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I reviewed 17 children with overriding of the fifth toe, treated by Butler's arthroplasty; 6 underwent bilateral operation. Satisfactory results were obtained in all but 1 patient, and all could wear normal shoes.
Toe phalanges with attached periosteum can be transferred to hands with congenital aphalangia, constructing rudimentary digits with growth potential. Using a volar technique, rather than the traditional dorsal method, allows stabilization of the constructed metacarpophalangeal joint and maximizes flexor function.
We present a unique case of congenital bilateral simple syndactyly of the first and second toes that was surgically treated using a full-thickness skin graft harvested from the same foot at the lateral aspect of the ankle. This surgical approach eliminates the potential need to involve another surgical team to harvest a donor graft from above the ankle, saving operating room time, anesthesia time, and overall cost to the patient. Cosmetically, scar formation above the ankle is also eliminated.
The few available reports of arthroscopic treatment of the first MTP joint in the literature indicate favorable outcome. However, arthroscopy of the great toe is an advanced technique and should only be undertaken by experienced surgeons.
Lethocerus americanus is a large water bug commonly found in ponds and slowly moving fresh water. Also known as the "toe biter" for its encounters with swimmers, it has the reputation of inflicting painful bites when carelessly handled. It normally feeds on other pond life: insects, tadpoles, salamander, small fish, and snails. These large tan or brown bugs may leave their habitat at night in search of mates or another pond. It is thought that the relative nearness of bright lights for a creature that evolved using celestial navigation, results in disorientation, spiral flight paths, and eventual death from exhaustion. This would account for the occasional find of several dead giant water bugs underneath street lamps.
A 35-year-old woman from Virginia presented with purplish, tender toes. She was diagnosed with pernio and successfully treated, initially with nifedipine and subsequently with management of the affected area's environment. Clinical presentations and treatment strategies are discussed below.
Secondary malignant transformation of a solitary enchondroma into a chondrosarcoma is extremely rare. We report a case of such transformation in anenchondroma of the distal phalanx of a toe.
The subject based on the technology of transplanting a toe to stump, which provides reliable information for the artificial limb operation. The artificial limb control system is researched and set up. This system controlling five degrees of freedom adopts the microprocessing technology and fuzzy sets approach.
Three cases of infants with strangulation of toes by either hair or threads are reported. The potential riks of amputation and the need for a premature diagnosis and treatment are stressed. A simple vertical, short and deep incision over the strangulation, avoiding injury to tendons and digital nerves and vessels is suggested. A complete recovery is obtained in a short period.
The purpose of this study was to determine whether children with mild spastic diplegic cerebral palsy (CP) could be differentiated from those with idiopathic toe-walking (ITW) based on an obligatory coactivation during voluntary contraction of the quadriceps or gastrocnemius. Twenty-four subjects participated in this study, eight children with mild spastic diplegia CP, eight with ITW, and eight age-matched controls. Measurements included passive range of motion and surface electromyographic recordings of the lateral quadriceps and lateral gastrocnemius. Electromyographic recordings were obtained during resisted knee extension with knee flexed 30 degrees, isometric quadriceps contraction with knee extended (quad set), active plantarflexion, and during gait. The range-of-motion values were not different between the CP and ITW subjects, with the exception of the popliteal angle, which was greater in subjects with CP, with an overlap in values. Gait electromyography showed premature firing of gastrocnemius in swing in both groups of subjects compared with controls. During resisted knee extension and quad set, the mean duration of gastrocnemius coactivation in subjects with CP was high: 86% and 86% compared with 20% and 35% for the subjects with ITW and 0.4% and 3% for controls, respectively. Voluntary plantarflexion did not consistently elicit coactivation of the quadriceps. The results suggest that electromyographic testing of resisted knee extension and quad set to identify gastrocnemius coactivation can help differentiate patients with mild CP from those with ITW.
Twenty-six children with idiopathic toe-walking (ITW) were evaluated as to their neurodevelopmental outcome by means of a follow-up study. The ages of the subjects at the last follow-up ranged from 3 years and 4 months to 14 years and 10 months (mean: 7 years and 4 months). The neurodevelopmental outcome in the subjects was normal intelligence in 22 (of which 5 were clumsy and 4 were hyperkinetic), and borderline intelligence in 4 (of which 2 were clumsy). Thus, 13 of the 26 cases (50%) had neurodevelopmental problems including clumsiness and hyperkinesia. It is noteworthy that there was a high rate of the neurodevelopmental problems among the children with ITW. The clinical course of children with ITW should be carefully followed-up, and the appropriate care and intervention should be given to them, when the children are found to have these problems.
