Great Toe Research Articles

Fibrodysplasia ossificans progressiva: a comprehensive review

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder that causes heterotopic ossification of soft tissues, leading to abnormal bone growth in muscles, tendons, and ligaments. First identified in the 17th century, FOP was classified in 1968 and is linked to a mutation in the Activin A receptor type I gene (ACVR1) which affects bone morphogenetic protein (BMP). The autosomal dominant condition FOP has the potential to lead to aberrant bone development. At birth, FOP individuals appear normal, except for characteristic malformations of the great toes. FOP patients develop painful, inflammatory soft tissue swellings during the first decade of life, often precipitated by soft tissue injury. Minor trauma can trigger new flare-ups and leads to progressive heterotopic ossification. Most FOP sufferers are wheelchair-bound by their third decade and needs lifelong assistance with daily living tasks. Bone morphogenetic proteins (BMPs) are bound by the transmembrane kinase receptor ALK2, which is encoded by the (ACVR1/ALK2 gene). FOPs induce heterotopic bone formation in skeletal muscle and can be caused by mutations in the activin A receptor type I (ACVR1) and activin-like kinase 2 (ALK2) gene. Clinical therapy focuses on preventing and controlling inflammation, with ongoing research focusing on specific therapies targeting receptor activity, aberrant pathways, or cellular components influencing bone neo-formation.

Exceptional Rarity Unveiled: Isolated Fungal Osteomyelitis of Great Toe by Fusarium Solani-Unprecedented Presentation and Exquisite Management Insights

Fungal osteomyelitis is a rare but significant condition, often associated with immunocompromised states or severe systemic illnesses. This condition involves fungal pathogens, primarily Aspergillus, Candida, and Mucor species. Among these, Aspergillus is the most commonly implicated, especially in cases of vertebral osteomyelitis, although fungal infections involving bones like the distal phalanx of the toe are rare. In particular, Fusarium solani, though less frequently reported, has gained recognition for its role in causing localized osteomyelitis in both immunocompetent and immunocompromised patients. A case involving a 57-year-old male with no significant history of immunosuppression is presented. The patient developed localized pain and swelling in the left toe following a minor traumatic injury. Initial radiographic imaging revealed bone erosion, leading to a diagnosis of osteomyelitis. Cultures from bone biopsy identified Fusarium solani as the causative pathogen. This is noteworthy as the fungus, though commonly found in soil, water, and plants, rarely infects bone structures. The patient was treated with a combination of antifungal therapy, including voriconazole and surgical debridement. The rarity of Fusarium solani osteomyelitis and its unusual presentation in an immunocompetent host adds to the complexity of diagnosing fungal infections in osteomyelitis. Treatment typically involves a multidisciplinary approach that combines both medical and surgical interventions. The case highlights the importance of considering fungal pathogens, even in unusual clinical settings, especially when initial treatments fail to provide resolution. Early diagnosis and targeted therapy can improve outcomes, particularly in cases involving uncommon fungal pathogens such as Fusarium solani. This report emphasizes the need for awareness of fungal osteomyelitis in immunocompetent individuals and underscores the critical role of fungal cultures and imaging studies in guiding management.

Correlation Between Functional Ability and Great Toe Flexor Strength in Young Adults

Background: Functional ability refers to the capacity to perform daily tasks efficiently, which relies on maintaining balance and stability. Balance is essential for keeping the body’s center of gravity aligned over a stable base and is supported by the coordination of the vestibular, visual, proprioceptive, and musculoskeletal systems. Factors such as proprioception, muscle strength, and lower extremity range of motion significantly impact functional ability. Toe flexor muscles play a vital role in providing the necessary force for anterior-posterior stability, especially when leaning forward, and contribute to the proprioceptive feedback loop that is essential for maintaining balance. Objective: To find correlation between functional ability and great toe flexor strength in young adults. Methodology: 12 male and female young adults with normal BMI were selected for the study. functional ability was measured using Functional Reach Test, great toe flexor strength was assessed using Pinch Guage Dynamometer. Karl Pearson’s Correlation Coefficient was used for statistical analysis, with a p value < 0.05 considered as significant. Result: Statistically significant strong correlation was found between Functional Reach Test score and great toe flexor strength ( r = 0.887, p=0.035) suggesting that higher the great toe flexion strength higher the functional ability score. Conclusion: This study conluded that an increase in great toe flexor strength is associated With Improved Functional Ability In Young Adults.

