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At least 127 records · Page 7Linked to original sources
PubMed2004

Big-toe replantation in a three-month-old child: case report.

A 3-month-old child underwent successful replantation of her big toe at the level of the metatarsophalangeal joint after traumatic amputation caused by a falling heavy object. The length of the big toe from the metatarsophalangeal joint to the tip was equal to that of the contralateral big toe at a 6-month follow-up. Within 4 months, pain sensation returned to the toe. Traumatic amputation of the big toe is uncommon and only a few articles have been published on its replantation. The case presented here is the youngest patient for big toe replantation in the literature. The big toe plays an important role functionally in walking and standing. In addition, the appearance of the foot without the big toe may be unacceptable from an aesthetic point of view for many people. Reconstructive microsurgeons should not hesitate to replant the big toe in suitable cases, even if patients are only a few months old.

Amputation, Traumatic↗
PubMed2001

Contributions of active and passive toe flexion to forefoot loading.

Toe flexion during terminal stance has an active component contributed by the muscles that flex the toes and a passive component contributed by the plantar fascia. This study examined the relative importance of these two mechanisms in maintaining proper force sharing between the toes and forefoot. Thirteen nonpaired cadaver feet were tested in a dynamic gait stimulator, which reproduces the kinematics and kinetics of the foot, ankle, and tibia by applying physiologic muscle forces and proximal tibial kinematics. The distribution of plantar pressure beneath the foot was measured at the terminal stance phase of gait under normal extrinsic muscle activity with an intact plantar fascia, in the absence of extrinsic toe flexor activity (no flexor hallucis longus or flexor digitorum longus) with an intact plantar fascia, and after complete fasciotomy with normal extrinsic toe flexor activity. In the absence of the toe flexor muscles or after plantar fasciotomy the contact area decreased beneath the toes and contact force shifted from the toes to the metatarsal heads. In addition, pressure distribution beneath the metatarsal heads after fasciotomy shifted laterally and posteriorly, indicating that the plantar fascia enables more efficient force transmission through the high gear axis during locomotion. The plantar fascia enables the toes to provide plantar-directed force and bear high loads during push-off.

Adult↗
PubMed1996

Aesthetic refinements in toe-to-hand transfer surgery.

Techniques for aesthetic refinement are as important as those for functional improvement in toe-to-hand transfer. The appearance of the thumb reconstructed using various types of great toe transfer can be improved by reduction of the soft tissue, bone, interphalangeal joint, and nail and by secondary pulp reduction and contouring procedures. Finger and thumb reconstructions using lesser toes can be improved aesthetically by minimal inclusion of adipofibrous tissue under the plantar skin flap especially at the metatarsophalangeal joint region, thus decreasing the anterior-posterior bulkiness. Tight extensor repair, temporary K-pin fixation of the proximal and distal interphalangeal joint in extension, followed by prolonged use of a nighttime extension splint and secondary pulp reduction help to avoid the claw and drumstick appearances of the transferred lesser toe. Adequate soft-tissue coverage, cruciate skin incisions, extensive mobilization, and thinning and trimming of the skin flaps of the digital amputation stump lead to a smooth junction between the amputated digit and the transferred toe. In the distal digital reconstruction, skeletonization of medial and lateral neurovascular bundles of the harvested toe helps primary closure of the digital wound, thus avoiding the unsightly skin graft on the sides of the reconstructed digit. Regarding the donor foot, preservation of the proximal 0.5 to 1 cm of the proximal phalangeal stump of the great toe maintains the span of the foot, thus improving donor site appearance. In single lesser toe or combined second and third toe transfer, the proximal phalanx should not be preserved but an optimal web space should be reconstructed. Primary closure without skin graft is essential for aesthetic appearance of the donor foot.

Amputation, Traumatic↗
PubMed2003

Minimizing impairment in laborers with finger losses distal to the proximal interphalangeal joint by second toe transfer.

