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PubMed1990

[Multicentric reticulohistiocytosis (lipoid dermato-arthritis). A radiologic study of 3 cases].

The authors report their experience with 3 cases of multicentric reticulohistiocytosis observed over 6 years of outpatient radiological practice. The condition presents with the following radiological patterns: 1) clear-cut erosions of the articular surfaces, especially in the distal interphalangeal joints of the hands and in the metatarso-phalangeal joints of the feet, with symmetrical distribution (not necessarily); 2) osteolytic punched-out areas in the epiphyseal spongiosa, ranging in size from 1 mm to over 1 cm; 3) no osteoporosis, no osteo-proliferative or periosteal reactions, not even in the presence of large osteoarticular destructions; 4) frequent atlanto-epistropheal subluxation; 5) articular ankylosis at the sacroiliac joints only. The association of the above patterns and the relatively benign clinical course distinguish multicentric reticulohistiocytosis from rheumatoid arthritis, psoriasis arthritis, erosive osteoarthritis, and gout. A reliable diagnosis can be suggested on the basis of radiological findings alone, even before cutaneous or mucosal lesions appear--which are, at any rate, not sure to appear and typical of nails only. An unquestionable diagnosis can be made at histology of synovial and/or cutaneous nodules. Multicentric reticulohistiocytosis is considered an uncommon condition (nearly 100 cases in international literature to 1989); the authors believe it to be commoner though often misdiagnosed as a "variant of rheumatoid arthritis".

Adult↗

PubMed1996

Adaptive control for backward quadrupedal walking VI. metatarsophalangeal joint dynamics and motor patterns of digit muscles.

1. We compared the dynamics of the metatarsophalangeal (MTP) joint of the cat's hind paw and the motor patterns of two short and four long muscles of the digits for two walking forms, forward (FWD) and backward (BWD). Kinematic (angular displacements) data digitized from high-speed ciné film and electromyographic (EMG) data were synchronized and assessed for bouts of treadmill walking. Kinetic data (joint forces) were calculated from kinematic and anthropometric data with the use of inverse-dynamic calculations in which the MTP joint net torque was divided into gravitational, motion-dependent, ground contact (absent for swing), and muscle torque components. Swing-phase kinetics were calculated from treadmill steps and stance-phase kinetics from overground steps in which one hind paw contacted a miniature force platform embedded in the walkway. 2. The plantar angle at the intersection of the metatarsal and phalangeal segmental lines was used to measure MTP angular displacements. During swing for both walking forms, the MTP joint flexed (F) and then extended (E); however, the F-E transition occurred at the onset of FWD swing and at the end of BWD swing. For FWD walking, the MTP joint extended at a constant velocity during most of stance as the cat's weight rotated forward over the paw. During the unweighting phase at the end of stance, the MTP joint flexed rapidly before paw lift off. For BWD walking, the MTP joint extended briefly at stance onset (similar to a yield) and then flexed at a constant velocity as the cat's weight rotated backward over the paw. At the end of stance, the MTP joint extended and then flexed slightly as the paw was unweighted before paw lift off. 3. For both forms of walking, three of the six muscles tested were recruited just before paw contact and remained active for most (75-80%) of stance for both walking forms: plantaris (PLT), flexor hallucis longus (FHL), and flexor digitorum brevis (FDB). Their recruitment contributed to the flexor muscle torque at the MTP joint during most of FWD and BWD stance and was responsible for the absorption of mechanical power at the MTP joint for FWD stance and generation of mechanical power at the MTP joint during BWD stance. Also, the FHL and PLT, along with the soleus (SOL; also recorded in this study), contributed to an extensor muscle torque (described in paper IV of this series) and the generation of mechanical power at the ankle joint during stance of FWD and BWD walking. 4. The timing of activity for three muscles recruited during FWD swing was distinct for the two walking forms. The hallmark burst of the flexor digitorum longus (FDL)--a single burst, brief in duration and high in amplitude--occurred at the end of FWD swing (as the toes flexed rapidly) but shifted to the onset of BWD stance (as the claws protruded and toes extended) during paw weighting. The extensor digitorum longus (EDL) was recruited after paw off and was active for most of FWD swing; its activity contributed to an extensor muscle torque at the MTP joint and a flexor muscle torque at the ankle joint. For BWD walking, EDL recruitment shifted to an earlier phase in the step cycle and coincided with toe extension, which occurred at the end of stance before paw lift off. This pre-lift off activity continued into the first part of swing and contributed to an extensor muscle torque at the MTP joint and a flexor muscle torque at the ankle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗

PubMed2005

Ectopic dermal ridge configurations on the interdigital webbings of Hammertoe mutant mice (Hm): another possible role of programmed cell death in limb development.

