Interphalangeal Joint Of Great Toe Research Articles

Comparative Study of Degree of Great Toe Movement after Complete and Partial Flexor Hallucis Longus Harvest in Free Fibula Flap.

Background The flexor hallucis longus (FHL) muscle is crucial in fine motor control of the great toe but the muscle is often sacrificed in free fibula flap (FFF) reconstruction. The aim of this study was to compare great toe movement between complete and partial FHL resection during FFF harvest to see if FHL can be left behind (without undergoing fibrosis) in situ when bulk is not required at the recipient site. Methods A prospective, cross-sectional, observational study was performed including patients undergoing FFF harvest over a 2-year period. Movement of great toe interphalangeal joint was recorded of operated and unoperated legs in patients undergoing partial and complete FHL harvest and data analyzed. Results There was a statistically significant ( p < 0.05) difference between the two groups of patients. Conclusion FHL can be safely left in situ in patients not requiring bulk at the recipient site as blood supply, nerve supply, and muscle function are not compromised in partial FHL harvest. Further image-based and dye-based studies are warranted.

Surface localisation of master knot of Henry, in situ and ex vivo length of flexor hallucis longus tendon: pertinent data for tendon harvesting and transfer.

Length of flexor hallucis longus (FHL), localisation of master knot of Henry (MKH) and relationship between MKH and neurovascular bundle are essential for the achievement of FHL tendon transfer. The purpose of this study is to define the localisation of MKH in reference to bony landmarks of the foot, its relationship to plantar neurovascular bundle and to investigate in situ and ex vivo length of FHL tendon in single incision, double incision and minimally invasive techniques. Foot length was examined in 62 feet of 31 soft cadavers (9 males, 22 females). Various parameters including the relationship between MKH and neurovascular bundle, the distances from MKH to medial malleolus (MM), navicular tuberosity (NT) and the first interphalangeal joint of great toe (IP) were measured. Surface localisation of MKH in relation to a line joining the medial end of plantar flexion crease at the base of great toes (MC) to NT (MC-NT line) was determined. Lengths of FHL tendon graft from three surgical techniques were examined. In situ length was measured in the plantar surface of foot and ex vivo length was measured after tendon was cut from its insertion. The mean length of foot was 230.98 ± 15.35 mm with a statistically significant difference between genders in both sides (p < 0.05). No distance was found between medial plantar neurovascular bundle (MPNVB) and MKH. Mean distance of 17.13 ± 3.55 mm was found between lateral plantar neurovascular bundle (LPNVB) and MKH. MKH was located at a mean distance of 117.11 ± 1.00 mm proximal to IP, 26.28 ± 4.75 mm under NT and 59.58 ± 7.51 mm distal to MM with a statistically significant difference of MKH-IP distance between genders in both sides and MKH-NT in right side. MKH was located anterior to NT (66.1%), at NT (27.4%) and posterior to NT (6.5%) on the MC-NT line. Surface localisation of MKH was 94.75 ± 8.43% of MC-NT line from MC with a perpendicular distance of 25.11 ± 5.37 mm below MC-NT line. The in situ and ex vivo tendon lengths from MTJ to ST, to MKH and to IP were 39.05 ± 10.88 mm and 34.43 ± 10.23 mm, 73.45 ± 9.91 mm and 68.63 ± 9.43 mm, 197.98 ± 13.89 and 191.79 ± 14.00 mm, respectively. A statistically significant difference between genders was found in MTJ-IP of in situ and ex vivo length of both sides (p < 0.05). The mean length of tendon between in situ and ex vivo was significantly different in all techniques (p < 0.05). A moderate positive correlation between foot length and tendon length was found in MTJ-IP of both in situ and ex vivo tendon length. A statistically significant difference between in situ and ex vivo tendon length was shown in all harvesting techniques. Surface location of MKH was approximately at 95% of MC-NT line from MC with a perpendicular distance of 25 mm from MC-NT line.

