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Two patients presented with osteoid osteomas of the distal phalanx of a toe. A review of documented cases provided data on the characteristic features of these lesions. Diagnosis and treatment, in all cases, were ensured by excision biopsy, enabling a permanent cure to be obtained with a minimum of mutilation.
This article deals with implant arthroplasty using the angled great toe implant. Specific terminology is defined. Emphasis is on implant design, criteria for patient selection, and the operative procedure. Postoperative care and complications are briefly touched on.
Osteoid osteoma is a benign tumor which most commonly affects adolescents and young adults. Although this lesion occurs predominantly in the lower extremities, it has been described in the great toe only once before in medical literature. This bone lesion causes acute localized pain, worse at night, and it is relieved by aspirin or other anti-inflammatory medications. Treatment of choice is en bloc excision of the lesion. The prognosis with appropriate diagnosis and treatment is excellent.
The frequencies of quantitative and qualitative dermatoglyphic features of the toes and soles of 108 males and 108 females of two tribes from Northern Kenya are reported. These tribes are classified among the Kalenjin. The data are compared with those from other populations.
A rare injury consisting of an irreducible, closed complex dorsal dislocation of the metatarsophalangeal joint of the great toe was encountered in a 21-year-old man. A midline longitudinal dorsal incision over the metatarsophalangeal joint allowed easy and rapid approach to the joint, good visualization, and adequate access for reduction. The plantar neurovascular bundles are not at risk from the exposure, and scarring in the weight-bearing area after operation is avoided.
A 20-year-old male athlete had painful triggering and occasional locking of the great toe caused by entrapment of the flexor hallucis longus tendon within the flexor tendon sheath posterior to the left medial malleolus. No rupture of the tendon fibers, tendonitis, or supernumerary muscle was found. At open operation an elongated flexor hallucis longus was found entrapped under the tendon sheath in the ankle. After other therapy methods failed, the condition was relieved by a surgical procedure that released the flexor hallucis longus muscle from the tendon sheath.
While 32% of the patients in this series who required amputation in the lower limb presented with infected or gangrenous toes, only 9% had pedal pulses. In a prospective study of 26 phalangectomies and 9 ray or transmetatarsal amputations, the definition of a successful procedure was taken as a healed, painless wound at 1 month. By 1 month, 6 wounds were healed, 5 pain-free and granulating and 8 septic or painful; 16 patients had had further surgery. In the end 14 of 35 feet were salvaged, with 2 patients lost to follow-up and 4 with painful or septic feet. The 15 patients who later required below-knee or above-knee amputations were pain-free, but 7 could not be rehabilitated on prostheses. Blood supply and sepsis affected the healing rate, whereas diabetes was unimportant. The final salvage rate was apparent within 1 month of the initial surgery. In the absence of a pedal pulse, the use of clinical judgement for the selection of patients with dry gangrene gave a 50% salvage rate, but only 8 patients were selected for local surgery out of the total of 24 in this category. Sixteen amputations were performed for sepsis in the absence of a pedal pulse; no wound healed and only 2 patients had a clean, pain-free, granulating wound at the end of the 1-month period. Direct arterial surgery played an important role in restoring the pulse prior to amputation.
A review of the literature attests to a place for arthrodesis of the metatarsophalangeal joint of the great toe in the management of hallux valgus and rigidus. The predictability and consistency of the result of arthrodesis is noted with good results in approximately 90% of cases. The functional excellence and durability of such a result are impressive. The procedure is particularly indicated in patients with hallux rigidus and hallux valgus associated with metatarsalgia. There are a number of operative techniques, but the cone arthrodesis procedure described by Wilson is probably nearest to the ideal.
Injection into fertile chicken eggs of synovial fluids from some rheumatoid arthritis patients resulted in either embryo death or the development of the "crooked-toe" (CT) syndrome, or both, in newly hatched chicks. Synovial fluids from most RA patients (and fluids from a few non-RA individuals), however, were harmless. Dialyzing, partitioning, and gel filtration experiments indicated that the CT syndrome-inducing factor consists of 1 or more heat stable, dialyzable, polar lipids with molecular weights of about 3 to 4 x 10(3). Thin-layer chromatography revealed quantitative and qualitative differences between partially purified lipid preparations from "active" and "inactive" synovial fluids.
At the orthopedic clinic of Lübeck College of Medicine surgical treatment of disorders of the metatarsophalangeal joint of the big toe has, since 1975, included arthrodesis of this joint using a small bone chip. In the light of experience gathered in 150 arthrodeses performed to date, this paper aims to point out major considerations in surgical technique and postoperative treatment; keeping these in mind should help to prevent unsatisfactory courses and optimize results.
