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Painful legs and moving toes syndrome associated with herpes zoster myelitis.

A 75-year-old woman developed painful legs and moving toes syndrome (PLMT) 16 months after the onset of herpes zoster (HZ) myelitis. Although the scattered extensive lesions due to HZ myelitis were observed to be eccentric near the posterior horn on MRI, these changes had disappeared upon the development of PLMT. Combined median and tibial nerve somatosensory evoked potentials demonstrated abnormal findings only in the tibial nerve stimuli, suggesting that a severe alteration occurred in the somatosensory fibers coming selectively from the lower legs. These findings suggest plasticity in the ascending somatosensory pathway including the posterior horn cells, probably involving the interneuron networks, for the lower legs may underlie the development of PLMT associated with HZ myelitis.

Aged↗

The activation of the cortical hand area by toe tapping in two bilateral upper-extremities amputees with extraordinary foot movement skill.

Functional reorganization of the human brain after an arm amputation has been documented in several investigations, but as far as we know, there has been no report on amputees with skilled foot movement ability. To further assess the power of functional reorganization of the brain after an amputation, we investigated two bilateral upper-extremities amputees who were professional sculptors and painters with their feet. Performance tests showed that they possessed high foot movement ability. Functional MRI data indicated that toe tapping of the amputees not only activated the classical foot primary motor cortex, but also activated the hand area. In the T1-weighted MRI, the central sulci of both amputees kept their characteristic shape. Our study suggests that there is a remarkable power of neural plasticity in the motor cortex, and the maturation of the cortex develops in response to daily practice. The possible mechanisms of the reorganization are tentatively discussed.

Adult↗

Idiopathic purpura fulminans and varicella gangrenosa of both hands, toes and integument in a child.

Chicken pox is a common childhood illness and, though a vaccine is readily available, it is not routinely included in the vaccination schedule of most countries owing to its mild clinical nature. However, varicella gangrenosa is a rare complication of this disease, infrequently reported in the literature. We report the case of a child who developed purpura fulminans in the convalescent phase of chicken pox and subsequently presented with peripheral gangrene of both hands and the toes of the right foot, and skin gangrene. To our knowledge, bilateral gangrene of the hands has rarely been reported, and we present this case to highlight the serious nature of complications following varicella infection.

Amputation, Surgical↗

Thumb reconstruction by pedicled transfer of the second toe.

Microsurgery and free tissue transfer play a vital role in the modern practice of reconstructive surgery. Prior to the advent of microsurgical free tissue transfer pedicle flaps were the workhorse of a reconstructive surgeon. We report a case of thumb reconstruction by pedicled transfer of the second toe with functional and aesthetic outcome. This case was performed in Pakistan where microsurgical facilities were not available.

Accidents, Occupational↗

The relationships between otoacoustic emissions and relative lengths of fingers and toes in humans.

Both otoacoustic emissions (OAEs) and the relative length of the index and ring fingers (the 2D:4D ratio) exhibit large sex differences, and both exhibit masculinization effects in female homosexuals and bisexuals. Because these sex differences exist in young children, the implication is that both types of measure are affected by prenatal androgen exposure, but it has been unknown to what degree these two types of measure are related. Accordingly, OAEs and the relative lengths of the fingers and the toes were measured in 59 heterosexual females, 55 heterosexual males, 29 homosexual females, and 33 homosexual males. The correlations between the two types of measure were unexpectedly quite low in both the heterosexual and nonheterosexual groups. For example, the correlation between number of spontaneous OAEs per ear and 2D:4D was less than 0.25, for both sexes and both sexual orientations. One interpretation of these results is that the prenatal hormonal mechanisms producing the sex differences in OAEs differ in quality, degree, or timing from those producing the sex differences in relative finger length. That is, OAEs and 2D:4D may be windows onto slightly different prenatal processes or times during prenatal development. Measures of mental-rotation ability also were obtained on these participants, and those correlations with relative finger length also were small.

Acoustic Stimulation↗

Injuries to the toes and metatarsals.

Traumatic injuries to the toes and metatarsals are common injuries affecting nearly every individual. Injuries may be precipitated by industrial accidents or simple bumps in the night. They can produce a wide spectrum of consequences ranging from permanent disability to asymptomatic deformities. With appropriate treatment, most individuals should have the capacity to return to their preinjury functional status.

Foot Injuries↗

Microvascular great toe transfer for congenital absence of the thumb.

Two cases of microvascular great toe transfer for congenital absence of the thumb in children are reported. A rationale and operative details are discussed. A long term follow up is needed, but at this stage the results are most encouraging. There has been no interference with gait.

Child, Preschool↗

Simultaneous double toe transfer for severely disabled hands.

Two cases are presented in which a severely damaged hand was reconstructed by the simultaneous transfer of two toes using microvascular techniques. A two year evaluation of the functional result is made in both cases. Conventional reconstructive methods have little place in the reconstruction of these severe disabilities.

