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We present the case of a patient with a presumed tinea pedis infection who was referred to us after being treated with oral griseofulvin for two weeks with no improvement. We used a simple Wood's light examination and culture to establish the diagnosis of Pseudomonas toe web infection and achieved rapid resolution with oral ciprofloxacin treatment and local application of Castellani's paint.
A 68-year-old Japanese woman presented with a brownish macule, containing two papules, on her left fourth toe. Histological examination revealed an intradermal epithelioid cell tumour with irregularly shaped, bizarre giant cells. In the upper portion of the tumour, the epithelioid cells contained abundant melanin. A low amount of 5-S-cysteinyldopa and a diploid DNA distribution histographic pattern were helpful in differentiating the lesion from malignant melanoma. This location of a Spitz naevus is exceptional.
A 4-month-old male infant had a red and swollen left fourth toe due to strangulation by a hair.
Klippel-Trenaunay syndrome is a rare congenital malformation characterized by a large angiomatous nevus; hypertrophy of soft tissue or overgrowth of bone, or both; and venous varicosities. The cases of 108 patients who had a diagnosis of this syndrome between 1956 and 1990 were reviewed. One hundred and twenty-six anomalies were found in twenty-nine patients, each of whom had one to thirteen malformations of the fingers or toes, or both. The ratio of female patients to male patients was approximately two to one. Twenty-six patients had macrodactyly affecting one to six digits; nine, syndactyly involving two or more digits; five, metatarsus primus varus; two, clinodacytly; two, polydactyly; one, camptodactyly; and one, a congenital trigger finger. Thirty-three of the 126 anomalies were in extremities that had no nevi, varicose veins, or generalized hypertrophy.
Acquired lesser toe deformities are frequent and can be very troublesome. Often they are combined with other diseases of the foot. When conservative treatment fails, many operative procedures can be offered, which do not always achieve a satisfactory result.
Pedal metastases from visceral cancers, while rare, constitute a consideration in the presence of an otherwise unexplained mass in the skin, subcutis, or bones of the foot. Metastatic lesions may be presenting signs of visceral malignant tumors, or may remain occult for years after extirpation of the primary visceral lesion. The presented case depicts sudden activation and growth of an occult renal cell carcinoma metastasis in the subcutaneous tissue of a 69-year-old man's left fifth toe, 10 years after ipsilateral nephrectomy. Cytogenetic studies correlate with tumor histologic patterns and help to predict heritability, uni- or bilaterality, and local and systemic biologic behavior of renal cell carcinoma, thereby aiding in prognosis and treatment planning.
A female patient with a recurrent synovial sarcoma of right 1st toe (35 years) after the first operation is presented. The histology of the tumor 35 years ago showed evidence of the biphasic structure, while the recurrent tumor contained only the fibrous elements. The patient has been examined 3 years after the last operation. She has no pain and there is no evidence of any recurrence. The patient refuses any radiation or additional surgery at this time.
A 42-year-old man with multiple cutaneous neurofibromacules, café-au-lait and gangrene of toes was diagnosed having neurofibromatosis in 1976. An aortography performed because of severe hypertension had shown a coarctation and bilateral renal artery stenosis in 1982. Conservative antihypertensive therapy with an ACE-inhibitor, a vasodilatating agent and a diuretic resulted in gradual normalisation of blood pressure values. A recent follow-up revealed minimal progression of neurofibromatosis and hypertensive lesions documenting a benign course for over 13 years.
In a toe transplantation in a child with symbrachydactyly the authors were faced with a no-reflow phenomenon. The medication they used in prophylaxis was not an absolute guarantee to prevent this problem. Success also depends on some general measures, as a stable blood pressure, a constant blood volume, normal body temperature, short operation time, and an early revision in case of a no-reflow phenomenon. Some questions about the appearance of spasm still remain: are they provoked by pain, stress, medication as anaesthetics, or is a congenital structural vessel problem responsible?
The first Danish case of great toe to hand transfer after amputation of the left thumb is presented. The course was uneventful. Twenty months after the operation, there was good function in the reconstructed thumb. The patient had no major problems at the donor site.
A new case of painful legs and moving toes syndrome is reported in a patient with a neuropathy due to high-doses of cytosine arabinoside (Ara C). A few cases of this complication have been reported. The neuropathy was sensory, axonal, and incompletely regressive. Carbamazepine had a dramatic effect on pain and involuntary movements.
Mucoid cysts of the fingers and toes may be cured by injection of a sclerosant such as sodium tetradecyl sulfate. Easy to perform and inexpensive, this technique appears to be without complications. Most patients are cured after a single injection. Very few need a second or third injection. Relapses are uncommon.
For many decades, resecting the base of the proximal phalanx was a popular method of correcting hammertoes. The long-term result of the procedure, however, is a flail, proximally retracted, "floating" toe. Correction of this challenging surgical problem can be accomplished with a V-Y advancement flap and specific releases.
Referring to recent studies, we discuss the epidemiology of tinea pedis and its position within the range of polyetiological foot infections caused by microbial agents. 201 industrial workers used to wear rubber boots because of moist working conditions were examined with regard to their feet. 107 of them showed clinically altered toe web; in 45 cases, we found ringworm infection (22.4%), in correlation to increased daily wearing time of rubber boots. 85 workers showed colonization of pathogenic bacteria (42.4%), especially gram-negative species (25.8%). Frequently, mixed infections were found. The clinical picture not always allows definite conclusions as to the causal agents. The symptom "maceration" is seen in each of the 3 pathogenic groups of germs (fungi, gram-positive pathogenic cocci, gram-negative bacteria), frequently in bacterial foot infections, especially gram-negative infections. Marked clinical symptoms involve increased infection rates. The predisposing factors to foot infection such as interdigital maceration and the promoting role of rubber boots have been confirmed. The final diagnosis is to be reassured by cultural investigations, in order to set up a specific treatment.
Five patients presented with the painful legs and moving toes syndrome as defined by Spillane et al. (1971). A peripheral nervous disorder was present in 4 of these cases while the fifth patient showed evidence of a central lesion. Results of clinical and electrophysiologic investigations in the 4 peripheral cases, are compared with data from the literature.
There is presently no recognised therapy for the painful legs and moving toes syndrome. Treatment by progabide, a GABA-agonist, was successful in one case: a gradual improvement was observed during four weeks and the movements have now disappeared after six months of progabide therapy.
In this case of painful legs and moving toes the essential characteristics were to be secondary to a neuropathy due to vincristine and metronidazole. The disorders regressed in six weeks after the arrest of chemotherapy. To our knowledge, this is the first case due to a toxic, and more precisely to a drug.
A case of lumbosacral spina bifida occulta presented with resorption of toes which started at six years of age. Its differential diagnosis with neural leprosy is discussed.