Traditionally, toe-to-hand transfers have been reserved for thumb amputations or for use after severe mutilating injuries. The authors report their experience with the use of second toe-for-finger amputations with preserved or reconstructible proximal interphalangeal joints in manual workers. The aim of the procedure was to reduce impairment and to upgrade the hand from a functional and cosmetic standpoint. Fifteen second-toe wrap-around or variations were carried out on 11 adults (18 to 41 years old). Four patients with two or more finger amputations received two sequential second toes; four patients with two finger amputations received one toe; and each of three patients with single-digit amputation received a single toe. All but one amputation were performed less than 3 weeks after the accident. All toes survived. Range of motion at the native proximal interphalangeal joint was more than 90 percent in all patients but one; however, it was minimal at the transplanted joints. Patient satisfaction was high from a cosmetic and functional standpoint. Ten of 11 laborers resumed their previous activity. On the basis of this experience, a classification with aesthetic and functional implications is proposed to help in the decision-making process when dealing with multidigital injuries. It is concluded that second-toe transfer is an excellent choice for finger amputation distal to the proximal interphalangeal joint in laborers. Its prime indication is for amputations of two fingers where at least one toe should be transferred, as required, to achieve an "acceptable hand" (three-fingered hand). Early transfer allows salvage of critical structures from the damaged finger, such as joints, tendons, and bone, that otherwise would be lost. Early transplantation is highly recommended.

Accidents, Occupational↗
PubMed2005

Toe spreading ability in men with chronic pelvic pain syndrome.

BACKGROUND: We examined toe-spreading ability in subjects with chronic pelvic pain syndrome (CPPS) to test the hypothesis that subjects with CPPS could have deficiencies in lower extremity functions innervated by sacral spinal roots. METHODS: Seventy two subjects with CPPS and 98 volunteer controls were examined as part of a larger study on CPPS. All the subjects underwent a detailed urologic and neurological examination including a toe-spreading examination with a quantitative scoring system. We compared the groups in terms of ability of toe-spreading as either "complete" (all toes spreading) or "incomplete" (at least one interdigital space not spreading) and also by comparing the number of interdigital spaces. For CPPS subjects only, we also analyzed the variation of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scales by toe-spreading categories. RESULTS: CPPS subjects were less often able to spread all toes than subjects without CPPS (p = 0.005). None of the NIH-CPSI sub-scales (pain, urinary symptoms, and quality of life), nor the total score showed an association with toe spreading ability. CONCLUSION: We found toe spreading to be diminished in subjects with CPPS. We hypothesize that incomplete toe spreading in subjects with CPPS may be related to subtle deficits involving the most caudal part of the spinal segments.

Adult↗
PubMedDate not supplied

Blood pressure in the great toe with simulated occlusion of the dorsalis pedis artery.

Blood pressure was measured in both great toes using strain-gauge plethysmography in 100 healthy persons aged 18 to 43 before and during successive compression of the dorsalis pedis artery, the posterior tibial artery, and both arteries at the same time. In 54 (27 percent) of 200 feet, successive compression of the dorsalis pedis and the posterior tibial arteries produced no decrease in pressure in the great toe. In 47 of the feet, toe pressure decreased significantly only after compression of the posterior tibial artery, and in 65 of the feet toe pressure decreased significantly only after compression of the dorsalis pedis artery. In 34 of the feet, toe pressure decreased significantly after compression of each of the arteries. Thus in 99 (50 percent) of 200 feet, compression of the dorsalis pedis artery decreased the pressure in the great toe significantly, and in 4 feet the pressure decreased below 40 mm Hg. When both arteries were simultaneously compressed, 69 feet showed detectable blood pressure in the great toe. Attempts to evaluate adequacy of collateral circulation by pressure blanching of the great toe prior to artery compression and then observing capillary refilling time upon release of toe compression proved unreliable.

Adolescent↗
PubMed2005

[The correlation between toe- and ankle pressure, clinical symptoms and angiography in patients with leg ischemia].

OBJECTIVE: The severity of leg ischemia is usually evaluated by measuring ankle pressure. This is a simple measurement but can be misleading in patients with severe sclerosis in ankle arteries in which case toe pressure is believed to be more reliable. The purpose of this study was to compare toe pressure with ankle pressure, clinical symptoms and angiography and thus evaluate the usefulness of toe pressure in the assessment of leg ischemia. MATERIAL AND METHODS: In total of 58 legs from 30 patients that came to Landspítali University Hospital because of leg ischemia we measured toe- and ankle pressure and assessed the clinical stage of leg ischemia. All patients also had an angiography of their leg arteries. RESULTS: There was a correlation between pressure measurements and the clinical stage of leg ischemia and also between pressure measurements and results from angiography of leg arteries. There was not a significant difference between the correlation for toe- and ankle pressure respectively. In two cases it was impossible to measure ankle pressure but in both cases it was possible to measure toe pressure. CONCLUSIONS: Toe- and ankle pressure measurements are equally useful in the evaluation of leg ischemia. Ankle pressure is a more simple measurement than toe pressure but can be impossible to perform when the ankle arteries are very sclerotic. When that is the case toe pressure can often be measured instead.

