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At least 109 records · Page 6Linked to original sources
PubMed1986

Polydactyly and polysyndactyly of the fifth toe.

Classification and treatment of polydactyly and polysyndactyly of the fifth toe are described based on a study of 37 patients with 46 affected feet. Polydactyly was seen in 26.1% of duplicated toes, polysyndactyly in 28.3%, and polysyndactyly fused with the fourth toe in 45.7%. Thirty-three patients with 42 toes were surgically treated. The medial toe was removed in patients with the duplicated fifth toe fused with the neighboring fourth toe; if necessary, a free full-thickness skin graft was performed on the fourth toe and not on the fifth toe. Either the lateral or the medial fifth toe was excised for better contour of the forefoot in patients with polysyndactyly without fusion with the fourth toe. The lateral digital ray, including the metatarsal, was excised in patients with polydactyly of the metatarsal type. The average age of patients at operation was 12.3 months (range, five days to five years). Reorganization of the foot was facilitated when the child was treated early or before it could walk.

Female↗
PubMed1997

Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging.

OBJECTIVE: To investigate using magnetic resonance imaging (MRI) the part played by flexor and extensor tenosynovitis and synovitis of the metatarsophalangeal (MTP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in producing the "sausage-like" aspect of spondyloarthropathy (SpA) toe dactylitis. METHODS: Twelve sausage-like toes and corresponding contralateral toes of 7 consecutive patients meeting Amor criteria for SpA were studied by MRI. RESULTS: All dactylitic toes showed fluid collections in the flexor synovial sheaths on MRI. Due to the sheath distension the plantar bone to skin distance was significantly increased (p < 0.05) in the dactylitic toes compared to normal contralateral toes. Peritendinous soft tissues were not involved since these were significantly thicker (p < 0.05) in normal toes. Extensor synovial sheaths were involved in only 4 dactylitic toes. Of the 36 joints of the 12 dactylitic toes only 2 MTP joints showed capsule distension. Considering MRI as the "gold standard", examination showed 100% sensitivity and specificity for flexor sheath involvement but lacked sensitivity for extensor synovial sheaths and showed a low specificity for joint capsule distension. CONCLUSION: Like finger dactylitis, toe dactylitis may also be due to flexor tenosynovitis and synovitis of MTP, PIP, and DIP joints may not be a required condition for sausage-shaped appearance. Extensor tenosynovitis may be present in addition to flexor tenosynovitis. Physical examination is a sufficient method for diagnosing toe dactylitis.

Adult↗
PubMed2006

Classification of idiopathic toe walking based on gait analysis: development and application of the ITW severity classification.

Idiopathic toe walking (ITW), considered abnormal after the age of 3 years, is a common complaint seen by medical professionals, especially orthopaedic surgeons and physiotherapists. A classification for idiopathic toe walking would be helpful to better understand the condition, delineate true idiopathic toe walkers from patients with other conditions, and allow for assignment of a severity gradation, thereby directing management of ITW. The purpose of this study was to describe idiopathic toe walking and develop a toe walking classification scheme in a large sample of children. Three primary criteria, presence of a first ankle rocker, presence of an early third ankle rocker, and predominant early ankle moment, were used to classify idiopathic toe walking into three severity groups: Type 1 mild; Type 2 moderate; and Type 3 severe. Supporting data, based on ankle range of motion, sagittal joint powers, knee kinematics, and EMG data were also analyzed. Prospectively collected gait analysis data of 133 children (266 feet) with idiopathic toe walking were analyzed. Subjects' age range was from 4.19 to 15.96 years with a mean age of 8.80 years. Pooling right and left foot data, 40 feet were classified as Type 1, 129 were classified as Type 2, and 90 were classified as Type 3. Seven feet were unclassifiable. Statistical analysis of continuous variables comprising the primary criteria showed that the toe walking severity classification was able to differentiate between three levels of toe walking severity. This classification allowed for the quantitative description of the idiopathic toe walking pattern as well as the delineation of three distinct types of ITW patients (mild, moderate, and severe).

Adolescent↗
PubMed1996

Vascularized toe joint transfer to the hand.