BACKGROUND: The mechanism underlying the development of aberrant phalangeal pads and dermal ridge configurations in malformed limbs is not well understood. The forelimbs of Hammertoe (Hm) mutant mouse fetuses were examined sequentially to clarify the relationship between the occurrence of abnormal programmed cell death (PCD) and the formation of phalangeal pads and dermal ridge patterns. METHODS: Relevant morphological features, with special emphasis on pads and dermal ridge configurations, were inspected on the exposed dermal surface of the forelimbs of adult Hm mutant mice. The forelimbs of Hm mutant mouse fetuses (GD13-18) and newborns were examined histologically. The forelimbs of GD13 fetuses were subjected to Nile blue (NB) vital staining for in situ labeling of PCD. RESULTS: In the forelimbs of +/+ mice, the formation of dermal ridges was confined to pads, while in Hm/+ and Hm/Hm animals, which have interdigital webbing involving digits II-V, dermal ridges were formed also on the ventral side of the webbing, specifically on its lateral margins between the neighboring digits and on the medial margin of the webbing extending toward the palmar pad. PCD was decreased in the interdigital zones II-IV in GD13 Hm/+ and Hm/Hm fetuses. CONCLUSIONS: Reduced PCD interdigital tissue of Hm/+ and Hm/Hm fetuses may result in the failure of physiological elimination of interdigital cells and in the persistence of soft tissue webbing between digits. The failure of PCD to occur may also interrupt the interdigital surviving cells to reach the neighboring digits and the distal area of the palm, thereby producing ectopic dermal ridges. It seems that interdigital PCD contributes not only to digit separation but also to the development of digital and palmar pads.

Animals↗

PubMed1997

Ewing's sarcoma of the foot.

The results of treatment were reviewed in 16 patients (10 male and six female) who had Ewing's sarcoma of the foot from 1954 through 1992. Mean age was 17 years (range, 10-42 years). The tumor involved the metatarsals (six patients), phalanges (four), calcaneus (three), navicular (one), talus (one), and calcaneus and phalanx (one). Seven patients had metastatic disease at the time of diagnosis, and only one of these patients survived. None of the patients with pulmonary metastasis at presentation survived. Nine patients had localized disease at the time of diagnosis, and eight survived. In the overall series, nine of the 16 patients were alive at followup (eight survived at least 5 years). Diagnosis was established at an average of 14 months from the onset of symptoms: 7 months in forefoot tumors and 22 months in hindfoot tumors. None of the six patients who had a resection had local failure. Seven of the 10 patients with forefoot lesions survived, and two of the six patients with hindfoot lesions survived. Treatment of Ewing's sarcoma of the foot by local control with radiation or operation and systemic control with chemotherapy is recommended. Survival appears to be better in patients who present with localized disease and forefoot lesions. Survival is worse in patients who present with metastatic disease. Surgical treatment appears to have an important role in local control and survival.

Adolescent↗

PubMed2005

The association of radiographic foot osteoarthritis and radiographic osteoarthritis at other sites.

OBJECTIVE: To quantify the association between radiographic foot osteoarthritis (OA) and radiographic OA at four joints: second distal interphalangeal (DIP), third proximal interphalangeal (PIP), first carpometacarpal (CMC), and the knee. METHODS: Data collected for the Clearwater Osteoarthritis Study (COS) were analyzed (N=3436). The study outcome was first metatarso-phalangeal joint (first MTP) OA status. The predictor variables were second DIP, third PIP, first CMC, and knee OA. The Kellgren and Lawrence scale determined OA status. The strength of the association between foot OA and other sites was further explored by unilateral and bilateral categories. RESULTS: For both genders, we found a significant, positive relationship between grade 2+ foot OA and second DIP, third PIP, first CMC, and knee OA. This relationship maintained its significance after adjustment for age, body mass index, and occupational history. Adjusted odds ratios ranged from 3.2 for the second DIP joint (P<0.0001) to 3.7 for the knee joint (P<0.0001). Relative to unilateral joint disease, co-existing bilateral disease yielded a significantly elevated risk for foot OA for all joints examined. While other studies have not specifically examined co-occurrence with foot OA, our findings are consistent with results from related studies. CONCLUSIONS: There is a dearth of studies exploring foot OA. Our findings support the theory of a systemic etiology involved in the development of OA. Future epidemiological studies that further distinguish the relationship between OA at differing sites will provide an enhanced ability to describe the respective influences of mechanical and systemic factors in the development of this disease.

Adult↗

PubMed1996

Claw retraction and protraction in the Carnivora: skeletal microvariation in the phalanges of the Felidae.

