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Orthopaedics & Traumatology, Surgery &... Feb 2023Lesser-toe deformity is frequent and varied, with severe functional impact. In elderly subjects, it leads to loss of autonomy and increases the risk of falls. The aim of... (Review)
Review
Lesser-toe deformity is frequent and varied, with severe functional impact. In elderly subjects, it leads to loss of autonomy and increases the risk of falls. The aim of the present study was to provide an update on management, addressing 5 questions. What are the normal anatomy and pathophysiology? These acquired deformities mainly result from imbalance between the intrinsic and extrinsic muscles of the foot or from capsule-ligament stabilizer failure. How to analyze the deformity? It is important to identify the cause, site, reducibility and metatarsophalangeal joint stability. What are the main deformities and how should they be classified? Classifications used to be based on confusing terminology as the deformities were poorly defined. The French Foot Surgery Association (AFCP) therefore validated a classification with standardized, exhaustive and reproducible morphologic descriptions. What treatments are there? Treatment needs to take account of the cause. Footwear adaptation, physiotherapy and podologic measures are in first line, with surgery in second line. Surgery concerns soft tissues (tendon lengthening, tendon transfer, arthrolysis, plantar plate repair), bone (metatarsal and phalangeal osteotomy) and joints (replacement and fusion), with percutaneous and open approaches. What are the treatment strategies? Surgery is performed sequentially, from proximal to distal, if necessary. Options are set out in the decision-trees included in this article. LEVEL OF EVIDENCE: V, expert opinion.
Topics: Humans; Aged; Foot Deformities; Metatarsophalangeal Joint; Toes; Foot; Tendon Transfer
PubMed: 36942795
DOI: 10.1016/j.otsr.2022.103464 -
Journal of Foot and Ankle Research Dec 2020Adequate footwear fit is critical in preventing diabetes-related foot ulcers. One important element is the toe gap, the difference between foot length and internal... (Review)
Review
BACKGROUND
Adequate footwear fit is critical in preventing diabetes-related foot ulcers. One important element is the toe gap, the difference between foot length and internal footwear length available to the foot. We summarised the literature on toe gaps in studies assessing footwear worn by people with diabetes, the methods used to measure both foot length and internal footwear length and identify ambiguities which may impact on toe gap assessment in clinical practice, and suggest pragmatic solutions.
METHODS
The Google Scholar database was searched to April 2020 for peer-reviewed studies using keywords related to incorrectly fitting or ill-fitting and diabetes, foot and ulcer which returned 979 results. Included studies within this narrative review encompassed toe gap measurement to assess footwear worn by people with diabetes.
RESULTS
A total of eight studies were included after full paper review. Toe gap ranges as used in assessments of footwear worn by people with diabetes vary, with a minimum of 1.0-1.6 cm and a maximum of 1.5-2.0 cm, as do methods of measuring internal footwear length. Only three published studies suggested possible measuring devices.
CONCLUSIONS
Toe gap ranged as used when assessing footwear fit in people with diabetes vary and a gold standard device for internal footwear length measurement has yet to emerge. International guidelines provide welcome standardisation, but further research is needed to evaluate both the effect of toe gap ranges upon pressure, plantar stress response and ulceration and available measuring devices to facilitate development of toe gap measurement protocols that may further enhance consistency in practical assessments.
Topics: Adult; Aged; Anthropometry; Diabetes Mellitus; Diabetic Foot; Female; Foot; Humans; Male; Middle Aged; Shoes; Toes
PubMed: 33276804
DOI: 10.1186/s13047-020-00439-3 -
Journal of Plastic, Reconstructive &... Nov 2022Foot injuries due to vehicular or other accidents are common. However, complete toe amputation is rare. This study explored the current protocols and clinical... (Review)
Review
BACKGROUND
Foot injuries due to vehicular or other accidents are common. However, complete toe amputation is rare. This study explored the current protocols and clinical significance of toe replantation.