From 1984 to 1993, 36 vascularized toe joints were transferred in 33 patients. The present study group excludes 3 toe joint transfers to elbow and temporomandibular joints and 4 toe joint to hand transfers lost to follow-up. The final study group includes 29 vascularized toe joint transfers in 27 patients, 21 males and 6 females. All were performed for posttraumatic reconstruction, except one transfer for congenital deformity. Follow-up averaged 32.4 months. Mean range of motion was 34 degrees in toe metatarsophalangeal joint to hand metacarpophalangeal joint transfers, 32 degrees in toe proximal interphalangeal joint to hand metacarpophalangeal joint transfers, and 24 degrees in toe proximal interphalangeal joint to hand proximal interphalangeal joint transfers. Although vascularized toe joint transfer is an alternative to arthrodesis, in order to have a greater range of motion than average, the patient must have well-functioning muscle and associated tendons effecting joint motion. Good results were obtained in two immediate free vascularized toe joint transfers to complex injuries involving loss of the metacarpophalangeal joint. We encourage toe joint transfer in selected complex hand injuries.

Adolescent↗
PubMed2000

Delayed toe transplantation: experimental study and clinical application.

Delay of the operation in toe transplantation was performed with circulatory crisis, and 100 percent survival of the transplants was achieved. In 10 cases of toe transplantation in which circulatory crisis occurred, the operation was delayed. The vascular pedicle was divided, and the toe was transferred 17 to 21 hours after the donor toe was dissected. To investigate the mechanism of delayed toe transplantation, experiments in rabbits were carried out. In 36 rabbits, the hind limbs were severed except for the vascular pedicle. The endothelin content and nitric oxide content of the tissues in the hind limb and the arterial wall were tested in postoperative intervals of 4, 8, 16, 24, and 48 hours, respectively. The results showed that in 10 cases of delayed toe transplantation, all toes survived. As for the results of the experiment, there was significant increase of endothelin content and decrease of nitric oxide content in the local tissues and the arterial wall 4 to 8 hours after the operation. In postoperative 16 to 24 hours, endothelin content returned to normal level, and nitric oxide content increased remarkably. It is concluded that delayed pedicle division and toe transfer is an effective method in toe transplantation with vascular variations and circulatory crisis. The mechanism is related to the endothelin and nitric oxide content in the local tissue and the arterial wall. The indications for delayed toe transfer are also discussed.

Adolescent↗
PubMed2004

Immediate toe-to-hand transfer in acute hand injuries: overall results, compared with results for elective cases.

In the past 5 years, 25 mutilated digits were reconstructed with immediate toe-to-hand transfers after acute hand injuries, for 21 patients. The overall results of the immediate toe-to-hand transfers were evaluated and compared with the results of 65 elective procedures performed during the same period by the same surgeon. There were 15 cases of great toe-to-hand transfer for thumb reconstruction, two cases of second toe transfer for index finger reconstruction, and four cases of simultaneous two-toe transfer for reconstruction of multiple-digit amputations. Two cases (two of 25 cases, 8 percent) were successfully salvaged with emergency reexploration. The incidences of emergency reexploration and postoperative infection were not significantly different from those for elective toe-to-hand transfer cases. The duration of industrial insurance coverage was much shorter than for elective cases, averaging 225 days (p < 0.001). Approximately 44 percent of the patients maintained their original jobs after immediate toe-to-hand transfer. The subjective satisfaction self-assessment scores of aesthetic appearance and function for the newly reconstructed thumb averaged 80 and 88 (of a total score of 100), respectively. Although satisfaction was lower than for elective reconstruction (p < 0.001), it was higher than for reconstruction of other digits. The donor-site appearance after great toe harvesting was mostly unsatisfactory. Immediate toe-to-hand transfer provides many advantages over the elective procedure in acute hand injuries, including single-stage reconstruction, shortened convalescence, early return to work, and socioeconomic efficiency. Because there were no significant differences in the success rates, frequencies of complications, or ultimate functional results, immediate toe-to-hand transfer is a safe and reliable procedure that is indicated for specific cases of acute digital amputation.

Acute Disease↗
PubMed1995

Biphalangeal and triphalangeal toes in the evolution of the human foot.

The number of phalanges of the human toes was investigated in a series of 2,550 radiographs. Classical triphalangia of the lateral toes (2-5) was observed in 1,440 cases (56.47%). Biphalangeal disposition was observed for the 5th toe in 1,110 cases (41.02%), for the 4th toe in 64 cases (2.51%), for the 3rd toe in 5 cases (0.20%), and for the 2nd toe in 3 cases (0.12%). The frequency of biphalangia of a given toe was not independent of the others. Biphalangeal toes result primarily from the absence of development of the distal interphalangeal joint. Biphalangia of the toes is a derived character which is restricted, within primates, to the human species, in relation to the reduction of the toes in adaptation to bipedalism.

Adult↗
PubMed1992

Toe walking and language development.

