PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Toe Joint”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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

At least 793 records · Page 44Linked to original sources
PubMed2006

Flexor hallucis longus tendon transfer for hallux claw toe deformity and vertical instability of the metatarsophalangeal joint.

BACKGROUND: Historically, operative treatment of hallux claw toe deformity has been the Jones procedure or one of its modifications. Review of the literature confirms its ability to maintain alignment and achieve patient satisfaction; however, several complications have been reported. Many of these are related to altered biomechanics across the metatarsophalangeal (MTP) joint. A similar approach to this clinical problem involves restoration of the flexion moment across the MTP joint without an interphalangeal (IP) joint arthrodesis. METHODS: We conducted a retrospective review of 10 patients who had a flexor hallucis longus (FHL) tendon transfer to the proximal phalanx of the great toe for hallux claw toe deformity, as well as for symptomatic vertical instability. Four patients had a positive drawer test indicating vertical instability without static deformity. Two patients with vertical instability were found to have a dynamic deformity. Mean followup was 24 (SD 15.2) months. RESULTS: All deformities were corrected and alignment was maintained at the time of followup. Pain under the first metatarsal head was reliably improved in symptomatic patients (p < 0.05). Patient satisfaction also was assessed. All six patients treated for hallux claw deformity were satisfied with their outcomes. Two of the four patients treated for vertical instability were satisfied. The other two patients expressed dissatisfaction because of persistent pain that occurred during strenuous exercise. Their symptoms during routine activity were improved, however. CONCLUSION: Based on initial results, the FHL transfer to the proximal phalanx appears to be a viable treatment option for hallux claw deformity in terms of deformity correction, pain relief, and patient satisfaction. Further evaluation is warranted regarding the indication of vertical instability.

Adolescent↗
PubMed1994

Irreducible proximal interphalangeal dislocation of the fourth toe: a case report.

Dislocation of the interphalangeal joints of the lesser toes is an uncommon injury, and complex (irreducible) dislocation has rarely been reported. All previous reports note that, during open reduction, the volar plate is interposed within the joint, thereby blocking reduction. In this case, the medial collateral ligament was the primary obstruction to reduction. Clinically, these dislocations are difficult to appreciate. It is recommended that x-ray studies be performed so that this diagnosis is not overlooked.

Child↗
PubMedDate not supplied

Proximal interphalangeal joint arthrodesis in 34 horses using two parallel 5.5-mm cortical bone screws.

OBJECTIVE: To report clinical experience with arthrodesis of the proximal interphalangeal joint in horses using two parallel 5.5-mm cortical bone screws placed in lag fashion. STUDY DESIGN: Retrospective, clinical study. ANIMALS: Thirty-four horses, aged 1 to 19 years. METHODS: Medical records for all horses admitted (1991-1997) for pastern arthrodesis using two 5.5-mm ASIF cortical bone screws, in parallel orientation, and placed in lag fashion by use of a combined aiming device to facilitate accuracy were reviewed. Signalment, lameness diagnosis, duration of lameness, limb(s) involved, and outcome were recorded. Criteria for successful outcome were determined as return to previous level of function or future intended athletic use. RESULTS: Thirty-nine proximal interphalangeal joint arthrodeses were performed on 34 horses. One horse was euthanatized in the recovery room and was excluded from data analysis. Successful outcome occurred in 85% of frontlimbs and 89% of hindlimbs. Failure occurred in 5 joints; 1 horse had lameness directly associated with surgery, whereas 4 horses had unrelated lameness. CONCLUSION AND CLINICAL RELEVANCE: Age, breed, and initial disease did not affect outcome. Arthrodesis of the proximal interphalangeal joint by use of two 5.5-mm ASIF cortical bone screws, in parallel orientation, placed in lag fashion by use of a combined aiming device, resulted in sound use of the limb in >85% of the joints with shortened postoperative coaptation.

Animals↗
PubMed2006

Safety of intra-articular injection of etanercept in small-joint arthritis: an uncontrolled, pilot-study with independent imaging assessment.

