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Painful legs and moving toes: evidence on the site of the lesion.

A condition of painful legs with moving toes was described in 1971. Further examples of this condition are now reported, showing lesions in the posterior root ganglion, cauda equina, nerve roots, or a peripheral nerve of the lower limb. It is concluded that this syndrome is caused by a lesion of the afferent fibres of the posterior nerve roots. It is likely that this lesion causes frequent spontaneous impulses in the posterior roots which activate local circuits of interneurones and motoneurones and result in co-ordinated movements involving local muscles.

Adult↗

"Painful legs and moving toes" associated with polyneuropathy.

Three patients showing clinical and electrophysiological evidence of peripheral neuropathy also suffered from the syndrome of "painful legs and moving toes". Polygraphic recordings during wakefulness and sleep were consistent with the hypothesis that pathological afferent discharges arising peripherally may induce, via the spinal cord, motor excitation and pain. A severe disruption of the pattern of sleep was found in all cases.

Electromyography↗

The stubbed great toe: a cause of occult compound fracture and infection.

Six children suffered Salter I fractures of the distal phalanx of a great toe caused by stubbing. The first four children presented with cellulitis and osteomyelitis. The last two were treated promptly with antibiotics, and no infection developed. Analysis of the anatomic relationship of the distal phalanx and nail indicates that these fractures were compound despite the absence of usual clinical signs. Recognition of these occult compound fractures and treatment with antibiotics should prevent infectious complications.

Adolescent↗

Imagery of voluntary movement of fingers, toes, and tongue activates corresponding body-part-specific motor representations.

We investigate whether imagery of voluntary movements of different body parts activates somatotopical sections of the human motor cortices. We used functional magnetic resonance imaging to detect the cortical activity when 7 healthy subjects imagine performing repetitive (0.5-Hz) flexion/extension movements of the right fingers or right toes, or horizontal movements of the tongue. We also collected functional images when the subjects actually executed these movements and used these data to define somatotopical representations in the motor areas. In this study, we relate the functional activation maps to cytoarchitectural population maps of areas 4a, 4p, and 6 in the same standard anatomical space. The important novel findings are 1). that imagery of hand movements specifically activates the hand sections of the contralateral primary motor cortex (area 4a) and the contralateral dorsal premotor cortex (area 6) and a hand representation located in the caudal cingulate motor area and the most ventral part of the supplementary motor area; 2). that when imagining making foot movements, the foot zones of the posterior part of the contralateral supplementary motor area (area 6) and the contralateral primary motor cortex (area 4a) are active; and 3). that imagery of tongue movements activates the tongue region of the primary motor cortex and the premotor cortex bilaterally (areas 4a, 4p, and 6). These results demonstrate that imagery of action engages the somatotopically organized sections of the primary motor cortex in a systematic manner as well as activating some body-part-specific representations in the nonprimary motor areas. Thus the content of the mental motor image, in this case the body part, is reflected in the pattern of motor cortical activation.

Adult↗

The touch corpuscles of the plantar surface of the big toe. Histological and histometrical investigations with respect to age.

Meissner's corpuscles of the plantar surface of the big toe of 30 persons were investigated histologically and histometrically with respect to age. The number of corpuscles decreases exponentially with increasing age. During the first decades of life the corpuscles exhibit a steady lateral and longitudinal growth. At an advanced age an atrophy of Meissner's corpuscles occurs. In spite of considerable individual variations, a distinct dependency on age can be noticed. Certain diseases, particularly disorders resulting in polyneuropathies, may initiate changes in the numbers and the structure of the corpuscles. Possible interrelationships between morphological neurophysiological and clinical findings are discussed.

Adolescent↗

Development of a bladder-free cuff for measuring the blood pressure of the fingers and toes.

In the present study, we investigated the technique and reliability of measuring digital blood pressure by means of a rigid, airtight container (a bladder-free cuff) and a photocell placed on the digit. As cuff pressure increased, the position of digits in the cuff was maintained in the hand by fixing one or two fingers inside the cuff and, in the foot, by using a supporting stick to keep the distance from the cuff to the bed constant. An airtight seal inside the cuff was achieved using a thin rubber sleeve and adhesive tape. Blood pressures determined by the bladder-free cuff correlated well with those obtained by the conventional cuff with bladder. By using the bladder-free cuff, blood pressure could be measured at the distal phalanx of the fingers and in all toes.

Adult↗

Hypereosinophilic syndrome accompanying gangrene of the toes with peripheral arterial occlusion--a case report.

The authors herein report the case of a teenage boy who presented with peripheral arterial occlusion of both upper and lower extremities associated with hypereosinophilia. During a 10-year follow-up, corticosteroid therapy was continued for the treatment of hypereosinophilia. The patient underwent bilateral lumbar sympathectomies because of severe ischemia of the bilateral lower extremities with gangrene of the toes. Based on the progress of his disease over the past 10 years, he was suspected to have idiopathic hypereosinophilic syndrome (HES) accompanied by peripheral arterial obstruction. Idiopathic HES is a disease characterized by unexpected hypereosinophilia, which may lead to organ damage. This is a very rare case of peripheral arterial occlusion associated with idiopathic HIS.

Amputation, Surgical↗

The "blue toe" syndrome with renal atheroembolism and failure.

The occurrence of atheromatous embolization following cardiac catheterization and coronary artery bypass surgery is described. It was manifested initially by bluish discolored toes inciting suspicion of vasospasm and then by progressive renal failure. The diagnosis was confirmed by renal biopsy. The syndrome of multiple atheromatous or cholesterol emboli is probably more common than previously reported because of its masquerade of other illnesses and failure of consideration of diagnosis.

Arteriosclerosis↗

Stress fractures of the great toe sesamoids.