Neurodevelopmental markers that are present early in childhood may identify children at risk for later developmental disabilities. This paper attempts to clarify the relationship between one such proposed marker, toe walking, and language development in a general pediatric population. One hundred sixty-three children being seen for well-child visits were included in the study. Information from each child's caretaker was obtained for language development and a history of toe walking; observation of toe walking during the visit was also included. The frequency of toe walking was 24%. Language quotients were calculated and compared for toe walkers (n = 39) and non-toe walkers (n = 127). The mean language quotient for toe walkers tended to be consistently lower than that for non-toe walkers. The specificity of toe walking for low language scores was 85% but had a sensitivity of only 32%. Although an association between toe walking and language delay is supported by the present data, the association does not appear to be clinically significant.

Age Factors↗
PubMed1987

Intrinsic toe flexion deformity following correction of spastic equinovarus deformity in adults.

In the treatment of spastic equinovarus foot deformities in adults with neurologic impairment, various surgical procedures are used including the split anterior tibialis tendon transfer and tendo achilles lengthening. Release of the flexor hallucis longus and flexor digitorum longus tendons in the midfoot is routinely included with these procedures to correct or prevent toe curling. In follow-up, residual toe curling has been observed in some patients despite release of the long toe flexor tendons. This study was undertaken to investigate this problem and its consequences, treatment, and treatment success. Forty-one feet in 34 consecutive patients were examined for residual toe curling an average of 2.5 years postoperatively. Thirty-two feet (78%) were noted to have significant flexion deformities of the lesser toes. The residual toe curling caused pain in 72% of the feet and was associated with callosities on the dorsum of the toes in 59%. The incidence of residual toe curling secondary to spasticity of the flexor digitorum brevis and intrinsic muscles of the foot was similar in the patients who had sustained traumatic brain injury and in those who had suffered a cerebrovascular accident. Twelve of these feet (37%) underwent surgical release of the flexor digitorum brevis and intrinsic tendons to correct the toe curling. There were no complications of surgery and no recurrences of deformity following the surgery. A second surgical procedure to release the flexor digitorum brevis and intrinsic tendons to correct the toe curling was more commonly performed in the younger more active brain-injured patients than in the older stroke patients (44% versus 20%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

[A new method of thumb reconstruction using big and second toe elements].

The author's modification of thumb reconstruction using the big and second toe elements is presented. Two separate parts were raised on one common pedicle to form future thumb. The main element including bones, tendons and soft tissues were taken from the second toe. The flap comprising nail radix, matrix and lateral fragment of the second toe pulp was prepared and left in situ. Similar flap was raised on the hallux. Winding of the hallux flap round the second toe part allowed to form nearly normal thumb. The nail radix and matrix were harvested subperiosteally without any bone fragments of distal phalanges. Harvesting of minimum of tissues from the hallux and covering the wound by similar flap from the second toe markedly limited the big toe deformation, typical for this type of procedure. The nail plate of the second toe looked acceptable on the slightly thinner hallux. Scares were localized out of the weight bearing surfaces. Best indications for this procedure include cases when the thumb is amputated on the proximal phalanx level. Rare anatomical variation of the toe vascularity may restrict application of this method. Individual length differences between the hallux and the second toe sometimes make it difficult to put the hallux flap in the proper position on the thumb. A small hallux valgity may appear when the second toe is too short.

Humans↗
PubMed2006

Functional MR imaging of the human sensorimotor cortex after toe-to-finger transplantation.

BACKGROUND: A model of toe-to-finger transplantation has been used in studying peripheral nerve regeneration and central reorganization. It was found that recovery of sensory perception depends not only on peripheral reinnervation but also on central integrative mechanisms. OBJECTIVE: Our aim was to investigate functional changes of the brain and somatotopic representation of the transplanted toes after toe-to-finger transplantation. MATERIALS AND METHODS: Six patients who had toe-to-finger transplantation from 3 to 8 years earlier underwent motor and sensory functional MR imaging studies of transplanted toes and opposite corresponding normal fingers. The motor task was performed by repetitively tapping of the transplanted toe or finger against the thumb, whereas the sensory task was applied by tactilely stimulating the pulp of the transplanted toe or finger. RESULTS: The main activation areas from both types of stimulations were located in the expected location of the finger homunculus of the primary sensorimotor cortex. In addition, activated volumes from the transplanted toes were significantly greater than those from the opposite fingers (P = .017 for motor task and P = .005 for tactile sensory task, paired samples Student t test). CONCLUSIONS: Functional recruitment in the primary sensorimotor cortex seemed to have occurred following toe-to-finger transplantation. The transplanted toe was somatotopically represented in the hand area.