Adult↗

Submandibular synovial sarcoma with t(X;18) and synovial sarcoma of the toe with additional cytogenetic abnormalities: presentation of two cases and review of the literature.

We report cytogenetic findings from fine-needle aspiration samples of two synovial sarcoma patients. The cases are of interest because (1) one case is of a rare site (submandibular region) of the head and neck, and (2) the other is a patient with synovial sarcoma of the toe showing additional cytogenetic abnormalities along with t(X;18). The literature of this tumor is reviewed.

Adult↗

Gram-negative bacterial toe web infection: successful treatment with a new third generation cephalosporin.

Fifteen patients with gram-negative bacterial toe web infections were treated for 1 week with intramuscular cefoperazone, a broad-spectrum third generation cephalosporin. Initial bacterial cultures in eleven patients (73%) grew more than one gram-negative organism. Pseudomonas aeruginosa was the most frequent isolate. All bacteria isolated were sensitive to cefoperazone (Cefobid). Swelling, redness, and flow of exudate resolved within 1 week of antibiotic administration. By day 7 there was no evidence of inflammation, and denuded areas had begun to re-epithelialize. Side effects were mild and did not require cessation of therapy. This antibiotic causes rapid resolution of a disease which previously required prolonged hospitalizations.

Adult↗

Standard and high resolution magnetic resonance imaging of glomus tumors of toes and fingertips.

BACKGROUND: High-resolution magnetic resonance imaging (MRI) of subungual glomus tumors has been recently reported. OBJECTIVE: Our purpose was to compare high-resolution MRI and standard MRI for the diagnosis of 44 glomus tumors of the toes and fingertips. METHODS: Glomus tumors (11 cases) were first examined by MRI with a commercial surface coil (set 1). Thirty-three other glomus tumors and one tumor from set 1 were then examined with a high-resolution module designed for skin imaging (set 2). RESULTS: All 44 glomus tumors were identified with MRI. The limits of the tumors were detected in 54% of set 1 and 100% of set 2. A capsule was present in most cases, but was incomplete or absent in eight cases. Subtypes of glomus tumors were more easily differentiated in set 2. CONCLUSION: Standard MRI was adequate to detect glomus tumors, but high-resolution MRI assessed tumor characteristics more accurately.

Adolescent↗

[Value of the radiographic criteria "fingers and toes" in the early diagnosis of psoriatic arthritis].

PURPOSE: To assess the value of Fournie's radiological criteria "fingers and toes" in the early diagnosis of psoriatic arthritis. MATERIALS AND METHODS: 47 patients with psoriatic arthritis were studied retrospectively. Clinical and radiological features at the hands and fingers were assessed. Radiographic analysis was performed using Fournie's criteria. RESULTS: Of 47 patients studied, 25 patients developed hand and finger involvement. Asymmetrical joint distribution was observed in 76% of cases. Distal interphalangeal arthritis was noted in 60% of cases. Nail lesions were present in 11 cases and dactylitis in 3 cases. Eight patients had erosions of the distal interphalangeal joints. Osteolysis with pencil-in-cup deformity was noted in 3 cases. Ankylosis of interphalangeal joints was found in 7 cases and acro-osteolysis in 3 cases. CONCLUSION: Psoriatic arthritis frequently affects the small joints of the hands and fingers. Asymmetrical and distal interphalangeal joint involvement are a characteristic feature of this arthropathy. Some radiological lesions are suggestive and contribute to the early diagnosis of psoriatic arthritis.

Adult↗

Immediate free vascularized joint transfer from second toe to index finger proximal interphalangeal joint: a case report.

The results of treatment of severe injuries to the proximal interphalangeal joint are unsatisfactory. The methods of joint reconstruction are discussed, including fusion, implant arthroplasty, perichondrial grafting and vascularized joint transfer. A patient is presented with a severe crush injury to the dorsum of the index finger with loss of skin and extensor tendon and proximal interphalangeal joint disruption. Immediate reconstruction of the finger is described using a composite free flap of skin, extensor tendon and proximal interphalangeal joint from the second toe. Follow-up at two years is described, demonstrating proximal interphalangeal motion and finger function.

Adult↗

Toe to hand transfer in children. Part 2: Functional and psychological aspects.

Forty children with congenital (85%) or acquired hand disorders underwent transfer of one or two toes to one hand. The children were reviewed with their parents and assessed for functional and psychosocial performance. There was some evidence that the older the child at the time of transfer, the better the range of motion. The passive range of motion was on average 60 degrees more than the active range of motion despite subsequent procedures such as tenolysis. All transfers recovered protective sensibility and the majority recovered good levels of two point discrimination and light touch perception. Almost all transfers were naturally incorporated into the use pattern of the limb for some or most of the time. Most parents and patients reported a very positive effect of this surgery on the child's psychosocial functioning.

Adolescent↗