A 20-year-old Japanese man with aggressive digital papillary adenocarcinoma on the right great toe was presented. The tumor was comprised of multiple lobules of epithelial cells exhibiting solid areas, lacking cystic spaces. A pattern of fused back-to-back glands lined by cuboidal to low columnar epithelial cells with little evidence of papillary formations was observed. Apocrine-like decapitation secretion was not observed, and continuity of the tumor to the epidermis was evident. The neoplastic cells were immunohistochemically positive for S-100 protein, but negative for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and gross cystic disease fluid protein (GCDFP). Intraluminal contents, however, showed positive reactivity with CEA and EMA. On the basis of their histologic and immunohistochemical features, the tumor was diagnosed as aggressive digital papillary adenocarcinoma.
A case of Ewing's Sarcoma originating the great toe is reported. Because of the rarity of its appearance outside the pelvis and long tubular bones, Ewing's Sarcoma is often misdiagnosed when it occurs in the distal portion of the extremities. Ewing's Sarcoma may be difficult to distinguish from infection. Biopsy is recommended for any indolent or refractory lesions presumed to be infectious. Bone scanning with Technetium Polyphosphate is a useful tool for diagnosis and evaluation of this tumor. Vigorous integrated chemotherapy and radiotherapy had little effect in this patient with metastatic disease.
An alternative to joint destructive procedures for the treatment of overlapping second toe deformity is presented. This manuscript examines a modification of the cartilaginous articulation preservation procedure previously described. A total of seven patients, eight feet were evaluated. The follow-up period ranged from 6 months to 7 1/2 years, with the average of 3 years. Subjective results were very satisfactory. Objectively there were complications, but overall, patient improvement was noted postoperatively. This study indicates that the procedure should be part of the surgeon's armentarium.
We report a 43 years old male admitted to the hospital for progressive lumbar pain, lasting 20 years, that caused severe disability. On admission the patient had a serum phosphate of 2 mg/dl, an urine phosphate excretion over 300 mg/dl and serum alkaline phosphatases over 750 U/L. Serum intact parathormone was normal and tubular maximum phosphorus/glomerular filtration was 0.7 mg/dl. Bone scintigraphy showed an increased radionuclide uptake in condro-costal joints. Bone densitometry showed femoral osteoporosis. A violet colored mass was detected in a great toe. It was removed and the pathological diagnosis was a composite hemangioendothelioma. After tumor excision, serum phosphate levels returned to normal values and symptoms disappeared within 15 days.
It is the purpose of this report to focus attention on the clinical features, diagnosis, and management of chronic pernio. Thirty-nine patients meeting our strict criteria for a diagnosis of chronic pernio were seen at the Mayo Clinic between 1976 and 1988 and form the basis for this report. Persons with upper extremity lesions only were excluded. Twenty-eight of the patients were female, 11 were male. Age at onset of symptoms ranged from 13 to 68 years of age, with symptoms appearing from 1 to 37 years following cold injury. The lesions were bilateral in 35 (90%) of patients and symmetric in 28 (71%). Nine patients who underwent skin temperature studies following cold water immersion, showed a vasospastic response. Chronic pernio is characterized by recurring erythematous, vesicular or ulcerative lesions of the lower extremities and toes, but may present with only digital cyanosis, usually bilateral and commonly symmetrical. The diagnosis is suggested by eliciting a temporal relation between cool weather and symptom onset, particularly if there is no associated occlusive peripheral arterial disease. Treatment consists of avoidance of cold and other vasoconstrictive influences. Prazosin has been effective in the acute management and as prophylaxis against recurrences.
Giant cell tumor of the tendon sheath (GCTTS) is the second most common benign tumor of the hand. Although bony indentation from external compression by the GCTTS is frequently seen on x-ray film, the intraosseous invasion is relatively rare and is a sign for high recurrence. We present a woman with extensive GCTTS located in the left index finger at the level of distal interphalangeal joint. X-ray films revealed multiple osteolytic cystic cavities in the shaft of the middle phalanx. Amputation of the index finger at the base of the middle phalanx was performed because of extensive bony involvement and concern about possible recurrence from inadequate excision. Her left second toe was transferred to replace the amputated index finger in the same session. Follow-up examination at 15 months postoperative revealed good function and appearance of the reconstructed index.
We report a case of indolent herpetic whitlow of the toe occurring in an elderly male patient with poorly controlled diabetes mellitus. In this case, the mechanism of transmission was not clear, although he was in a habit of taking a hot spring bath. This patient's symptoms were unusual for herpes simplex; he had no pain in the presence of diabetic neuropathy. The standard therapeutic dose of acyclovir was not effective in suppressing the lesions, and a higher dose was required to induce complete healing.