METHODS
From December 2011 to December 2018, ten patients with 13 severed toes underwent toe replantation in our hospital. Seven cases were replanted antegrade, and three cases were replanted retrograde.
RESULTS
All patients were followed for two to three years after toe replantation. One big toe underwent necrosis, while the other 12 toes survived completely. The appearance and feel of the successfully replanted toes were satisfactory, and the patients exhibited a normal gait.
CONCLUSION
Toe replantation can achieve an acceptable appearance and function of the foot and considerably reduce the psychological effects experienced by the patients. Increased clinical attention and application of toe replantation are needed.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
Topics: Humans; Amputation, Traumatic; Retrospective Studies; Replantation; Toes; Hallux; Microsurgery; Finger Injuries
PubMed: 36207234
DOI: 10.1016/j.bjps.2022.08.050 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Sep 2020To review the research progress of interphalangeal arthrodesis in the treatment of interphalangeal joint deformity. (Review)
Review
OBJECTIVE
To review the research progress of interphalangeal arthrodesis in the treatment of interphalangeal joint deformity.
METHODS
The literature about interphalangeal arthrodesis at home and abroad was extensively consulted, and the indications, fusion methods, fixation methods, complications, and so on were summarized and analysed.
RESULTS
The indications of interphalangeal arthrodesis are hammer toe, claw toe, and mallet toe. From the different forms of fusion surface, fusion methods include end-to-end, peg-in-hole, conical reamer type, and V-shape arthrodesis. There are three kinds of fixation methods: Kirschner wire fixation, stainless-steel wire suture fixation, and intramedullary fixation, and there are many kinds of intramedullary fixation. The complications of interphalangeal arthrodesis include vascular injury, fixation related complications, and postoperative complications.
CONCLUSION
Interphalangeal arthrodesis is a good way to correct some deformities of toes, but the incidence of various complications can not be ignored, and there is still a lack of clinical research on interphalangeal arthrodesis.
Topics: Arthrodesis; Bone Wires; Hammer Toe Syndrome; Humans; Toe Joint; Toes
PubMed: 32929916
DOI: 10.7507/1002-1892.201910093 -
Indian Journal of Dermatology,... 2023
Topics: Humans; Tennis; Toes
PubMed: 36688895
DOI: 10.25259/IJDVL_652_2022 -
Deutsches Arzteblatt International Sep 2018
Topics: Calciphylaxis; Diabetes Mellitus, Type 2; Fingers; Humans; Kidney Failure, Chronic; Male; Middle Aged; Necrosis; Toes
PubMed: 30375326
DOI: 10.3238/arztebl.2018.0645 -
Journal of Orthopaedic Surgery and... Dec 2020The relationship of metatarsalgia and toe function is poorly understood. We investigated the efficacy of toe exercises for the treatment of metatarsalgia.
BACKGROUND
The relationship of metatarsalgia and toe function is poorly understood. We investigated the efficacy of toe exercises for the treatment of metatarsalgia.
METHODS
Forty-one (56 feet) metatarsalgia patients (mean age ± SD: 63.4 ± 10.6) underwent toe strength measurement. We recorded pre- and post-treatment VAS score, AOFAS score, marble pickup, single-leg standing time (SLST), and compared in two subgroups to evaluate impact of disease duration on treatment outcome.
RESULTS
Post treatment, toe plantarflexion strength improved (all p < 0.01); VAS scores decreased (p < 0.01); AOFAS scores, marble pickup, and SLST improved (all p < 0.01). Patients symptomatic for > 1 year had significantly lower changes in VAS scores (p < 0.01). Multivariate analysis showed patients with longer disease duration, and larger body mass index had significantly lower improvement in VAS scores (p = 0.029 and p = 0.036, respectively). Device consistency assessed by ICC was excellent (0.89-0.97).
CONCLUSION
Toe function and metatarsalgia are improved by toe exercises, suggesting that they are closely related.