Adolescent↗
PubMed1995

Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography.

We evaluated possible differential effects of vecuronium on the thumb and great toe using two types of neuromuscular transmission monitor. Train-of-four stimuli were simultaneously applied to the ulnar nerve and tibial nerves using cutaneous electrodes. The responses were quantified with accelographs (thumb and left great toe) and an electromyograph (right great toe). Twenty ASA 1 or 2 patients received, by random allocation, one of two types of anaesthesia: neuroleptanaesthesia or sevoflurane-based anaesthesia. With both techniques, the shortest time to maximum block after vecuronium 0.1 mg.kg-1 occurred in the thumb as measured by accelography. The average (SD) values with neuroleptanaesthesia were: 173(23) s for thumb using accelography; 220(16) s for great toe using accelography; 205(44) s for great toe using electromyography. The average (SD) value(s) with sevoflurane-based anaesthesia were: 137(15) for thumb using accelography; 179(21) for great toe using accelography; 153(23) for great toe using electromyography. The differences between the thumb and great toe were statistically significant during both types of anaesthesia when measured with the accelograph (p < 0.01). The time from completion of maximal block to 25% recovery of twitch height in the thumb was significantly longer than that of the great toe as measured by accelography during both types of anaesthesia (p < 0.05). In contrast, there were no statistically significant differences between time to maximum block and 25% recovery of twitch height of the thumb as measured by accelography compared to the values measured for the great toe using electromyography during either anaesthetic technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Movement detection at the human big toe.

1. To be detected, movements of the interphalangeal joint of the big toe must be greater than at other joints. This poor acuity may arise because the anatomy of the foot and ankle results in poor coupling between the toe and the muscles that operate it. To vary this coupling, the effect of ankle position on proprioceptive acuity at the toe was measured. 2. We measured proprioceptive acuity at the toe with the ankle in different positions and found that ankle plantarflexion did improve acuity. This implies that, with the ankle at mid-range or dorsiflexed, toe movement is inadequately transferred to muscle fascicles. 3. To determine actual changes in fascicle length of the toe extensor, movements of extensor hallucis longus near the toe and at the muscle-tendon junction were measured during surgical exposure in one subject. Ankle position greatly affected movement transfer from toe to muscle-tendon junction: no tendon movement was transferred with the ankle dorsiflexed, but all movement was transferred with the ankle plantarflexed. 4. When the relationship between joint rotation and muscle fascicle length measured in vivo was used to express the smallest detectable movements of the toe as proportional changes in muscle fascicle length, these detectable changes were similar to those at all other limb joints. This suggests that change in muscle fascicle length is of major interest to the nervous system.

Adult↗
PubMed2006

Biphalangeal fifth toe.

BACKGROUND: A biphalangeal fifth toe is a common variant in the European population. The frequency is higher in the Japanese population. It is considered an anatomical variant of the normal triphalangeal fifth toe. METHODS: Patients divided into three study groups were retrospectively reviewed to determine the effect of a biphalangeal fifth toe on the occurrence of clinically symptomatic pathology of the fifth ray. RESULTS: The prevalence of a biphalangeal fifth toe in patients with hammer or claw toes was 65%, bunionettes 47%, and overriding fifth toe 37%. Only for the group with hammer or claw toes was prevalence significantly higher than that in the control group (39%). CONCLUSION: The stiffness and rigidity of the biphalangeal fifth toe may predispose it for symptomatic hammer or claw toe.

Adolescent↗
PubMed1996

Current perception thresholds in toe-to-digit transplantation and digit-to-digit replantation.

Recovery of digital nerve function in toe-to-digit transplantation and digit-to-digit replantation was evaluated by transcutaneous constant current sine wave stimulation at 5-, 250-, and 2000-Hz frequencies to determine the current perception thresholds (CPT). For toe transplantation and digit replantation, the mean interval between injury and surgery was 9 months and 7 h, respectively, while the mean interval between surgery and CPT study was 52 months and 20 months, respectively. Control CPTs evoked by three frequency stimuli were obtained from contralateral corresponding normal finger and normal toe. Normal finger had significantly lower 250- and 2000-Hz CPTs than normal toe, but the 5-Hz CPT was not different between them. Replanted digit achieved nearly complete recovery of these three frequency CPTs when compared to normal finger. In toe transplantation, 2000-Hz CPT was comparable to normal finger, while 5- and 250-Hz CPTs were comparable to normal toe. The present findings suggest that the transplanted toe was intermediate between normal finger and normal toe, but more like normal toe than normal finger with regard to detection thresholds of the current-evoked sensation.

