Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Toes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed1995

Single third-toe transfer in hand reconstruction.

Eighteen third-toe transfers to the hand were performed from 1984 to 1993 in 15 patients. These patients had multiple amputations, and follow-up ranged from 5 to 78 months with an average of 27 months. Single third-toe-to-hand transfer was elected when (1) the second toe was not available or not suitable for transfer, (2) the second toe was located in the same foot where the great toe had been transferred to the thumb and the second toe was, therefore, spared for gait, or (3) the third toe was a better size match.

Adolescent↗
PubMed1986

Functional evaluation of the hand and foot after one-stage toe-to-hand transfer.

Twenty toe-to-hand transfers in 17 patients with an average follow-up of 54 months have been reviewed to quantify hand function and donor morbidity. Eleven toe-to-thumb and nine toe-to-finger procedures were performed. Surgical and follow-up data were available for all patients. Twelve patients (14 procedures) were reviewed in detail, with particular attention given to foot and hand function. Total active motion after toe-to-thumb transfer was 48 degrees and 106 degrees after toe-to-finger transfer. Two-point discrimination was less than or equal to 15 mm in 13 digits (65%). Grip and pinch power were related to the number of digits present on the reconstructed hand and to the presence or absence of functioning thenar muscles. Eleven of 12 patients can walk and run normally (mean of 5 years after surgery). Six (50%) cannot wear thongs or heavy boots, but all can wear normal shoes. The transferred great toe decreased in volume by an average of 10% over the years since the operation. Transferred toes became useful digits in the hand, and foot morbidity was minor and not progressive.

Adolescent↗
PubMed2003

Isolated flexor muscles of the little toe in the feet of an individual with atrophied or lacking 4th head of the M. extensor digitorum brevis and lacking the 4th tendon of the M. extensor digitorum longus.

While dissecting the body of a 75-year-old male we observed variations in the Mm. flexor digitorum brevis and longus of both feet. In the left foot, the 4th tendon of the M. flexor digitorum brevis was atrophied and the respective tendon of the M. flexor digitorum longus to the little toe was absent. In the right foot, the 4th tendons of both the Mm. flexor digitorum brevis and longus to the little toe were absent. The lacking deep flexor tendon to the little toe in the left foot was replaced by an isolated flexor muscle originating from the medial and lateral processes of the calcaneal tuberosity, which additionally had connections to the tendinous plate of the M. flexor digitorum longus and the M. quadratus plantae. The absent superficial and deep flexor tendons to the little toe in the right foot were replaced by an isolated flexor muscle arising from the M. quadratus plantae distal from the medial process of the calcaneal tuberosity. The tendon of both isolated flexor muscles inserted in the distal phalanx of the little toe. The left isolated flexor muscle for the little toe had connections to the M. flexor digitorum longus and the M. quadratus plantae. From these results it seems likely that the M. quadratus plantae could be regarded as additional flexor head (caput breve or plantare) of the M. flexor digitorum longus as is described in classic textbooks. In the individual's lifetime the described variation perhaps led to the possibility of an isolated flexion of the little toe.

Aged↗
PubMed2002

Sausage-like toe and heel pain: value for diagnosing and evaluating the severity of spondyloarthropathies defined by Amor's criteria. A retrospective study in 161 patients.

AIM: To evaluate the frequency of sausage-like toe and talalgia in spondyloarthropathies diagnosed by the 12 items of Amor's criteria; to study the frequency of a diagnosis which would be impossible without these two symptoms; and to study the correlations between Amor's criteria score and the clinical and biological symptoms in the presence of both of these. METHODS: Retrospective study of 161 cases (age, 38.8 +/- 13.1 years; duration, 7.12 +/- 7.3 years; HLA B27, 112). Peripheral involvement is observed in 89 cases (52 cases of pure peripheral form). RESULTS: Eighty cases (group N1) experience talalgia and/or sausage-like toe and 80 do not (group N2). Talalgia concerns 68 patients (42.2%) and sausage-like toe 37 (23.3%); both signs are present in 18. Age, duration, morning stiffness, SR, CRP are similar in both groups. Ankle involvement and oligoarthritis are significantly more frequent in group N1. In 17 cases the presence of talalgia or sausage-like toe are indispensable to the diagnosis (10.6%): 11 undetermined spondyloarthropathies, six psoriatic arthritis. In the N1 group, a positive correlation is present between the score of the 12 items and, respectively, morning stiffness (+ 0.69; P = 0.0001), SR (+ 0.6; P = 0.001 8), CRP (+ 0.59; P = 0.001 8) in patients with sausage-like toe, probably because of the associated oligoarthritis, but neither in patients with talalgia (N1) nor in patients of the group N2. CONCLUSION: Talalgia and sausage-like toe are present respectively in 42.2 and 23.6% of spondyloarthropathies and are indispensable to the diagnosis using Amor's criteria in 10.6% of cases. The sausage-like toe would indicate a more severe spondyloarthopathy because of the synovitis, even though talalgia (pure enthesopathy) does not reflect the inflammatory process.