Aged↗
PubMedDate not supplied

Toe blood pressure. A valuable adjunct to ankle pressure measurement for assessing peripheral arterial disease.

Ankle pressure measurements fail to reflect the severity of peripheral ischemia when the underlying vessels are calcified or when there is extensive pedal or digital arterial disease. These problems may be obviated by measuring pressures at toe level. In this study, toe pressures were correlated with ankle pressures, clinical symptoms, and the presence or absence of diabetes in 294 limbs. The relationship of toe pressures to healing of ulcers or amputations of the foot was investigated in 58 limbs. Measurements were made with a digital pneumatic cuff and a photoplethysmograph. The ability of absolute toe pressure, ankle/brachial index, toe/brachial index, toe/ankle index, and the brachial pressure minus the toe pressure to differentiate between asymptomatic, claudicating, and ischemic limbs was determined. The toe/brachial index, arm minus toe pressure, and the absolute toe pressure had an average sensitivity and specificity of 85% and 88% for asymptomatic limbs and 89% and 86% for ischemic limbs. A toe pressure greater than 30 mmHg was indicative of a good healing potential, and ankle pressure less than 80 mmHg was associated with poor healing. The correlation between ankle and toe pressures was essentially the same in both diabetic (r = 0.60) and non-diabetic limbs (r = 0.62).

Amputation, Surgical↗
PubMed1997

Train-of-four and double burst stimulation fade at the great toe and thumb.

PURPOSE: We compared probabilities of tactile detection of fade in response to train-of-four (TOF), double burst stimulation3.3 (DBS3.3), and DBS3.2 at the great toe with those at the thumb. METHODS: One hundred and thirty adult patients anaesthetized with nitrous oxide, oxygen, isoflurane, and fentanyl were studied. At varying degrees of neuromuscular block caused by vecuronium, an observer determined the presence or absence of fade in response to TOF DBS3.3, or DBS3.2 at the great toe and that at the thumb. The relationship between T1/T0 or TOF ratio (T4/T1) measured at the great toe and that at the thumb was also examined. RESULTS: When TOF ratios were 0-0.10, 0.11-0.20, 0.21-0.30, 0.31-0.40, 0.41-0.50, 0.51-0.60, 0.61-0.70, and 0.71-1.00, the probabilities of detection of fade in response to TOF at the great toe (thumb) were 77 (100), 66 (100), 58 (96), 52 (77), 39 (38), 26 (23), 2(4), and 0(0)%, respectively (P < 0.05 at TOF ratio 0-0.40). Similarly, the probabilities of detection of fade in response to DBS3.3 at the great toe were lower than at the thumb when TOF ratios were 0.21-0.80, and those in response to DBS3.2 at the great toe were lower than at the thumb when TOF ratios were 0.61-0.80. A dose relationship was observed between T1/T0 or TOF ratio at the great toe and that at the thumb. CONCLUSION: This study suggests that the probability of tactile detection of fade in response to TOF, DBS3.3, or DBS3.2 at the great toe is less than that at the thumb. The present results may be because the flexor hallucis brevis muscle is more resistant to non-depolarizing neuromuscular relaxant than the adductor pollicis muscle and that the ratio of fade in response to neurostimulation at the great toe is higher than at the thumb.

Adult↗
PubMed1997

Torque-velocity relationship during cycle ergometer sprints with and without toe clips.

The torque-velocity relationship in cycling has been studied during all-out sprints (n = 6 subjects) with and without toe clips on an electronic Lode ergometer with strain gauges, to estimate the importance of the expected decrease in torque, velocity and power output. As previously found with different cycling protocols, the torque-velocity relationship was linear for all-out sprints with toe clips. A similar relationship was observed when cycling without toe clips but the torque-velocity relationship was inflected downwards at low or high velocities in several subjects who were not regular cyclists. The pulling action during the rise of the pedal at low velocities cannot explain why the torque-velocity relationship is not hyperbolic for cycling exercises with toe clips because similar relationships were observed without toe clips. The maximal power output was significantly higher during cycling with toe clips (782 W vs 668 W, P < 0.05), probably because of the pulling action at low and medium velocities as indicated by the higher value of the extrapolated maximal torque T0 (138 N x m vs 122 N x m, P < 0.05). In contrast, the maximal extrapolated velocity, V0 and peak velocity were not significantly improved by the use of toe clips. The comparison of the angle-torque patterns at low and high velocities suggested that the kinetic energy of the legs can be transformed into power output when cycling without toe clips as well as it can when cycling with toe clips.