Examination of Proprioceptive Reliance During Backward Walking in Individuals With Multiple Sclerosis

Background: Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception’s role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers. Methods: Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure. Results: Significant correlations were seen for vibration sensation and FW comfortable (ρ = 0.35), FW fast (ρ = 0.34), BW comfortable (ρ = 0.46), and BW fast (ρ = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β = 0.57; fast β = 0.58) compared to FW (comfortable β = 0.41; fast β = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation (P = 0.04). Discussion and Conclusions: Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention. Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490).

Comparison of the efficacy of medial tarsal venous flaps and traditional venous/arterial free flaps in the reconstruction of hand soft tissue defects: A new type of physiological flap.

The treatment of hand soft tissue defects primarily relies on flap reconstruction. However, traditional venous/arterial free flaps have several disadvantages, including damage to the donor site, bruising, discoloration, blister formation, and even necrosis. These issues can significantly impact patient recovery and outcomes. Therefore, there is a need for alternative approaches that minimize these complications and improve overall patient care. To compare the efficacy of medial tarsal venous flaps and traditional venous/arterial free flaps in the reconstruction of hand soft tissue defects, evaluating various clinical outcomes and patient recovery metrics. We screened 30 suitable patients with hand soft tissue defects and randomly assigned them to three groups. Patients in each group were transplanted with either medial tarsal free venous flaps or traditional arterial/venous free flaps to achieve coverage and reconstruction of the soft tissue defects. The results were compared and analyzed using the following metrics: operation time, survival rate, complication rate, pain index, postoperative infection rate, and functional evaluations of both the donor and recipient areas. There was no significant difference in operation time between the medial tarsal free venous flaps and the traditional forearm free venous flaps. The operative time for both types of flaps was shorter than that of the traditional free fibular flap from the hallux. The survival rate of the medial tarsal free venous flaps was comparable to that of the fibular free arterial flaps from the great toes and significantly higher than that of the traditional forearm free venous flaps. The complication rate showed an inverse trend to the survival rate of the flaps. In terms of pain, the pain index for the medial tarsal free venous flaps was significantly lower than that of the fibular free arterial flaps from the hallux and comparable to that of the forearm free venous flaps. Regarding postoperative infection rates, the forearm free venous flap had the highest rate, while there was no significant difference between the medial tarsal free venous flaps and the fibular free arterial flaps from the great toes. The functional recovery of the medial tarsal free venous flaps was good in both the donor and recipient areas. There was no poor functional performance in the donor areas of the fibular free arterial flaps from the hallux or the recipient areas of the forearm free venous flaps. The medial tarsal free venous flaps effectively avoid the disadvantages of traditional venous and arterial free flaps, combining their advantages. These flaps offer shorter operative times, higher survival rates, and lower pain indices. They also provide excellent functional recovery in both donor and recipient areas. Thus, medial tarsal free venous flaps represent an ideal solution for reconstructing hand soft tissue defects.

Arthroscopically Assisted Reconstruction of Lateral Metatarsosesamoid Suspensory and Lateral Metatarsophalangeal Collateral Ligaments in the Management of Iatrogenic Hallux Varus Deformity