Adolescent↗
PubMed2004

The cuff width influences the toe blood pressure value.

BACKGROUND: Toe blood pressure is a valuable and often used parameter when lower limb ischaemia is evaluated in patients with diabetes, but little has been done to standardise the method. The aim of this study was to evaluate if the cuff size influences the toe blood pressure values obtained in patients with diabetes. PATIENTS AND METHODS: Eleven patients with diabetes without a history of peripheral vascular disease, and six age matched healthy subjects were investigated. Their blood pressures were measured in the upper arm and at the ankle level repetitively. For measurement of toe blood pressure two different cuff widths were used. RESULTS: All blood pressures were similar in patients and control subjects, as well as over time. The toe blood pressure values were 18 mmHg higher (p < 0.01) if measured with a 2.0-cm compared to a 2.5-cm wide cuff. There was a relationship (r = 0.63, p < 0.05 for patients) between toe circumference and the toe blood pressure value, where smaller hallluxes gave lower values. CONCLUSIONS: The cuff width influences the obtained toe blood pressure value and needs to be considered when evaluating limb ischemia in patients with diabetes.

Blood Pressure↗
PubMed2002

Age-related changes in peripheral pulse timing characteristics at the ears, fingers and toes.

It is accepted that older subjects have increasing arterial stiffness, which results in increasingly faster pulse transmission to the periphery. However, this age association is less clear in younger subjects and for different peripheral measurement sites. The aims of this study were to determine the association between age and pulse timing characteristics over a five decade age range at the ears, fingers and toes, and to compare these with any additional effects associated with differences in subject height, systolic blood pressure and heart rate. Photoplethysmography pulse wave-forms were recorded noninvasively from the right and left sides at the ears, fingers and toes of 116 normal healthy human subjects. Their median age was 42 years (range 13-72 years). Systolic blood pressure, height and heart rate were also measured. Pulse transit times (PTTs) were determined and referenced to the electrocardiogram R wave. The results revealed that age was the strongest contributor to PTT differences at all sites (P<0.0001). The decrease with ageing was greatest at the toes: -1.6, -0.6, -0.4 ms/year for the toes, fingers, and ears, respectively. Changes for the right and left body sides at each level were highly similar. Blood pressure was also an important contributor to PTT at all sites (P<0.0001); -1.0, -0.4, -0.3 ms/mm Hg, respectively, with approximately half of the effect explained by age. Height was significantly and independently related to PTT at the fingers and toes (P<0.0001); +1.1, +0.7 ms/cm, respectively. The fraction of PTT variability explained by these relationships was 0.65, 0.48, 0.26 for the toes, fingers and ears, respectively (P<0.0001). Finally, we concluded that the age effect decreased linearly from the second to the seventh decades, demonstrating that the effect of changes in arterial stiffness can be detected noninvasively from an early age at three main peripheral sites. Age is the dominant factor in contributing to PTT, and is greatest at the toes, followed by the fingers and then the ears.

Adolescent↗
PubMed2001

The value of toe pulse waves in determination of risks for limb amputation and death in patients with peripheral arterial disease and skin ulcers or gangrene.