Adult↗
PubMed2004

Arthrodesis of the toe joints with an intramedullary cannulated screw for correction of hammertoe deformity.

Twenty-four patients (37 feet, 51 toes) affected by hammertoe deformity of the lesser toes and treated surgically by arthrodesis of the proximal interphalangeal joint, stabilized with an intramedullary titanium cannulated screw, were reviewed 1-4 years after the operation. At follow-up, the arthrodesis was fused in 48 toes; three toes showed an asymptomatic radiographic nonunion, and in one of them the screw was broken. In seven toes, the cannulated screw was removed because of persistent pain at the tip of the toe where the head of the screw was located. In one case only, there was a late infection, with toe malalignment. All the patients were able to use street shoes 2 weeks after surgery. The average AOFAS score at follow-up was 86.54 points. Compared to the conventional temporary stabilization with an intramedullary Kirschner wire, the stabilization with a cannulated screw decreases the risk of infection, of radiographic nonunion, and of mallet toe deformity.

Adolescent↗
PubMedDate not supplied

Effect of orthotic therapy on claw toe loading: results of significance testing at pressure sensor units.

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system's ability to export detailed data. Plantar pressure-time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure-time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure-time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure-time integral changes and, therefore, could advance the clinical application of plantar pressure measurement.

Aged↗
PubMed1987

Toe and plantar dermatoglyphics in adult American Caucasians.

The scarcity of information on control data of toe and plantar dermatoglyphics led us to undertake this study of adult American Caucasians. Toe and sole prints of 168 male and 83 female participants of the Baltimore Longitudinal Study of Aging were analyzed. Toe pattern frequencies demonstrate that fibular loops are the most prevalent pattern on the toes in both males and females. Pattern distribution by digit shows that arches are most often located on the fifth toe while whorls are found with greatest frequency on the third toe. Plantar pattern frequencies indicate that the most common pattern found in the hallucal area is the distal loop. Open fields are frequently found in the II and IV interdigital areas while distal loops are prevalent in the III area. These results are compared to the finger and palmar patterns of the same individuals. The distribution of patterns on the toes and fingers of the same individuals appear to be quite different. Population comparisons did not demonstrate a clear racial difference in the toe pattern frequencies or in the plantar areas.

Adult↗
PubMed2005

Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity.

Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer toe deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer toe deformity, and 13 age- and gender-matched neuropathic diabetic controls without deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force-time integral for each of 11 foot regions were calculated. Degree of toe deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with toe deformity (mean 626 (SD 260)kPa) when compared with controls (mean 363 (SD 115) kPa, P<0.005). MTH peak pressure was significantly correlated with degree of toe deformity (r=-0.74) and with fat-pad displacement (r=-0.71) (P<0.001). The ratio of force-time integral in the toes and the MTHs (toe-loading index) was significantly lower in the group with deformity. These results show that claw/hammer toe deformity is associated with a distal-to-proximal transfer of load in the forefoot and elevated plantar pressures at the MTHs in neuropathic diabetic patients. Distal displacement of the plantar fat pad is suggested to be the underlying mechanism in this association. These conditions increase the risk for plantar ulceration in these patients.

Diabetic Foot↗
PubMed2006

The neuromuscular demands of toe walking: a forward dynamics simulation analysis.