All carnivorans retract and protract their claws. In felids and some viverrids the claws of digits II through V of both the manus and pes have a larger arc of rotation than those of other carnivorans; the claws retract to the lateral side of the middle phalanx rather than onto its dorsal surface as in most other carnivorans. This condition should be termed hyper-retraction. Morphological features of the middle and distal (ungual) phalanges that have been purported to be necessary for hyper-retraction in felids vary considerably among digits within the manus and pes. These features include the lateral projection of the distal head and the asymmetry of the shaft of the middle phalanx, and the oblique orientation of the articular surface on the distal phalanx. None of these features is necessary in every instance for hyper-retraction, and some of the variation in these features is associated instead with protraction. Differences among digits in the orientation of the articular surface on the distal phalanx are associated with differences in the degree to which the claws must move laterally to rotate from the protracted to the retracted position. Differences in the orientation of the distal head on the middle phalanx are associated with the spreading of the claws during protraction. The manual claws are hook-shaped, whereas the pedal claws are more blade-like; this morphological difference is associated with differences in function between the manus and pes. In the manus the medial claws have a larger radius of curvature and a smaller angle of arc as compared to the more lateral claws; in the pes, the claws on digits III and IV have larger radii of curvature and smaller angles of arc. Digit I of the manus lacks the hyper-retraction mechanism; nonetheless, this digit shares many of the attributes that are associated with this mechanism.

Animals↗

PubMed2005

Heel bulb lacerations in horses: 101 cases (1988-1994).

OBJECTIVE: To determine clinical history, structures involved, treatment, and outcome of lacerations of the heel bulb and proximal phalangeal region (pastern) in horses. DESIGN: Retrospective study. ANIMALS: 101 horses. PROCEDURES: Medical records of horses with lacerations of the heel bulb and pastern were reviewed, and follow-up information was obtained. RESULTS: 75 horses were Quarter Horses. Most horses were not treated with antimicrobial drugs prior to referral. Mean +/- SD time from injury to referral was 24 +/- 45 hours (range, 1 to 168 hours). Lacerations were most frequently caused by contact with wire or metal objects. In 17 horses, lacerations involved synovial structures; the distal interphalangeal joint was most commonly affected. One horse was euthanatized after initial examination. Wound treatment consisted of cleansing, lavage, debridement, lavage of affected synovial structures, suturing of fresh wounds, and application of a foot bandage or cast. Fifty-six horses were treated with systemically administered antimicrobial drugs. Follow-up information was collected for 61 horses. Fifty-one horses returned to their intended use and had no further complications; 10 horses had complications associated with the wound, and of those horses, 5 were euthanatized and 1 horse died from an unrelated cause. Horses with lacerations that involved synovial structures had worse outcomes than horses with lacerations that did not involve synovial structures. CONCLUSIONS AND CLINICAL RELEVANCE: Horses that sustain heel bulb lacerations can successfully return to their intended use. Involvement of the distal interphalangeal joint is associated with poor prognosis.

Animals↗

PubMed2007

Two novel point mutations in the long-range SHH enhancer in three families with triphalangeal thumb and preaxial polydactyly.

Spatio-temporal expression of sonic hedgehog (SHH) is driven by a regulatory element (ZRS) that lies 1 Mb upstream from SHH. Point mutations within the highly conserved ZRS have been described in the hemimelic extra toes mouse and in four families with preaxial polydactyly [Lettice et al., 2003]. Four North American Caucasian families were identified with autosomal dominant triphalangeal thumb. DNA from 20 affected and 36 unaffected family members was evaluated by sequence analysis of a 774-bp highly conserved ZRS contained within LMBR1 intron 5. Mutations within ZRS were identified in three of four families. In pedigree A and C, a novel A/G transition was identified near the 5' end of ZRS at bp 739 that segregated with disease or carrier status. Pedigree A, described previously [Dobbs et al., 2000], is a large family with 19 affected members who exhibit a milder phenotype, including predominantly triphalangeal thumbs and low penetrance (82%) relative to other families. Pedigree C is a small family with two affected family members with triphalangeal thumb, and one affected with both triphalangeal thumb and preaxial polydactyly. A novel C/G mutation at bp 621 was identified in pedigree B that segregated with the disease in all four affected individuals who manifested both preaxial polydactyly and triphalangeal thumb. Both mutations alter putative Cdx transcription factor binding sites. Mutations within ZRS appear to be a common cause of familial triphalangeal thumb and preaxial polydactyly. A genotype/phenotype correlate is suggested by pedigree A, whose mutation lies near the 5' end of ZRS; this family demonstrates a higher rate of nonpenetrance and milder phenotype. However, modifier genes may be contributing to the milder phenotype in this family.

Base Pairing↗

PubMedDate not supplied

Three-dimensional kinematics of the equine interphalangeal joints: articular impact of asymmetric bearing.