OBJECTIVES: The purpose of this study was to determine whether the presence of low amplitude of pulse waves recorded from the toes is related to the risk of subsequent amputation and death in patients with skin ulcers or gangrene and peripheral arterial disease, and how the risk of low wave amplitude relates to the risk associated with low peripheral pressures. METHODS: A total of 309 patients with 346 limbs with skin lesions and arterial disease referred to the vascular laboratory were followed up for an average of 5 years (range, 1-8 years). Measurements were carried out to obtain ankle and toe pressures, pressure indices, and toe pulse wave amplitude. These variables were related to the risks of major amputation and total and cardiovascular death by means of the Cox proportional hazards model. RESULTS: Low toe pulse wave amplitude (< or = 4 mm) was associated with increased risk of amputation (relative risks 4.20 in all limbs and 2.63 in those with toe pressure < or = 30 mm Hg; P <.01). Wave amplitude remained significantly associated with increased risk of amputation after controlling for each pressure variable (P <.01). Low pulse wave amplitude and toe/brachial index were associated with increased risks of both total and cardiovascular death in all patients (relative risks ranged from 1.43-1.73; P <.05) and in those with toe pressure of 30 mm Hg or less (relative risks 1.56-1.90; P <.05). CONCLUSIONS: Low toe pulse wave amplitude is related significantly to increased risks of amputation and death in patients with skin lesions and arterial disease. The presence of low wave amplitude provides significant information in addition to peripheral pressures with respect to the risk of amputation.

Aged↗
PubMed2004

The natural history of idiopathic toe-walking: a long-term follow-up of fourteen conservatively treated children.

AIM: To determine the long-term results after conservative treatment (physiotherapy, casting, orthoses, or a combination of these) of idiopathic toe-walking (ITW). METHODS: Tiptoe-walking is diagnosed as idiopathic (habitual) if no signs of neurological, orthopaedic, or psychiatric disease are detected. The diagnosis is one of exclusion. Sixteen former patients with ITW, all now at least 13 y old, were asked to participate in a follow-up investigation 7-21 y after being first diagnosed. Two cases were excluded because heel-cord lengthening had been performed later on in other hospitals. The remaining 14 patients completed a questionnaire. Eleven patients consented to a clinical examination, during which they were videotaped and their active and passive ankle-joint dorsiflexion measured. These data were compared with the assessment at the initial evaluation. In one instance, the toe-walking ceased after conservative treatment (plaster cast). In all other cases the toe-walking pattern recurred. RESULTS: At follow-up three patients showed some toe-walking when they were unobtrusively observed. When videotaped, they did not toe-walk, although a distinct heel-strike was missing. The remaining eight patients all walked with a heel-strike. Two patients had slight symptoms possibly related to toe-walking. No fixed contracture was present at the first evaluation, and none was found at follow-up. There was no systematic change in ankle-joint dorsiflexion from initial assessment to follow-up examination. CONCLUSION: Non-surgical treatment of ITW does not have a lasting effect and the long-term results in this study are considered to reflect the natural history, i.e. the toe-walking pattern eventually resolves spontaneously in the majority of children. Surgical treatment of ITW should be reserved for the few cases with a fixed ankle-joint contracture.

Child↗
PubMed2002

Effects of age and gender on toe flexor muscle strength.

BACKGROUND: Toe flexor muscle strength determines the anterior limit of the functional base of support, thereby affecting a standing individual's maximum forward reach or lean capacity. We developed a method for measuring toe flexor muscle strength in order to test the null hypotheses that it is neither affected by age nor gender. METHODS: Gender-balanced groups of 20 healthy young adults (YA) (average age 22.8 years) and 20 healthy older adults (OA) (average age 73.2 years) participated in the study. Toe flexor isometric muscle strength, calculated as the maximum volitional moment developed simultaneously in the sagittal plane by the toe flexor muscles about a reference axis through the first metatarsophalangeal joint, was measured in three trials while subjects reached forward as far as possible while standing on a force plate. RESULTS: Significant age (p <.005) and gender (p <.0005) differences were found in maximum toe flexor muscle strength. OA were 28.9% less strong than the YA [mean (SD) 13.5 (5.7) Nm and 19.0 (6.8) Nm, respectively]. The men developed 39.1% greater strength than the women [20.2 (7.1) Nm and 12.3 (3.7) Nm, respectively]. However, when normalized by body size (body weight x height), the gender difference in strength no longer reached statistical significance. Across all subjects, the anterior limit of the functional base of support was significantly correlated with toe flexor strength (coefficient of determination: 0.84). CONCLUSIONS: Toe flexor muscle strength decreased significantly with age. This decrement underlies the known age-related reduction in the functional base of support.