Topics: Aged; Body Mass Index; Conservative Treatment; Exercise Therapy; Female; Humans; Male; Metatarsalgia; Middle Aged; Muscle Strength; Toes; Treatment Outcome
PubMed: 33267902
DOI: 10.1186/s13018-020-02113-7 -
Bioinspiration & Biomimetics Oct 2018During typical human walking, the metatarsophalangeal joints undergo extension/flexion, which we term toe joint articulation. This toe joint articulation impacts...
During typical human walking, the metatarsophalangeal joints undergo extension/flexion, which we term toe joint articulation. This toe joint articulation impacts locomotor performance, as evidenced by prior studies on prostheses, footwear, sports and humanoid robots. However, a knowledge gap exists in our understanding of how individual toe properties (e.g. shape, joint stiffness) affect bipedal locomotion. To address this gap, we designed and built a pair of adjustable foot prostheses that enabled us to independently vary different toe properties, across a broad range of physiological and non-physiological values. We then characterized the effects of varying toe joint stiffness across a range of different ankle joint stiffness conditions, and the effects of varying toe shape on walking biomechanics. Ten able-bodied individuals walked on a treadmill with prostheses mounted bilaterally underneath simulator boots (which immobilized their biological ankles). We collected motion capture and ground reaction force data, then computed joint kinematics and kinetics, and center-of-mass (COM) power and work. To our surprise, we found that varying toe joint stiffness affected COM Push-off dynamics during walking as much as, or in some cases even more than, varying ankle joint stiffness. Increasing toe joint stiffness increased COM Push-off work by up to 48% (6 J), and prosthetic anklefoot Push-off work by up to 181% (12 J). In contrast, large changes in toe shape had little effect on gait. This study brings attention to the toes, an aspect of prosthetic and robotic foot design that is often overlooked or overshadowed by design of the ankle. Optimizing toe joint stiffness in assistive and robotic devices (e.g. prostheses, exoskeletons, robot feet) may provide a complementary means of enhancing Push-off or other aspects of locomotor performance, in conjunction with the more conventional approach of augmenting ankle dynamics. Future studies are needed to isolate the effects of additional toe properties (e.g. toe length).
Topics: Artificial Limbs; Biomechanical Phenomena; Gait; Humans; Locomotion; Mechanical Phenomena; Prosthesis Design; Robotics; Toe Joint; Toes; Walking
PubMed: 30187893
DOI: 10.1088/1748-3190/aadf46 -
The Journal of Thoracic and... Mar 2022
Topics: Humans; Toes
PubMed: 32868049
DOI: 10.1016/j.jtcvs.2020.05.065 -
Hand (New York, N.Y.) Nov 2022Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ... (Review)
Review
Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ but is limited by equivocal functional outcomes. This systematic review aims to provide an update on vascularized toe-to-finger PIPJ transfers, examining functional outcomes, complications, and the latest refinements in operative technique. A systematic review of the available literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining vascularized toe-to-finger PIPJ transfer for post-traumatic indications were included for analysis. Outcomes assessed included postoperative active range of motion, extension lag, and complications. Thirteen studies examining 210 VJTs were analyzed. Five VJTs experienced microsurgical failure giving an overall survival rate of 97.6%. Average postoperative PIPJ active range of motion (ROM) was 40.3° ± 12.9°, with an average extensor lag of 29° ± 10.5° and mean flexion of 68.9° ± 10.9°. For studies reporting complication outcomes, 59/162 complications were seen. No significant differences were seen between studies published prior to 2013 and after 2013 when comparing digital ROM ( = .123), flexion ( = .602), and extensor lag ( = .280). Studies using a reconstructive algorithm based on prior assessment of the donor toe central slip and recipient finger anatomy had significantly improved ROM outcomes ( = .013). Although VJT provides a reliable option for autologous reconstruction in posttraumatic joints, it is limited by impaired postoperative ROM. Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes.
Topics: Humans; Toe Joint; Finger Joint; Fingers; Range of Motion, Articular; Toes
PubMed: 33511878
DOI: 10.1177/1558944720988081