The medial and lateral metatarsosesamoid suspensory ligaments together with the sesamoid apparatus are the main contributors to the rotational stability of the first metatarsophalangeal joint (MTPJ). Rotational instability of first MTPJ is a major factor in the development of hallux valgus and varus deformities. As the great toe starts to rotate, the muscle pulls across the first MTPJ, causing it to become imbalanced and lead to progressive medial or lateral deviation of the great toe. The gold standard and most reliable option for hallux varus deformity is first MTPJ fusion. However, it results in stiffness and loss of joint function and is reserved for arthritic and stiff first MTPJ. Flexible iatrogenic hallux varus is corrected by optimally anatomic ligament reconstruction. The purpose of this Technical Note is to describe the details of arthroscopically assisted reconstruction of lateral metatarsosesamoid suspensory and lateral metatarsophalangeal collateral ligaments in management of iatrogenic hallux varus deformity. We reconstruct the lateral metatarsosesamoid suspensory ligament to restore the rotational stability of the first MTPJ in hallux varus deformity. This together with reconstruction of the lateral metatarsophalangeal collateral ligament anatomically corrects both the medial deviation and rotation deformity of the great toe.

Endoscopic Resection of Horseshoe Ganglion of the Great Toe

Twelve percent of the foot ganglion cysts occur on the toes, and they are often symptomatic and recurrent. When conservative treatment failed, surgical excision is recommended, which is classically an open resection of the ganglion cyst. However, communicating lesions between ganglion cysts and the interphalangeal joint or tendon sheath make it difficult to prevent a recurrence. Techniques of arthroscopic or endoscopic toe ganglionectomy have been reported, which is either arthroscopic/endoscopic internal drainage to the adjacent joint or tendon sheath or endoscopic resection of the ganglion cyst. Difficulty in identifying the communicating valvular lesion and high incidence of multiloculated lesions make endoscopic internal drainage not always feasible for toe ganglion. The purpose of this Technical Note is to describe the details of endoscopic resection of horseshoe ganglion of the great toe. This minimal invasive approach may help to reduce the risk of recurrence.

Delayed Correction of Intra-articular Lateral Head Fracture of the Proximal Phalanx of the Great Toe in Children.

Conservative treatment of intra-articular lateral head fracture of the proximal phalanx (LHFPP) of the great toe in young children has a high rate of nonunion, leading to hallux valgus interphalangeus (HVIP). This study presents a case series of surgically managed, late-diagnosed LHFPP, highlighting the difficulties of the surgery and presenting satisfactory results. Nine unilateral cases (8 late-diagnosed and 1 acute) were treated by open reduction and Kirchner wire fixation. The average time from trauma to surgery was 2.9 years (range, 0.5-10.1 years) in our late-diagnosed cases. The average age at the time of operation was 9.2 years (range, 3.4-16.3 years). The causes of injury were various. Intraoperative findings were reviewed through medical records and photographs. Pre- and postoperative HVIP angle, American Orthopedic Foot and Ankle Society (AOFAS) score, and range of motion of the interphalangeal joint were measured and compared statistically. Progressive HVIP was a chief complaint in all 8 late-diagnosed cases. Bony fragment size depended on the time elapsed after trauma (fragments increased in size due to ossification of cartilage) with a mean of 23.5% articular involvement. Four cases required bone graft, and union was achieved in all cases. The mean HVIP angle improved from a mean of 17.8° to 10.5°. The average AOFAS score and range of motion were significantly improved after surgery. Although LHFPP is rare and difficult to diagnose, even cases detected long after the initial trauma can be successfully treated, albeit with difficulty. All 9 of our patients had successful outcomes when treated by open reduction and internal fixation.

Evaluating the Effectiveness of Virtual Fracture Clinics in Managing Toe Fractures: Patient Demographics and Outcomes.