Adult↗
PubMed1984

Electrical stimulation to reduce chronic toe-flexor hypertonicity. A case report.

Electrical stimulation reduces hypertonicity, but the mechanism for the effectiveness is not well understood. In this particular case, electrical stimulation to the toe extensors resulted in inhibition of the toe-flexor hypertonicity. This phenomenon may be explained by Sherrington's theory of reciprocal inhibition. Liberson found that electrical stimulation of an agonist is associated with a concomitant inhibition of the antagonist in the healthy individual. I applied Liberson's findings in my treatment of the patient. By facilitating the toe extensors, and thus inhibiting the toe flexors, toe posturing improved considerably and allowed the patient volitionally to control his toes, which, in turn, improved his foot and toe comfort. Stimulation also allowed the patient to assume a plantigrade and forefoot weight-bearing position to improve his gait. This patient benefitted dramatically from the use of electrical stimulation in inhibiting hypertonicity, and I believe this modality may be helpful in other cases dealing with increased muscle tone. The patient will continue to be observed on a regular basis for reassessment of the long-term effects of electrical stimulation on hypertonicity and on the skin at the electrode sites.

Adult↗
PubMed1993

Toe-to-hand transfers in the rehabilitation of frostbite injury.

In our experience digitless hands from frostbite injury are typically seen in young men as a result of an episode of intoxication. Such deformities occur bilaterally in 80% of cases and often lead to total loss of prehensile capability. Because of a uniformly high degree of motivation in this group of patients, toe-to-hand transfer carries an excellent prognosis. Microanastomoses in a frostbitten hand are as reliable as in a mechanically injured hand, provided the ulnar artery and its branches are intact. Because amputations occur at the level of the metacarpal heads, the preferred transplant is the combined second and third toe composite. However, a satisfactory thumb post is essential for proper function of the composite. Well-planned sharing of available toe resources is necessary for establishing optimum bilateral hand function, especially in the face of simultaneous toe frostbite. Squandering valuable foot resources bilaterally on behalf of a single hand makes reconstructing the opposite hand more difficult. Economy may be gained if two separate microvascular toe transfers are taken from the same foot or if a single block of toes may be applied to the hand as an opposable unit. Clinical management is described of 25 digitless patients whose frostbitten hands were treated by microsurgical toe transfer.

Adult↗
PubMed1994

Microsurgical thumb reconstruction with toe transfer: selection of various techniques.

Microsurgical toe transfer is an established method for reconstruction of missing thumbs. However, there is little agreement on which of the various techniques represents the ideal transfer. Basically, selection of technique requires balancing the patient's functional needs, appearance of the reconstructed thumb, and donor-site cosmesis. Based on our experience with 103 toe-to-thumb transfers performed over the past 9 years, this paper attempts to provide guidelines for appropriate selection among the four most commonly employed toe transfer techniques (e.g., second toe, total great toe, great toe wrap-around, trimmed great toe) so that optimal results and patient's acceptance can both be achieved.

Adolescent↗
PubMed2000

Fingertip reconstructions using partial-toe transfers.

Fifty-six partial toes were transferred to reconstruct fingertip deficits. The transfers from the big toe mainly consisted of 3 trimmed big toetips, 3 vascularized nail grafts, 3 onychocutaneous flaps, 19 thin osteo-onychocutaneous flaps, and 2 hemipulp flaps. The transfers from the second toe mainly consisted of 8 trimmed second toetips, 5 reduced second toes, and 9 whole distal phalanges. The average values of postoperative sensory recovery of the osteo-onychocutaneous flaps including the vascularized nail grafts were 3.1 (Semmes-Weinstein test) and 6.3 mm (moving two-point discrimination) at 2.6 years after the transfer; those of the thin osteo-onychocutaneous flaps were 3.1 and 7.2 mm at 2.0 years after surgery; those of the trimmed big toe tip transfers were 3.61 and 6.5 mm at 1.8 years after surgery; and those of the trimmed second toetip transfers were 3.37 and 6.3 mm at 2.6 years after transfer. Those of the distal phalanx of the second toe were 3.41 and 7.9 mm at 1.2 years after surgery, and those of the reduced second toe were 3.2 and 6.7 mm at 10.6 months after surgery.