Stress fractures of the great toe sesamoids have not been previously confirmed as a clinical entity. In this report, we present four such cases, and document the diagnosis by histological sections. All of the patients had experienced the insidious onset of activity-related forefoot pain, and had radiographs that demonstrated a sesamoid fracture. None of the fractures healed with 6 weeks of immobilization and prolonged (4-6 months) inactivity. In all cases, the fractured sesamoid was excised, and the hematoxylin and eosin sections of the fracture segments documented the prefracture stress and incomplete repair characteristic of a stress fracture.

Adolescent↗

Toe extensor weakness resulting from trivial athletic trauma. Report of three unusual cases.

Three patients exhibited variable weakness of toe extensors after trivial injuries. The first patient suffered an acute, partial anterior compartment syndrome during a prolonged motorbike ride; the second a traction injury of the deep peroneal nerve while slipping during a racquetball game. The third patient developed a compression injury of the peroneal nerve on the basis of a generalized demyelinating polyneuropathy. The major clues for diagnosis and management came from electromyographic (EMG) examination.

Adolescent↗

Effect of viscoelastic shoe insoles on vertical impact forces in heel-toe running.

The purposes of this study were: 1) to compare the impact forces in running using running shoes with conventional insoles to the impact forces using running shoes with four different viscoelastic insoles, 2) to discuss possible effects of the viscoelastic insoles on lower leg kinematics, and 3) to explain the force and kinematic results using a mechanical model. Kinetic and kinematic data were collected for 14 subjects running heel-toe at an average speed of 4 m/s. The results showed that the four tested viscoelastic insoles did not differ in variables describing the vertical impact forces (vertical force peak, time of occurrence of vertical force peak, maximum vertical loading rate) compared to the conventional insoles furnished in running shoes. Furthermore, the viscoelastic insoles did not influence kinematic variables of the lower extremities in a systematic way.

Computer Simulation↗

Fourth toe flexion sign: a new clinical sign for identification of the superficial peroneal nerve.

We describe a clinical sign for identification of the superficial peroneal nerve. Flexion of the fourth toe accentuates the subcutaneous course of the cutaneous branches of the superficial peroneal nerve. Thirty feet from 15 volunteers were examined for presence of this sign. Twenty-six of 30 feet had a positive sign that was confirmed by infiltrating the observed nerve with 1% lignocaine and correlating the consequent area of hypoaesthesia with the known distribution of the superficial peroneal nerve.

Adult↗

Fibroma of a tendon-sheath presenting as toe deformity.

We describe a rare manifestation fibroma in a tendon-sheath in an 83-year-old man. The patient complained initially of a slowly progressive spreading, apart of the right second and third toes. A mass was found in the plantar aspect of the foot. It was completely excised at surgery. Histological examination revealed sparse spindle or stellate cells with slit-like vessels in the dense collagenous matrix. There had been no recurrence at follow-up 17 months after surgery.

Aged↗

Traumatic 'mallet toe' of the hallux: a case report.

We describe a case of a traumatic avulsion fracture of the distal phalanx of the hallux. In the upper limb this fracture leads to a "mallet" deformity. Such an injury in the great toe has not been reported previously in the English orthopaedic literature to our knowledge. The injury was treated in a dorsal extension splint for eight weeks. At six months follow-up, a satisfactory clinical outcome was achieved.

Follow-Up Studies↗

Arthrodesis of the interphalangeal joint of the great toe--an improved technique.

At the Mayo Clinic between 1950 and 1975, initial fusion of the interphalangeal joint of the great toe was attempted 166 times in 139 patients utilizing a Kirschner wire for stabilization. Follow-up examination of these patients disclosed an overall pseudarthrosis rate of 44%. Because of these disappointing results, a technique involving use of a longitudinal mini-cancellous bone screw was devised which provides increased stability and compression at the arthrodesis site. With this method, used 20 times in 18 patients, the pseudoarthrosis rate was decreased to 10%.

Adult↗

Congenital duplication of the foot and toes.

Congenital duplication of the foot and toes is a commonly diagnosed condition in newborn nurseries across the United States. The foot involvement varies from simple fleshy tags to complex attempts at whole extremity duplication. We reviewed 59 patients (82 feet) with a variety of duplications (excluding skin tags). During our review, we devised a new descriptive system of classification of congenital duplications of the foot based primarily on the type and complexity of the skeletal duplication. Variables related to sex, bilaterality, age at surgery, family history, and follow-up results were documented, and an exact classification of each foot was accomplished. Results and prognosis vary with the class of duplication being treated and must be individualized case by case.

Animals↗

A biomechanical study using cadaveric toes to test the stability of fixation techniques employed in arthrodesis of the first metatarsophalangeal joint.

Arthrodesis of the first metatarsophalangeal joint of 15 pairs of cadaveric big toes were performed. The arthrodesis site was shaped with either a dome and socket or planar surface contact between the metatarsal head and proximal phalanx. A template was used to standardize the position of arthrodesis in 20 degrees of valgus and 20 degrees dorsiflexion. Various fixation devices were used to hold this position in corresponding pairs of specimens, and these fixation devices were tested to determine their relative effectiveness to prevent displacement on loading. Force-deflection curves were obtained for the various techniques tested, and by comparing these curves, the stability of the metatarsophalangeal arthrodesis site was found to be maintained most effectively using the cancellous screw fixation device with planar metatarsophalangeal surfaces.

Arthrodesis↗

Laser matricectomy in the toes.

Methods and results are described for a series of laser matricectomy cases in the toes, 23 partial matricectomies and 58 total matricectomies. A high incidence of nail recurrence was experienced, 48% for partial matricectomy and 50% for total matricectomy. After review of results, the laser method seemed to be less satisfactory than traditional surgical methods.

Adult↗