Background Virtual fracture clinics (VFCs) offer a remote alternative to traditional fracture clinics, potentially reducing the burden on in-person services. This is particularly relevant for fractures that typically do not require follow-up, such as toe fractures, which are commonly managed conservatively. Methods This study evaluated the effectiveness of VFCs in managing toe fractures. Patients treated conservatively were identified using HIVE software, and their outcomes were assessed via a telephone survey. The survey included the Foot and Ankle Ability Measure (FAAM) and additional questions about their recovery process. Results Among 56 respondents (62.5% male, median age 26.0 years), the majority sustained injuries to the right foot (62.5%), great toe (71.4%), and proximal phalanx (67.9%). Patient satisfaction was high, with 92.9% reporting a positive experience and 98.2% finding the advice provided helpful. Median FAAM scores were 100% across both subscales, with a median recovery time of 6.0 weeks. Despite high satisfaction and favorable clinical outcomes, factors such as female gender and increased age were linked to poorer outcomes. Conclusion VFCs demonstrate high patient satisfaction, positive clinical outcomes, and cost-efficiency, making them a viable alternative to traditional fracture clinics, particularly for conservatively managed fractures. Further research should involve larger sample sizes, prospective study designs, and control groups to validate these findings.

Arthroscopic-assisted uni-portal ligament flavum sparing bone anchoring annular suture technique for lumbar disc herniation: A case report and literature review.

Lumbar disc herniation (LDH) manifests in diverse forms. If the nucleus pulposus or endplate tissues protrudes, the location of annular tears also varies, which poses various challenges for the annular suture technique. Tears at the annular attachment area at the edge of the vertebral body (cephalad or caudad) are considered a prohibitively challenging area for annular suturing. A 37-year-old woman presented with a gradual onset of symptoms, experiencing leg pain and numbness over the left leg for 1 year before presentation. The pain radiated to the left S1 dermatome. Despite undergoing continuous medical therapy for more than 6 months, her symptoms showed no improvement. The strength of the left plantar flexion in the ankle and great toe was rated at 4 out of 5. The straight leg-raising and strengthening tests were positive for the left sides. Lumbar computed tomography and magnetic resonance imaging revealed left-sided disc herniation at the L5-S1 level, and nerve root compression, confirming the diagnosis of LDH. The preoperative impression was LDH, intraoperative confirmation of a tear in the annular attachment area at the vertebral body edge. This patient was treated with an arthroscopic-assisted uniportal spinal surgery (AUSS) technique focusing on ligament flavum (LF) preservation, protruding nucleus pulposus removal, nerve root decompression, and vertebral edge tear was then sutured using a bone anchoring annular suture with the Smile suture device. This technique was performed successfully in a patient with LDH. Significant improvements were observed in postoperative pain and numbness, Visual Analog Scale, and Japanese Orthopaedic Association scores. No postoperative instability or complications were observed, with computed tomography and magnetic resonance imaging confirming complete decompression. To the best of our knowledge, this is the first used AUSS with LF preservation and bone anchoring annular suture technique for LDH. This case study demonstrates the AUSS combined with LF preservation and the bone anchoring annular suture technique provides favorable clinical and imaging outcomes and is a safe and effective technique for the treatment of LDH.

Early effectiveness of modified minimally invasive Chevron-Akin osteotomy for moderate to severe hallux valgus

To explore early effectiveness of modified minimally invasive Chevron-Akin (MICA) osteotomy in the treatment of moderate to severe hallux valgus. A clinical data of 49 patients (61 feet) with moderate to severe hallux valgus, who met the selection criteria between December 2019 and October 2022, was retrospectively analyzed. There were 7 males (8 feet) and 42 females (53 feet) with an average age of 38.0 years (range, 15-59 years), including 37 of unilateral foot and 12 of bilateral feet. There were 41 feet of moderate hallux valgus [hallux valgus angle (HVA) 20°-40°] and 10 feet of severe hallux valgus (HVA>40°). All patients underwent modified MICA osteotomy. A transverse osteotomy on the distal end of the first metatarsal bone was performed to replaced the traditional Chevron osteotomy, and three Kirschner wires were used to assist in three-dimensional correction. The other treatments were the same as traditional MICA osteotomy. The HVA, inter metatarsal angle (IMA), Hardy score of the sesamoid, and American Orthopaedic Foot and Ankle Society (AOFAS) score of 61 feet before operation and at last follow-up were recorded, and the results were compared between the various severity of hallux valgus. All patients were followed up 6-24 months with an average of 12.0 months. After operation, the redness and swelling around the incision occurred in 1 foot; limited mobility of the metatarsophalangeal joint occurred in 2 feet; mild numbness of the skin occurred in 5 feet; mild inversion of the great toe occurred in 2 feet. No complication such as tendon injury was found. X-ray films showed no abnormal healing, nonunion, or necrosis of the metatarsal head after osteotomy. The healing time of osteotomy ranged from 3 to 4 months, with an average of 3.2 months. At last follow-up, the HVA, IMA, Hardy score of sesamoid, and AOFAS scores all significantly improved when compared with preoperative levels ( P<0.05). The AOFAS scores were excellent in 45 feet, good in 15 feet, and fair in 1 foot, with an excellent and good rate of 98.4%. The above indicators for moderate or severe hallux valgus patients were significantly improved when compared with preoperative levels ( P<0.05). The changes between pre- and post-operation in HVA, IMA, and Hardy scores of severe hallux valgus were all greater than those of moderate hallux valgus, with significant difference in HVA change between groups ( P<0.05), while there was no significant difference in the other two changes ( P>0.05). Modified MICA osteotomy can achieve good orthopedic effects and early functional improvement in the treatment of moderate to severe hallux valgus.