Adult↗
PubMed2004

A comparison between primary and secondary toe-to-hand transplantation.

Although primary toe-to-hand transplantation is performed with increasing frequency, its use is still controversial because of the lack of any comparative studies documenting its safety and efficacy. Between August of 1990 and December of 1993, 175 consecutive toe-to-hand transplantations for crush and avulsion injuries were performed in 122 patients. The average interval between injury and primary reconstruction was 7 days, and the average interval between injury and secondary reconstruction was 10.7 months. Follow-up ranged from 18 to 91 months, with an average follow-up of 58 months. There were 31 primary transplantations and 144 secondary transplantations. The survival rate was 96.8 percent (30 of 31) for primary reconstruction and 96.5 percent (139 of 144) for secondary reconstruction. Intraoperative anastomotic revision was necessary in 3.2 percent (one of 31) of primary transplantations and 7.6 percent (11 of 144) of secondary transplantations. Three primary toe-to-hand transplantations (9.7 percent) and 17 secondary toe-to-hand transplantations (11.8 percent) were re-explored in the postoperative period. Each group had one superficial infection. The infection rate was 6.5 percent and 0.7 percent in the primary and secondary groups, respectively. Other complications included partial skin loss, which occurred in one patient (3.2 percent) in the primary group and six patients (4.2 percent of 144 transplantations) in the secondary group. Secondary procedures to improve function were necessary in six secondary transplantations (4.2 percent) and in none of the primary transplantations. There was no statistical difference between the two groups in terms of survival, intraoperative anastomotic revision, re-exploration, future secondary procedure, infection, and complications. This series demonstrates that primary toe-to-hand transplantation can be performed in the suitable candidate safely with as much success as secondary reconstruction. Primary toe transplantation can potentially reduce the overall period of recovery and rehabilitation, allowing the patient to return to work sooner. Further study to evaluate and compare the final functional outcome and return to work time between primary and secondary toe-to-hand transplantation is needed.

Adult↗
PubMed2004

A New Surgical Technique for Polysyndactyly of the Toes without Skin Graft.

Reconstruction for polysyndactyly of the toes aims at cosmetic improvement. A previous method that uses a skin graft has inherent disadvantages of mismatched pigmentation between the graft and the surrounding skin and scar formation at the donor site. The authors' new improved surgical technique for the treatment of polysyndactyly of the toes does not require a skin graft and therefore avoids these problems. The authors designed a subcutaneous flap from the distal portion of a rectangular flap of skin from the dorsal side of the interdigital webbing and moved the former flap to the sidewall of the base of a toe. Both flaps are the same size; therefore, an interdigital space had to be of sufficient size to accommodate both of them. To ensure an adequate blood supply to the flap, careful handling of the subcutaneous flap is essential for success. This procedure can apply to polysyndactyly of the fourth, fifth, and sixth toes when the fourth and fifth toes adhere over the distal side of the distal interphalangeal joint and when the skin on the dorsal side of the fifth toe, regarded as the excessive one, is at lease twice the size of the dorsal rectangular flap. Ten patients with polysyndactyly of the toe were treated with this method. Aesthetically good results were obtained.

Child↗
PubMed2005

Simultaneous double second toe transfer for reconstruction of adjacent fingers.