Acute Calcific Tendinitis of the Forefoot in Young Women- A Presentation of Two Cases

Introduction: Calcific tendinitis is an uncommon presentation in the forefoot with relatively few cases reported in the medical literature. It is commonly overlooked and should form part of a differential diagnosis when assessing patients presenting with acute pain of the forefoot localised to a single joint or tendon. We present two cases of young women involved in amateur running and martial arts respectively who presented with acute pain of their forefoot. Case Description: These 2 cases describe a 44 year old amateur female runner and 23 year old female martial arts athlete who presented with acute onset of pain affecting the dorsal aspect of their great toe interphalangeal joint and base of 1st metatarsal respectively. Both patients had tender erythematous swellings at the site of pain and difficulty weightbearing. Plain radiography revealed areas of calcification at the respective sites which was confirmed with ultrasound. Both patients underwent US guided corticosteroid injections with significant symptom improvement within 48 hours of injections and rapid return to sport. Discussion: These two cases demonstrate an atypical presentation of acute calcific tendinitis affecting the forefoot and add two more cases to the reported literature. Combining the characteristic clinical presentation of acute pain affecting a tendon or joint with a tender erythematous swelling on examination with the typical radiographic features of calcification can promptly diagnose this often misdiagnosed condition and avoid unnecessary investigations. Conservative treatment and intralesional injection with corticosteroids can lead to rapid resolution and favourable patient outcomes.

Irreducible Dislocation of Great Toe Interphalangeal Joint by an Accessory Sesamoid Bone: A Case Report and Review of Literature

ABSTRACT Irreducible dislocation of interphalangeal joint is a rare condition with only a few case reports in literature. Here, we report a case with irreducible dislocation of interphalangeal joint due to sesamoid bone interposition, which required open reduction. A 45-year-old male had a fall from height with irreducible dislocation of interphalangeal joint of great toe. Intraoperatively, the interposition of sesamoid bone over the dorsal aspect of proximal phalanx was identified. Displaced volar plate with sesamoid bone was reduced into the position, and the joint was stabilized with k wire. On follow-up, we observed that the patient had no discomfort or pain for 6 months. The displacement of sesamoid bone with volar plate and intact collateral ligaments locks the joint in extension and obstructs the reduction of interphalangeal joint dislocation. One should have the suspicion of possibility of open reduction after observing the interposition of sesamoid bone over the dorsal aspect of the proximal phalanx. Dorsal approach is usually advocated; medial approach can be used if there is wound over the plantar aspect. How to cite this article Silvampatti S, Rajasekaran S. Irreducible Dislocation of Great Toe Interphalangeal Joint by an Accessory Sesamoid Bone: A Case Report and Review of Literature. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):56-58.

Irreducible dislocation of the great toe interphalangeal joint secondary to an incarcerated sesamoid.

Irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe is rare. We report a case of a 29-year-old gentleman who presented to the Orthopaedic Surgery Specialist Outpatient Clinic with an irreducible IP joint of the great toe that had been untreated for 4 weeks. The mechanism of injury is believed to be a combination of axial loading with a hyperdorsiflexion force when the patient fell foot first into a drain. As the patient did not report severe symptoms and a true lateral radiograph was not ordered, the dislocation was missed initially at the emergency department. The patient had continued to run and play field hockey prior to visiting us. Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later. The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises. The operative course was uneventful. At 6 months after surgery, the patient could walk, run, and return to sports.

Valgus Deformity of the Great Toe Interphalangeal Joint Treated by Reversed Sliding Osteotomy of the Proximal Phalanx: A Case Report

Level of Evidence: V, Expert Opinion

ORTHOSPHERE® interpostitional arthroplasty used in great toe interphalangeal joint arthritis—A case report

We report the first case in which an ORTHOSPHERE(®) spherical ceramic interposition arthroplasty has been used successfully in a patient with complex great toe pathology. The ORTHOSPHERE(®) (Wright Medical Technology, Arlington, TN) is a spherical ceramic interpositional arthroplasty designed for use in CMC joint arthritis. It has also been documented for use in basal fourth and fifth metatarsal arthritis [Shawen SB, Anderson RB, Cohen BE, Hammit MD. Spherical ceramic interpositional arthroplasty for basal fourth and fifth metatarsal arthritis. Foot Ankle Int 2007;28(8):896-901].