The Role of Downsizing of Large-Bore Percutaneous Femoral Access for Pelvic and Lower Limb Perfusion in Transfemoral Branched Endovascular Aortic Repair.

Background: Transfemoral access (TFA) is a valuable alternative to upper extremity access (UEA) for branched endovascular aortic repair (bEVAR). However, TFA requires large introducer sheaths, which can reduce blood flow to lower limbs and the pelvis. This study aimed to evaluate the efficacy of sheath downsizing to maintain lower limb perfusion during TFA-bEVAR. Methods: A single-center retrospective review was conducted including patients managed with TFA-performed bEVAR between December 2020 and May 2021. Intra-operative lower limb perfusion was assessed using non-invasive ankle blood pressure measurements and great toe pulse oximetry, with measurements being taken prior to puncture (baseline), one minute after 10F-sheath insertion, three minutes after the main body delivery system insertion, and three minutes after downsizing to a 14F sheath. Outcomes included the incidence of limb perfusion reduction (LPR), defined as a drop in the ankle-brachial index (ABI) < 0.5 or peripheral oxygen saturation (SpO2) < 90%. Results: Out of 47 patients, 24 met the inclusion criteria. LPR occurred in 4.2% of cases after 10F-sheath placement, and 87.5% after main body delivery system placement, and decreased to 12.6% after downsizing to a 14F sheath. No periprocedural major bleeding occurred. Two patients required revision for inadequate hemostasis post-operatively. SCI occurred in 16% of patients, all recovered by discharge. Pre-operative hypogastric artery occlusion was related to persistent LPR after downsizing (100% vs. 16%, p = 0.009). Conclusions: Downsizing the introducer sheath during bEVAR is feasible and safe to restore lower limb and pelvic perfusion. Further research is needed to clarify the access downsizing value during bEVAR.

Real-time estimation of blood oxygenation parameters from human foot sole during leg elevation: A preliminary study with diffuse reflectance spectroscopy

This study investigated the applicability of diffuse reflectance spectroscopy (DRS) for real-time and non-invasive measurement of blood oxygenation parameters (BOPs) such as reduced hemoglobin (RHb), oxyhemoglobin (HbO2), and oxygen saturation (SO2) from human foot sole during leg elevation. Seventeen (17) healthy male subjects aged between 21 to 39 years were included in this study. Diffuse reflectance spectra were recorded from measurement sites namely the 5th metatarsal, ball of great joint, calcaneum, and great toe of the human foot sole w.r.t. leg elevation angles such as 00, 150, 300, 450, and 600, respectively. The localized BOPs were derived from the recorded spectra. In addition, blood hemodynamic parameters (BHPs) such as heart rate (HR), SO2, perfusion index (PI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were also measured for each elevating angle. To study and assess the changes in BOPs and BHPs w.r.t. leg elevation, a One-way ANOVA test followed by a Tukey HSD post-hoc test was performed. We observed a statistically significant increase in RHb (p < 0.001) and a decrease in HbO2 (p < 0.001) after 45° of leg elevation, however, there was no statistically significant difference in SO2 (p = 0.74) and HR (p = 0.84) for each measurement site w.r.t. leg elevation, respectively. Furthermore, PI (p < 0.01), ankle SBP (p < 0.001) and DBP (p < 0.001) were decreased w.r.t. leg elevation. The obtained results are in agreement with the literature. The preliminary results suggest that DRS has the potential for real-time estimation of BOPs from the local sites of healthy human foot soles during leg elevation. Thus, it opens the possibility of DRS to monitor and evaluate the diagnosis and treatment of ischemia and edema during leg elevation of patients through BOPs measurement.