BACKGROUND: The authors reviewed their results with simultaneous double second toe transfer for reconstruction of adjacent fingers. METHODS: From January of 1984 to January of 2003, simultaneous double second toe transfer was performed for reconstruction of adjacent fingers in 140 patients (48 before wound closure, 92 after). Functional thumbs were present in all of them. There were 104 male and 36 female patients, with an average age of 29.1 years (range, 2 to 57 years). Index and middle fingers were reconstructed in 90 patients, middle and ring fingers in 49 patients, and ring and little fingers in one patient. The average operation time was 11 hours 25 minutes, which was much shorter than double the average time of a single second toe transfer (8 hours 31 minutes; double time, 17 hours 2 minutes). Twenty-six toes were reexplored for vascular insufficiency and three of them were lost. Secondary surgery was performed in 98 patients to improve function and cosmesis. RESULTS: Patients were followed up at an average period of 47.5 months (range, 2 to 210 months). Forty-two patients had complete functional evaluation at a minimum 2-year follow-up. The mean active range of motion of the reconstructed finger joints in these patients was 69.4 degrees for metacarpophalangeal joints, 31.1 degrees for proximal interphalangeal joints, and 8.2 degrees for distal interphalangeal joints. Two-point discrimination was between 3 and 13 mm (average, 7.5 mm). All donor sites were closed primarily and no obvious donor-site morbidity was noted, except for one hallux valgus deformity that was corrected by surgery. CONCLUSIONS: The functional and aesthetic results of double second toe transfers for adjacent two-finger reconstruction are superior to those of a single second toe-to-single finger reconstruction in multiple-finger amputations. Double second toe transfer performed simultaneously reduces the cost and total time of the operation, enables faster rehabilitation, and hastens patient adaptation.

Adolescent↗
PubMed1996

Objective method to determine the contribution of the great toe to standing balance and preliminary observations of age-related effects.

The purpose of this study was to examine the relationship between toe pressure and tactile sensitivity in the great toe and to describe two newly developed measurements of postural stability. The subjects of the study were 21 healthy volunteers. The subjects were divided into two age groups, the young group (mean 21.0 +/- 1.6 years, 7 males and 6 females), and the elderly group (mean 71.4 +/- 2.8 years, 4 males and 4 females). The methods and materials used for the first experiment (balance test): The instrument for measuring standing balance was a force plate. Data were analyzed to provide two main variables: 1) body sway index (SI: mm) and 2) toe pressure (%BW/cm2). The subjects were asked to stand in a relaxed posture for 20 s. The variables of body sway were measured in four conditions: normal surface with eyes open or closed, and soft surface with eyes open or closed. Second experiment (tactile sense test): This experiment utilized a new system which was developed for measuring the tactile sensation. The tactile threshold value was measured with the subject seated in a chair, the back supported, and the hips and knees flexed at 90 degrees. The contactor pulled and pushed the toe longitudinally along its axis at a constant velocity of 1 mm/s. There were significant differences between the young and elderly groups in the tactile sense of the great toe (p < .001). No significant difference between age groups was found for postural sway while the subjects stood on the normal surface with eyes open; however, when they stood on the soft surface with their eyes open and closed, the elderly showed significantly more sway (p < 0.01) than the young. Moreover, the maximal great toe pressure in the elderly group was significantly greater than that in the young group. The results suggest that the reduced tactile sense, deprivation of visual information, and toe pressure weakness are all important factors associated with postural instability.

Adult↗
PubMed1996

A new non-invasive method using pulse oximetry for the assessment of arterial toe pressure.

We evaluated a novel, simple non-invasive method to assess systolic arterial toe pressures (ATP). It was employed in 63 subjects, of which 37 had suspected or established lower extremity arterial disease (LEAD) and 26 did not. 48 of the subjects had diabetes and 15 were non-diabetic. Pulsatile toe blood flow was monitored with a regular pulse oximeter (Biox 3700TM, BOC Ohmeda, Helsingborg, Sweden) (POX) with the sensor on the tip of the great toe. A small blood pressure cuff was placed around the proximal part of the toe and was connected to a sphygmomanometer (TycosTM, Levimed AB, Höganäs, Sweden). Systolic pressure was estimated as the cuff pressure at which pulsatile blood flow ceased during cuff inflation. Toe pressure measurement was obtained, in parallel, using the established strain gauge plethysmographic technique. There was a good concordance between the two methods (linear regression: r = 0.93; y = 1.1 x x-6.4; y = pressure obtained with the pulse oximeter, x = pressure obtained with strain gauge, in mmHg). However, patients with very low systolic toe pressures, < 20 mmHg, could not be reproducibly assessed using the POX method. In conclusion, the POX method was found to be a simple and reliable method for the estimation of systolic toe pressures, at least for those above the severely ischemic level. It may provide an easily accessible and cost-effective means of vascular assessment at the bedside, as well as for out-patients.

Adult↗