A 54-year-old man had an irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe, and injury that seems not to have been previously reported in the literature. The stability at the IP joint afforded by collateral ligaments, tendons, and plantar accessory ligament along with the short level arm of the distal phalanx normally resists dislocation. A strong dorsiflexion force to this joint with the foot and metatarsophalangeal joint fixed in a weight-bearing position is necessary to produce this injury. Treatment should begin with attempted closed reduction, but if this proves unsuccessful, an invaginated volar plate may be preventing reduction, in which case open reduction will be required. A dorsal approach affords easy exposure. Once the volar plate is reflected plantarward, the joint is easily reduced. Neither repair of the volar plate nor prolonged immobilization is necessary. At 15-month follow-up, our patient had no residual instability.
The toe pulse reappearance time study for ischemic arterial disease of the lower limb is an easy and accurate test which has great usefulness as a rapid screening method. It is well tolerated by the patients with ischemic arterial disease. Results of the test reflect the total blood flow, including that through the collateral vessels. They determine the severity of the occlusive arterial disease of the lower limb but do not determine the specific levels of arterial occlusion. A principle area of usefulness of the test is for patients who cannot exercise, such as those with a painful ulcer, incapacitating claudication and cardiopulmonary disease.
The author has had experience with ulcers of venous origin on the toes, knee and thigh, and demonstrates some of them. They are rare, and as a general rule are the result of a traumatism (shoes or seating). The author attaches little importance to cosmetic treatment and is strongly opposed to foot baths with Permanganate of K, since they require that the edematous leg remain in a vertical position in the warm water. In addition to elastocompression of the leg, well applied and only for walking, he insists on the efficacy of posture treatment reasonably and conscientiously practiced. The absence of posture treatment is, together with hemopathies and calcinosis, the root cause of so-called long-term ulcers.
Nine patients had replacement of the thumb and seven, reconstruction of a finger in a mutilated hand in which the thumb or all fingers had been amputated. There were twelve successes, three partial successes, and one failure. A clear knowledge of the anatomy of the dorsalis pedis artery, avoidance of kinking of the vessels, and adequate precautions against postoperative edema and venous congestion were essential for success. The donor foot did not suffer functionally despite the absent second toe.
The case is presented of a primary toe-to-thumb transfer by microvascular anastomosis for reconstruction of an acute degloving amputation of the thumb. This approach is not recommended as the standard practice for this type injury, however, there were certain advantages in this patient: (1) one stage procedure, (2) restoration of length, sensibility, and cover, (3) cosmetic improvement, and (4) minimal length of hospitalization.
A series of 68 second toe-to-long finger transfers in 55 patients, including 52 transfers in 41 patients with mutilating injuries and 16 transfers in 14 patients with congenital deformities, was reviewed. Mean followup was 6.7 years. The failure rate was 6%, and secondary procedures were done in 18% of the patients. In the group with traumatic injuries, mean flexion was 36 degrees, with a mean extension lag of 33 degrees. Two-point discrimination was an average of 11 mm. Grasp was 47% of that for the normal contralateral side, and pinch was 38%. Of the manual workers, 62.5% returned to the same job. Analysis of the congenital series was more difficult. Although mobility was not significantly better in these patients, discrimination was a mean 5 mm (10 patients were tested). Growth plates remained open in 86% of the patients. All patients were able to use their finger to pinch.
EMGs were recorded from the gastrocnemius and anterior tibialis muscles of 77 adult subjects in response to perturbation of stance by upward toe tilts. Subjects aged 22-88 y were initially grouped in seven decades (20s-80s). Each presented a history free of ear disease, eye disease not correctable by lenses, neurological disease, and persistent difficulty with balance or dizziness. All demonstrated functionally normal balance for their age on routine dynamic posturography. EMG recordings yielded onset and offset latencies, durations, and integrated amplitudes of the short and medium latency responses of the gastrocnemius and the long latency responses of the anterior tibialis. Analysis of the data revealed statistically significant left-right differences in amplitude of response and statistically significant height, gender, and age effects. Procedural issues were discussed; data were summarized for normative purposes; and suggestions were made for dealing with statistically significant differences in a clinical environment.
We describe a patient with deafness, normal intellect and a unique phenotype characterized by a rigid mask-like face, narrow, upslanting palpebral fissures, flat malar bones, thick lower lip, malformed auricles, preaxial polydactyly with triphalangeal thumbs, syn-ectrodactyly of toes and first degree hypospadias.