Establishing a Reference Database for Select Clinical Measures in National Basketball Association Players.

Musculoskeletal injuries are prevalent in the NBA and are associated with a significant number of games missed. There is a lack of reference data for clinical measures in NBA players, making it difficult for sports medicine professionals to set goals and develop programs. Values for clinical measures in NBA players will differ from those of the general population but will not differ between dominant (D) and nondominant (ND) limbs. Descriptive laboratory study. Level 3. Clinical measures were taken on 325 players invited to NBA training camp (2008-2022). Measures included range of motion for great toe extension, hip rotation, weightbearing ankle dorsiflexion, flexibility, arch height (AH) indices, and tibial varum. Clinical values for NBA players differ from reference norms of the general population. Results for NBA players include great toe extension (D, 40.4°; ND, 39.3°), 90/90 hamstring (D, 41.5°; ND, 40.9°), hip internal rotation (D, 29.0°; ND, 28.8°), hip external rotation (D, 29.7°; ND, 30.9°), total hip rotation (D, 60.2°; ND, 60.4°), Ely (D, 109.9°; ND, 108.8°), AH difference (D, 0.5 mm; ND, 0.5 mm), AH index (D, 0.310; ND, 0.307), arch stiffness (D, 0.024; ND, 0.024), arch rigidity (D, 0.924; ND, 0.925), tibial varum (D, 4.6°; ND, 4.5°), and weightbearing ankle dorsiflexion (D, 35.4°; ND, 35.6°). Descriptive statistics are presented; 2-tailed paired t tests show that, whereas most measures demonstrated differences between sides, the results were not statistically significant. Clinical measures of NBA players differ from those reported for the general population and athletes of other sports although there were no statistically significant differences between D and ND limbs. Establishing a reference database may help clinicians develop more sensitive and more effective preseason and return-to-play screening processes, aiding the management of player orthopaedic care and reducing injury risk.

Molecular Developmental Biology of Fibrodysplasia Ossificans Progressiva: Measuring the Giant by Its Toe.

When a genetic disease is characterized by the abnormal activation of normal molecular pathways and cellular events, it is illuminating to critically examine the places and times of these activities both in health and disease. Therefore, because heterotopic ossification (HO) in fibrodysplasia ossificans progressiva (FOP) is by far the disease's most prominent symptom, attention is also directed toward the pathways and processes of bone formation during skeletal development. FOP is recognizable by effects of the causative mutation on skeletal development even before HO manifests, specifically in the malformation of the great toes. This signature skeletal phenotype is the most highly penetrant, but is only one among several skeletal abnormalities associated with FOP. Patients may present clinically with joint malformation and ankylosis, particularly in the cervical spine and costovertebral joints, as well as characteristic facial features and a litany of less common, non-skeletal symptoms, all stemming from missense mutations in the ACVR1 gene. In the same way that studying the genetic cause of HO advanced our understanding of HO initiation and progression, insight into the roles of ACVR1 signaling during tissue development, particularly in the musculoskeletal system, can be gained from examining altered skeletal development in individuals with FOP. This review will detail what is known about the molecular mechanisms of developmental phenotypes in FOP and the early role of ACVR1 in skeletal patterning and growth, as well as highlight how better understanding these processes may serve to advance patient care, assessments of patient outcomes, and the fields of bone and joint biology.