Toe walking is a gait deviation with multiple etiologies and often associated with premature and prolonged ankle plantar flexor electromyographic activity. The goal of this study was to use a detailed musculoskeletal model and forward dynamical simulations that emulate able-bodied toe and heel-toe walking to understand why, despite an increase in muscle activity in the ankle plantar flexors during toe walking, the internal ankle joint moment decreases relative to heel-toe walking. The simulations were analyzed to assess the force generating capacity of the plantar flexors by examining each muscle's contractile state (i.e., the muscle fiber length, velocity and activation). Consistent with experimental measurements, the simulation data showed that despite a 122% increase in soleus muscle activity and a 76% increase in gastrocnemius activity, the peak internal ankle moment in late stance decreased. The decrease was attributed to non-optimal contractile conditions for the plantar flexors (primarily the force-length relationship) that reduced their ability to generate force. As a result, greater muscle activity is needed during toe walking to produce a given muscle force level. In addition, toe walking requires greater sustained plantar flexor force and moment generation during stance. Thus, even though toe walking requires lower peak plantar flexor forces that might suggest a compensatory advantage for those with plantar flexor weakness, greater neuromuscular demand is placed on those muscles. Therefore, medical decisions concerning whether to reduce equinus should consider not only the impact on the ankle moment, but also the expected change to the plantar flexor's force generating capacity.

Adult↗
PubMed1985

Retrospective survey of seventeen toe transfers relation between surgical techniques and functional results.

The functional results of 17 toe transfers (15 second toes, 1 great toe and 1 monobloc second and third toes) are presented: arteries: 16 revascularisations achieved successfully out of 17. Veins: only one re-exploration had to be performed and it was successful. Osteosynthesis: performed in 10 cases with plate and screws, in 5 cases with a single K-wire and in 1 case with a double K-wire. No osteosynthesis was necessary in one case. Uneventful bone healing was always achieved. Tendons: the amplitude of movement at the interphalangeal joints (PIP & DIP) in post-traumatic cases is sufficient to ensure the desired function. In cases of congenital anomaly, however, the mobility of the transferred toe is almost nonexistent and function relies on the mobility of the recipient stump. Nerves: either discriminative or protective sensation was always obtained. Skin: in all cases adequate skin cover was obtained without resorting to a flap. Sequellae at the foot: there are virtually none when the second toe is removed. Various gait impediments occur, however, particularly on uneven surfaces, when the great toe or the monobloc second and third toes are removed.

Bone Plates↗
PubMed1997

Long-term results of toe transfer: retrospective analysis.

Between February 1966 and February 1994, 400 cases of toe transplantation were analyzed, to evaluate toe-transfer procedures in thumb and finger reconstruction. Techniques utilized included single second-toe transfer, with and without the metatarsophalangeal joint (299): second- and third-toe transfer (28); second-toe and third proximal phalanx transfer (1); second-toe with flap transfers (66); and hallux nail flap with second toe or second and third toe transfer (6). There was a survival rate of 96.5 percent, with 386 cases surviving and 14 failing. A more than 2-year follow-up was possible in 240 cases. Excellent motor and sensory function (more than 90 percent of normal) was achieved in the reconstructed fingers and thumbs, as well as satisfactory function (between 86 and 91 percent of normal) in the donor foot.

Adolescent↗
PubMed1984

Functional comparison between pollicization and toe-to-hand transfer for thumb reconstruction.

The functional results of two methods of thumb reconstruction, pollicization, and toe transplantation were evaluated in four groups of patients: Group I, those missing the thumb but with four other normal digits; Group II, those missing the thumb with partially mutilated or amputated other digits; Group III, those with a metacarpal hand; and Group IV, those with a distal thumb amputation. In each group, results were compared in six categories: mobility, strength, sensibility, cosmetic appearance, pinch accuracy, and grasping power. In Group I, pollicization provided superior sensibility and mobility, but grasping power was best achieved by transfer of the big toe. Second toe transfer and pollicization both resulted in some weakness, compared with the normal hand. Pinch accuracy, related to the quality of sensibility, was better achieved by pollicization than by any free transfer. In Group II, although pollicization of a mutilated digit is more controversial, a very good functional level was reached in some cases, directly related to the amount of preoperative sensibility and the mobility of the proximal interphalangeal joint in the transferred digit. Reduction of strength and prehension depended on the number and quality of the remaining nontransferred digits. Toe transfer yielded better results in all six categories, as the severity of digit mutilation increased. In Group III, pollicization of the second metacarpal achieved a very rudimentary pinch, with toe transfer allowing for much greater prehension possibilities. In Group IV, distal thumb amputations were treated with distal digital pollicization as well as with partial toe transplantation. Both methods did well; however, indications for pollicization were extremely limited. Comparing results of big and second toe transfer for thumb reconstruction, big toe transfer achieved superior results, in both functional and cosmetic aspects.

Amputation, Traumatic↗