Adult↗
PubMed2007

Secondary centers of ossification of the human toes: exceptional polymorphism and evolutionary perspectives.

As great morphological variability characterizes the phalanges of the human toes in adults, we hypothesized for a possible variability in the presence or absence of their secondary (= epiphyseal) centers of ossification linked to the unique morphology of the human foot within primates. The aim of this study was thus to provide original and detailed data on the occurrence of these centers. Classically, the big toe or hallux (I) presents two secondary centers and the lateral toes (II-V) three centers, and consequently the five toes present a total of 14 secondary centers. The material studied consisted of 261 foot radiographs from 261 young individuals of European origin (202 males and 59 females; 6-16 years). The presence (or absence) of the secondary centers of the phalanges of the toes was assessed for each foot. Feet presenting a biphalangeal variant in one or more lateral toes were studied separately. The theoretical possibilities of association of the three secondary centers in a given lateral toe (II-V) are eight in number; these eight patterns were studied and coded in the present study by types A-H. An exceptional variability in the occurrence of the secondary centers in lateral toes (II-V) was observed, and the classic pattern of phalangeal ossification was never observed. The absence of one or more secondary centers seems to be observed only in the human species, and we suggest that this could be a derived pattern specific to the human species, i.e., autapomorphic pattern. These results are of interest in the characterization and understanding of the reduction in size of the lateral toes which characterizes the specific evolution of the human foot.

Adolescent↗
PubMed2006

Linking clinical measurements and kinematic gait patterns of toe-walking using fuzzy decision trees.

Toe-walking is one of the most prevalent gait deviations and has been linked to many diseases. Three major ankle kinematic patterns have been identified in toe-walkers, but the relationships between the causes of toe-walking and these patterns remain unknown. This study aims to identify these relationships. Clearly, such knowledge would increase our understanding of this gait deviation, and could help clinicians plan treatment. The large quantity of data provided by gait analysis often makes interpretation a difficult task. Artificial intelligence techniques were used in this study to facilitate interpretation as well as to decrease subjective interpretation. Of the 716 limbs evaluated, 240 showed signs of toe-walking and met inclusion criteria. The ankle kinematic pattern of the evaluated limbs during gait was assigned to one of three toe-walking pattern groups to build the training data set. Toe-walker clinical measurements (range of movement, muscle spasticity and muscle strength) were coded in fuzzy modalities, and fuzzy decision trees were induced to create intelligible rules allowing toe-walkers to be assigned to one of the three groups. A stratified 10-fold cross validation situated the classification accuracy at 81%. Twelve rules depicting the causes of toe-walking were selected, discussed and characterized using kinematic, kinetic and EMG charts. This study proposes an original approach to linking the possible causes of toe-walking with gait patterns.

Biomechanical Phenomena↗
PubMed2005

Botulinum toxin-A injections for spastic toe clawing.

Spastic toe clawing describes extension at the metatarsophalangeal joints of the feet, flexion at the proximal interphalangeal joints and flexion at the distal interphalangeal joints that results from upper motor neuron lesions, such as stroke, intracranial hemorrhage, cervical myelopathy and brain tumors. Even though toe clawing is often asymptomatic, it can be painful. Previous studies have described the efficacy of injections of botulinum toxin type-A (BTX-A) to the long flexors of the toes, but this is often unsatisfactory as high dosages (up to 175 units) have been required, and patients often report significant residual toe clawing. We performed an open label, prospective study to assess the efficacy of BTX-A injections, targeting the long and short flexors of the toes, performed with electrical (motor point) stimulation under electromyographic guidance. Outcome measures, which included timed walking over 20m, objective assessment of toe clawing (modified Ashworth scale and a visual analog scale rating) and patient assessment of functional disability, were assessed before injections and at six-weeks' follow-up. Seven patients (five male and two female) of mean age 51 (range 38-70) were recruited. Four had spasticity from underlying intracranial hemorrhage, the remaining three from cerebral infarct, astrocytoma and post-traumatic cervical myelopathy. The total dose of BTX-A injected for toe clawing ranged from 40 to 90 units. Improvements were observed in all outcome measures except timed walking. Injecting BTX-A to the long and short flexors of the toes, with electrical stimulation under electromyographic guidance, is well tolerated and efficacious in the treatment of toe clawing from spasticity, allowing for lower dosages to be used.

Adult↗