This study was conducted to test the safety of intra-articular tumor necrosis factor alpha (TNF-alpha) antagonists in small joints with arthritis. A dose of 2-8 mg etanercept was given intra-articularly guided by ultrasonography (US) in 26 patients with a flare of arthritis in a particular joint (16 wrists, two elbows, two ankles, six finger joints). Primary end points were imaging analyses by independent investigators: US-Doppler measurements were performed in all patients before and after the injection and MRI before and after were obtained in nine patients. The only adverse event was a case of swelling of the hand lasting 2 days after a wrist injection. Two patients had a supplementary glucocorticoid injection and were excluded from efficacy analysis after 4 days and 3 weeks, respectively. VAS for pain decreased after 1 week in 23 of 25 patients (median 0.62), and after 1 month in 14 of 24 patients (median 0.60). No significant changes were seen in erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). On MRI, all nine cases tested had a reduction in synovial thickness (P=0.008) and US Doppler signals diminished after treatment (resistance index (RI) P=0.02, pixels P=0.09). In conclusion, intra-articular injection of etanercept gave no noticeable adverse events.

Adult↗
PubMed1998

Scoring in forefoot surgery: a statistical evaluation of single variables and rating systems.

We assessed 13 scores for forefoot surgery and their single parameters in 200 cases of hallux surgery. Outcome expressed in descriptive terms from excellent to poor, as well as calculated as a numerical value differed to a great extent. The rank correlation between different scores showed poor conformity, in some combinations even slight negative correlations. The rank correlation between single parameters and the overall outcome gave good values for some variables included in most scores, e.g., walking distance, general activity, problems on uneven surfaces, shoe wear, cosmetics and pain. Little, if any, correlation was found for joint instability, range of motion of the MTP- and IP-joints, the use of walking aids and medication. We find a need for a generally accepted score, with parameters of high clinical relevance.

Activities of Daily Living↗
PubMed2003

Effect of foot balance on the intra-articular pressure in the distal interphalangeal joint in vitro.

REASONS FOR PERFORMING STUDY: Increased joint pressure has been implicated in the progression of osteoarthritis. HYPOTHESIS: That intra-articular pressure in the distal interphalangeal joint (DIP) is significantly higher in legs loaded with heel up (HU), low heel (TU), lateral side up (LU) and medial side up (MU) imbalance compared to the balanced position. METHODS: Twelve elbow down limbs were compressed in a hydraulic loading jig and DIP pressure measured. RESULTS: Elevating the heels by 5 degrees significantly increased DIP pressure. After 5 ml of contrast was injected into the joint, heel elevation caused a greater increase in DIP pressure and heel lowering decreased DIP pressure. Silicone rubber castings were taken of 20 DIP whilst under load. The articular contact area was localised on the dorsal aspect in the HU position, palmar aspect in the TU position and towards the elevated side with lateromedial imbalance. CONCLUSIONS: Altered foot orientation, which could result from trimming and shoeing, therefore influences intra-articular pressure in the DIP and the articular contact area. POTENTIAL CLINICAL RELEVANCE: The results support the view that a balanced foot is the ideal and that the elevated heels may be detrimental to long term viability of the DIP joint.

Abattoirs↗
PubMed2001

Arthrodesis of the interphalangeal joint of the hallux: a simple and effective technique.

The authors present a simple and effective technique to achieve arthrodesis of the hallucal interphalangeal joint. Stabilization is achieved by external fixation with crossing Kirschner wires joined together to create a single functional unit, a technique that avoids common problems often associated with Kirschner-wire fixation. The authors propose that this simple technique be considered for patients in whom it has been determined that screw fixation should not be used to obtain fusion of the interphalangeal joint.

Arthrodesis↗
PubMed1996

Local distribution of mepivacaine after distal interphalangeal joint injection in horses.