Unusual branch of the saphenous nerve to the sartorius muscle in a female cadaver.

The saphenous nerve is a predominantly sensory nerve. It is the longest nerve of the body which supplies the skin of the medial side of the leg and foot as far as the ball of the great toe. We present here an unusual motor branch of the saphenous nerve to the sartorius muscle. Institutional guidelines for use of human cadaver were followed. Routine dissection of the lower limbs for undergraduate medical teaching was performed in a 67 years old female cadaver employing standard methods. Relevant gross features of the variations were photographed. H&E staining of relevant structure was done and photomicrographed. The unusual motor branch to Sartorius was observed in the right thigh. The branch was given off in the lower third of the thigh after the saphenous nerve exited the adductor canal. The branch was distinctly seen entering the substance of the sartorius. The structure was confirmed to be a peripheral nerve by histological examination. The saphenous nerve then descended between the sartorius and gracilis tendons, pierced the fascia lata and became cutaneous. The motor branch to the sartorius muscle is a very rare branch whose knowledge is important for clinicians as it can get damaged during arthroscopy and other knee surgery or during adductor canal block.

Second Toe-to-thumb Transfer Using Intramedullary Screw Fixation after Traumatic Thumb Amputation.

Loss of the thumb secondary to trauma leads to significant disability due to the digit contributing 40% of overall hand function. Toe-to-thumb transfer has been a well-studied reconstructive method as a means to restore function after thumb amputation. First described in 1969 by Cobbett and colleagues, toe-to-thumb transfers have undergone several modifications in technique to better improve functional and aesthetic outcomes, including toe wrap-around flaps, trimmed great toe transfer, and second toe transfers. Although these methods have allowed patients to retain use of the thumb, traditional interosseous wire reattachment often leads to significant stiffness and need for prolonged rehabilitation to regain maximal function. Intramedullary screw fixation has been increasingly used in phalanx and metacarpal fractures, but its implementation outside of these contexts is not well reported. Here, we present a case of a patient who presented with traumatic thumb amputation and was treated with second toe-to-thumb transfer with intramedullary screw fixation, a novel mode of interosseous rigid fixation in toe-to-hand surgery. Postoperatively, our patient was able to begin mobilizing the new thumb immediately, which allowed for earlier return to work. We believe our technique can be applied to other cases of second toe, as well as great toe, transfers to improve length of recovery and rehabilitation postoperatively.

Characterization of Great Toe Extension Strength Using ToeScale-A Novel Portable Device.

Great toe strength (GTS) weakness is linked to declines in balance and mobility. Accurately assessing GTS, particularly great toe extension strength (GTES), is often neglected in clinical evaluations due to cumbersome and subjective methods. This study aims to characterize the force development curve output from the ToeScale and examine GTES variations with age, sex, BMI, and grip strength (GS) using traditional analyses and machine learning (ML). We conducted a pilot, cross-sectional feasibility study with convenience samples. We assessed GS using a hand-grip dynamometer and GTES using the ToeScale. The data analysis included descriptive statistics, correlations, independent samples t-tests, and accuracy and area under the curve (AUC) scores for three ML models. Thirty-one participants (males: 9; females: 22), 14 young (18-24 years) and 17 older (>65 years) adults, participated in the study. Males had significantly higher peak GTES than females in both age groups. The associations of GTES parameters with BMI and GS varied by age and sex. The ML model accuracies and AUC scores were low-moderate but aligned with traditional analyses. Future studies with larger samples and optimized ML models are needed.

A painful nodule on the right great toe

A painful nodule on the right great toe

Outcomes of Flexor Hallucis Longus Percutaneous Tenotomy for Great Toe Tip Callosity and Ulcers in Patients with Diabetes Mellitus: Cohort Study

Outcomes of Flexor Hallucis Longus Percutaneous Tenotomy for Great Toe Tip Callosity and Ulcers in Patients with Diabetes Mellitus: Cohort Study