The objective of this study was to assess the effects of asymmetric placement of the foot on the three-dimensional motions of the interphalangeal joints. Four isolated forelimbs were used. Trihedrons, made of three axes fitted with reflective markers, were screwed into each phalanx. They allowed to establish a local frame associated with each bone and thus to define the spatial orientation of the phalanges. The limbs were then placed under a power press, and subjected to compression with gradually increasing force (from 500 to 6 000 N). The procedure was performed in neutral position and with the lateral or medial part of the foot raised by a 12 degrees wedge. Flexion, collateromotion (passive abduction/adduction) and axial rotation of the interphalangeal joints were measured using a cardan angle decomposition according to the principle of the "Joint Coordinate System" described by Grood and Suntay. Raising the lateral or medial part of the hoof induced collateromotion (about 5.6 degrees +/- 0.8) and axial rotation (about 6.5 degrees +/- 0.5) of the distal interphalangeal joint. The proximal interphalangeal joint underwent axial rotation (about 4.7 degrees +/- 0.5 at 6 000 N) and slight collateromotion. Both interphalangeal joints underwent collateromotion in the direction of the raised part of the foot (i.e., narrowing of the articular space on the side of the wedge), whereas axial rotation occurred in the direction opposite to the raised part of the foot. These results confirm the functional importance of interphalangeal joint movements outside the sagittal plane. In particular they demonstrate the involvement of the proximal interphalangeal joint in the digital balance. These data are helpful for the identification of biomechanical factors that may predispose to interphalangeal joint injury. Also the data may be of use for the rational decision making with respect to exercise management and corrective shoeing of the lame horse.

Animals↗

PubMed2006

Use of transfixation pin casts to treat adult horses with comminuted phalangeal fractures: 20 cases (1993-2003).

OBJECTIVE: To determine the clinical applications, short and long-term survival, and complications of using transfixation pin casts for treatment of comminuted phalangeal fractures in adult horses. DESIGN: Retrospective case series. ANIMALS: 20 horses. PROCEDURES: Medical records were reviewed to obtain information regarding signalment, fracture location, treatment methods, complications, and short-term survival (discharge from hospital). Long-term follow-up information was obtained via contact with owners or trainers. RESULTS: 12 fractures were in a hind limb, and 8 were in a forelimb. Fourteen fractures occurred in a middle phalanx, and 6 occurred in a proximal phalanx. Eleven fractures were treated with internal fixation combined with transfixation pin casts, and 9 fractures were treated with transfixation pin casts alone. Transfixation pin casts were maintained for a mean of 52 days (median, 49 days; range, 1 to 131 days). Fourteen (70%) horses were discharged from the hospital, whereas 6 (30%) were euthanized during the treatment period. Reasons for euthanasia included secondary fracture of the third metacarpal or metatarsal bone, avascularity of the distal aspect of the limb associated with an open fracture, and displacement of the fracture after transfixation pin cast removal. A significantly greater number of horses was discharged from the hospital when the transfixation pin cast was maintained for > 40 days, compared with those in which the transfixation pin cast was maintained for < 40 days. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that horses should be maintained in a transfixation pin cast for a minimum of 40 days, as this was associated with an increase in short-term survival without an increased risk of catastrophic failure.

Animals↗

PubMed1993

Phalangeal regrowth in rodents: postamputational bone regrowth depends upon the level of amputation.

Conflicting reports of distal phalangeal regrowth prompted a reexamination of bone growth following phalangeal amputation in mammals. Digits of neonatal and adult mice and rats were amputated at various levels. The short-term response was examined on histological sections, and long-term growth was documented by alizarin red-staining of KOH-digested digits. Three patterns of response were seen to correspond to three general levels of amputation. Complete bone regeneration occurred frequently by five weeks following amputation through the distal one-quarter of the distal phalanx. Amputation through the central region of the distal phalanx yielded substantial bone growth, but the form of the regrowth was imperfect even three months after amputation. Amputation through more proximal levels of the digit yielded no significant elongation. To investigate why the response varies in relation to the level of amputation, we are conducting both in vivo and in vitro experiments. We have learned that simple avulsion of the nail plate provokes substantial remodeling of the distal phalanx. We are further exploring the trophic influence of nail organ on bone structure and growth in vivo. We have also recently determined that entire digits may be kept alive in vitro when cultured in DMEM:F-12:BGJb medium supplemented with insulin, EGF and FGF. This system sufficiently replicates in vivo conditions such that osteogenesis occurs both endosteally and distal to the amputation plane in vitro. The effects of growth factors, retinoic acid, and the presence or absence of nail organ components on amputational bone growth at all three levels are currently being studied in vitro. The goal of these studies is to determine why bone fails to grow, undergoes hyperplasia, or regenerates following amputation at different levels in mammals.

Amputation, Surgical↗