OBJECTIVE: To evaluate the distribution of mepivacaine hydrochloride after distal interphalangeal (DIP) joint injection in horses. DESIGN: Prospective, uncontrolled study. ANIMALS: 10 adult horses. PROCEDURE: 30 minutes before euthanasia, 8 ml of 2% mepivacaine hydrochloride was injected into the dorsal pouch of a forelimb DIP joint. Synovial tissue from the DIP joint and podotrochlear (navicular) bursa and bone tissue from the medullary cavity of the distal sesamoid (navicular) bone were taken from both forelimbs immediately after death. All synovial and bone specimens were analyzed for tissue concentration of mepivacaine by high-performance liquid chromatography. Synovial tissue and bone specimen concentrations from the injected forelimb were compared with corresponding specimens from the noninjected forelimb. All synovial tissue and bone specimen concentrations were compared with an estimated effective tissue concentration of mepivacaine (0.3 microgram/mg) for local anesthesia. RESULTS: Specimen concentrations of mepivacaine from the injected forelimb were significantly greater (P < 0.05) than those in the corresponding tissues of the contralateral noninjected forelimb. All DIP joint and navicular bursa synovial tissue specimens from the injected forelimb had greater than the estimated effective tissue concentration of mepivacaine for local anesthesia. Of the 10 navicular bone specimens from the injected forelimb, 4 were higher and 2 were within 20% of the estimated effective tissue concentration of mepivacaine for local anesthesia. CONCLUSIONS: Mepivacaine hydrochloride deposited into the DIP joint should anesthetize pain arising from navicular bursa synovia and may decrease pain arising from the medullary cavity of the navicular bone. CLINICAL RELEVANCE: DIP joint injection of mepivacaine hydrochloride is not specific for DIP joint pain.

Animals↗
PubMed1982

Degenerative joint disease with osteochondrosis of the proximal interphalangeal joint in young horses.

Degenerative joint disease of the proximal interphalangeal joint was diagnosed in 9 joint of 6 horses. All of the horses were 3 years old or younger and the affected joints were in the hindlimbs. Radiographic evidence of osteochondrosis involving the distal end of the proximal phalanx was apparent in 5 joints. Lameness and local soft tissue swelling were prominent in all cases. In 1 horse euthanatized tissues because of lameness, histologic examination of joint tissues revealed osteochondrosis as well as severe osteoarthritis. Surgical arthrodesis of the affected joint was performed on 2 horses, one of which became sound.

Animals↗
PubMed1989

Arthrodesis of metatarsophalangeal joints in a dog.

Chronic osteomyelitis and septic arthritis involving the 3rd and 4th metatarsophalangeal joints were diagnosed in a Doberman Pinscher. Arthrodesis of the 3rd and 4th metatarsophalangeal joints resulted in a subtle persistent gait abnormality, but limb function was preserved. Arthrodesis of metatarsophalangeal joints is an alternative to amputation, especially when main weight-bearing digits are involved.

Animals↗
PubMed2001

Proximal interphalangeal arthrodesis in 22 horses.

The purpose of this study was to evaluate a new method of internal fixation technique for pastern arthrodesis. Pastern arthrodeses are performed commonly in horses with chronic osteoarthritis of the pastern joint or, in cases of acute traumatic injury to the pastern, in which the weightbearing bony column must be restored. Chronic osteoarthritis of the pastern is a frequent cause of lameness in the equine athlete and is evidenced by chronic lameness localised to the pastern joint, and supported radiographically by periosteal proliferation and loss of joint space. Nonsurgical and surgical treatments have both been described in the literature. Complications following pastern arthrodesis have been reported on several occasions and appear to focus on excessive periarticular exostoses and increased time in a cast due to prolonged time to bony fusion. The hospital records of horses presenting for pastern arthrodesis to the Rood and Riddle Equine Hospital in Lexington, Kentucky, were reviewed and 22 met criteria for inclusion in the study. Horses with chronic osteoarthritis of the proximal interphalangeal joint or horses with an acute traumatic injury to the pastern undergoing pastern arthrodesis with one of the following techniques were included in the study. Horses with severe comminution of the middle phalanx were excluded. Three 5.5 mm cortical bone screws placed in lag fashion alone or in combination with a 4 or 3 hole dynamic compression plate affixed with 4.5 mm cortical bone screws were compared. A lower limb fibreglass cast was applied in all cases. Period in cast, time to return to intended use, complications encountered and outcome were evaluated. Seven of the 8 hindlimbs treated with the combination technique became sound. Three out of 6 of the front limbs treated with the combination technique became sound. Four of the 5 horses with hindlimbs, and one of the 2 with front limbs, treated with screws only returned to their intended use. The type of internal fixation did not appear to influence the overall number of horses returning to the intended level of performance. The period spent in cast and the time to return to soundness were decreased in horses operated on using the combination technique. We concluded that, in the immediate postoperative period, the combination of the parallel screw technique with a dorsally-applied dynamic compression plate provides the most stable and secure fixation, minimising motion, expediting bone remodelling and therefore favouring rapid fusion of that joint.

