the passive load on support leg are minimized concurrently. The goal of multi-criterion optimization is achieved by incorporating the criterion of Pareto optimality in the genetic algorithm. The proposed procedure can replace the popular weighted-sum approach for problems with multiple objectives. The selection of a final design from the Pareto optimum points (non-dominated designs) can be determined, based on the min-max objective deviation criterion. Nevertheless, a different decision can be made in the final selection without incurring recalculations. The scheme is readily adoptable for parallel computing, which deserves further study to reduce the execution time in a complex biomechanical analysis.

Algorithms↗