Animals↗
PubMed2000

Rheumatoid forefoot reconstruction. A long-term follow-up study.

BACKGROUND: The purpose of the present study was to assess the results of reconstruction of the rheumatoid forefoot with arthrodesis of the metatarsophalangeal joint of the great toe, resection arthroplasty of the metatarsal heads of the lesser toes, and open repair of hammer-toe deformity (arthrodesis of the proximal interphalangeal joint) of the lesser toes when this deformity was present. METHODS: A retrospective study of forty-three consecutive patients (fifty-eight feet) with severe rheumatoid forefoot deformities was performed. Six patients (six feet) died before the most recent follow-up, and five patients (five feet) were excluded because a subtotal procedure had been performed. No patient was lost to follow-up. Thus, the study included thirty-two patients (forty-seven feet) in whom reconstruction of a rheumatoid forefoot had been performed by the author. RESULTS: All first metatarsophalangeal joints had successfully fused at an average of seventy-four months (range, thirty-seven to 108 months) postoperatively. The average postoperative hallux valgus angle was 20 degrees and the average postoperative angle subtended by the axes of the proximal phalanx and the metatarsal of the second ray (the MTP-2 angle) was 14 degrees, demonstrating that a stable first ray protected the lateral rays from later subluxation. One hundred and thirty-two (70 percent) of the 188 lesser metatarsophalangeal joints were dislocated preoperatively, compared with thirteen (7 percent) postoperatively. The result of the procedure (as rated subjectively by the patient) was excellent for twenty-three feet, good for twenty-two, and fair for two. There were no poor results. The average postoperative score according to the system of the American Orthopaedic Foot and Ankle Society was 69 points. Postoperative pain was rated as absent in eighteen feet, mild in twenty-five, moderate in four, and severe in none. Fifteen feet were not associated with any functional limitations, twenty-eight were associated with limitation of recreational activities, and four were associated with limitation of daily activities. At the time of the most recent follow-up, no special shoe requirements were reported. Fourteen feet (30 percent) had a reoperation for the removal of hardware from the first metatarsophalangeal joint, a procedure on the interphalangeal joint of the great toe, or additional procedures on the lesser toes or lesser metatarsophalangeal joints. CONCLUSIONS: In the present study, arthrodesis of the first metatarsophalangeal joint, resection arthroplasty of the lesser metatarsal heads, and repair of fixed hammer-toe deformities with intramedullary Kirschnerwire fixation resulted in a stable repair with a high percentage of successful results at an average of six years after the procedures.

Adult↗
PubMedDate not supplied

[Early results of implantation of an unconstrained metatarsophalangeal joint prosthesis of the first toe].

PURPOSE: Does the ReFlexion Implant System provide an alternative in operative treatment of hallux rigidus? METHODS: We have been using the non-constrained prosthesis since April 1997. 26 implants were reviewed 13-41 months after insertion, analysing radiological and clinical data. A questionnaire was answered by the patients. RESULTS: Surgery was either performed cementless (8 cases), as a hybrid, i.e., only phalangeal part cemented (14 cases), or cemented in both components (4 cases). So far, 3 joint replacements had to be removed for pain. Radiological signs of loosening around the cemented phalangeal components were evident in 11 cases. There was no correlation between radiological loosening and discomfort. CONCLUSIONS: The implant can reduce pain distinctly. Patients satisfaction with the treatment is relatively high. The range of movement in the first MTP is still limited. In our opinion the ReFlexion Prosthesis can be quoted as an acceptable alternative for surgical treatment in advanced cases of hallux rigidus. In case of failure a conversion to the distraction-arthrodesis is possible.

Aged↗