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lesser toes AND anatomy

Phinit Phisitkul
The anatomy of the lesser toes is highly complicated and not yet well understood. The high propensity of the metatarsophalangeal joint to develop hyperextension deformity should be recognized. Surgeons should provide each patient with a realistic expectation for lesser toe reconstructive procedures. A successful surgical result requires a well-planned procedure, accurate execution using proper techniques, and meticulous postoperative care. When complications occur, surgeons should identify culprits so that proper treatment strategies can be successfully executed...
March 2018: Foot and Ankle Clinics
Fred T Finney, Ezequiel Cata, James R Holmes, Paul G Talusan
Knowledge and command of anatomy is paramount to effectively treating disorders of the lesser metatarsophalangeal (MTP) joints. The osseous structures consist of the proximal phalanx of the toe and the metatarsal head. The soft tissues on the dorsum of the MTP joint include the joint capsule and the tendons of extensor digitorum longus and extensor digitorum brevis. The proper and accessory collateral ligaments form the medial and lateral walls and contribute to stability in the coronal and sagittal planes...
March 2018: Foot and Ankle Clinics
Karan Malhotra, Kinner Davda, Dishan Singh
Deformities of the lesser toes are common and can be associated with significant morbidity. These deformities are often multiple, and numerous treatment strategies have been described in the literature.The goal of surgical treatment is to improve symptoms by restoring alignment and function, and avoiding recurrence. In order to achieve this, it is essential for the treating surgeon to understand the normal anatomy and pathology of the various deformities.There is a paucity of prospective studies and randomised-controlled trials assessing the efficacy of specific interventions...
November 2016: EFORT Open Reviews
Caio Nery, Daniel Baumfeld, Hilary Umans, André F Yamada
The metatarsophalangeal (MTP) joint complex is a weight-bearing structure important to the biomechanics of the standing position, walking, shoe wearing, and sport participation. Acute dorsiflexion injury of the first MTP joint, "turf toe," is common among American football and soccer players. The first and lesser MTP joint complexes can be affected by degenerative or inflammatory arthritis, infarct, and infection. These conditions can lead to plantar plate disruption. Imaging studies help physicians to properly diagnose and treat this condition...
February 2017: Magnetic Resonance Imaging Clinics of North America
Nico M G Maas, Margot van der Grinten, Wichor M Bramer, Gert-Jan Kleinrensink
BACKGROUND: Instability of the metatarsophalangeal (MTP) joints of the lesser toes (digiti 2-5) is increasingly being treated by repair of the plantar plate (PP). This systematic review examines the anatomy of the plantar plate of the lesser toes, and the relation between the integrity of the plantar plates of the lesser toes and lesser MTP joint stability. METHODS: The databases of, Medline (Ovid), Web of Science, Scopus, Cochrane, Pubmed not medline, Cinahl (ebsco), ProQuest, Lilacs, Scielo and Google Scholar were searched in June 2015 from inception...
2016: Journal of Foot and Ankle Research
Monica Tafur, Kenyu Iwasaki, Sheronda Statum, Christine B Chung, Nikolaus M Szeverenyi, Graeme M Bydder
OBJECTIVE: We obtained high-resolution 11.7-T MR images of the pulleys of the flexor tendons in cadaveric toe specimens. A detailed understanding of toe pulley anatomy as seen with MR is likely to be of benefit in recognizing disease and the effects of trauma. MATERIAL AND METHODS: Six cadaveric toes were imaged with an 11.7-T small-bore MR imaging system using optimized coils. Two-dimensional dual-echo SE scans were obtained in three planes (40 × 40 × 400-μm(3) voxel size, TE = 7/14 ms, TR = 3,500 ms, fat saturation)...
January 2015: Skeletal Radiology
Miquel Dalmau-Pastor, Betlem Fargues, Enric Alcolea, Nerea Martínez-Franco, Patricia Ruiz-Escobar, Jordi Vega, Pau Golanó
UNLABELLED: Lesser toe deformities are one of the most common conditions faced by orthopedic surgeons. Knowledge of the anatomy of the lesser toes is important for ensuring correct diagnosis and treatment of deformities, which are caused by factors such as muscle imbalance between the extensor apparatus and flexor tendons. However, this apparatus has not received sufficient attention in the literature. In addition, the large number of inaccurate and erroneous descriptions means that gaining an understanding of these structures is problematic...
October 2014: Foot & Ankle International
Douglas E Lucas, Terrence Philbin, Safet Hatic
The plantar plate of the first metatarsophalangeal (MP) joint is a critical structure of the forefoot that has been identified as a major stabilizer within the capsuloligamentous complex. Many studies have clarified and documented the anatomy of the lesser toe MP plantar plates, but few have looked closely at the anatomy of the first MP joint. Ten cadaveric specimens were examined to identify and document the objective anatomic relationship of the plantar plate, tibial sesamoid, and surrounding osseus structures...
April 2014: Foot & Ankle Specialist
Almudena Cecilia-Matilla, José Luis Lázaro-Martínez, Javier Aragón-Sánchez, Yolanda García-Álvarez, Pedro Chana-Valero, Juan Vicente Beneit-Montesinos
The forefoot has been reported as the most frequent location of osteomyelitis in the feet of patients with diabetes. The forefoot includes toes and metatarsal heads as common locations of bone infections, but the anatomy of these bones is quite different. As a result, such differences in anatomy may have an impact on the outcomes. The aim of the present study was to determine whether different locations of osteomyelitis in the forefoot have any influence on time to healing after undergoing surgery in a prospective series including 195 patients without peripheral arterial disease and osteomyelitis confirmed by histopathology...
September 2013: International Journal of Lower Extremity Wounds
Christian Plaass, Ghassan Abuharbid, Hazibullah Waizy, Matthias Ochs, Christina Stukenborg-Colsman, Andreas Schmiedl
BACKGROUND: The flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon are routinely used in reconstructive foot and ankle surgery. The tendons cross in the chiasma plantare and show variable interconnections. This can complicate harvesting of the tendons. Previous anatomical studies were inconclusive and did not reference the connections to surgically relevant landmarks. The purpose of this study was to integrate these conflicting results, introduce a thorough classification system, and analyze the position of the interconnections relative to the surgically relevant bone landmarks...
November 2013: Foot & Ankle International
José A V Sanhudo, João L Ellera Gomes
Plantar plate rupture is a common cause of forefoot pain, multiplanar malalignment, subluxation, or dislocation of the metatarsophalangeal joint (MTPJ). The treatments that have been described for MTPJ instability of lesser toes include amputation, lengthening and/or tendon transfer, periarticular soft-tissue release (capsule, collateral ligaments, and plantar plate), colateral ligament reconstruction, metatarsal shortening osteotomy, and suture of plantar plate lesion. This article outlines the anatomy, pathogenesis, and diagnosis of plantar plate rupture, and describes a new technique that combines joint decompression by Weil osteotomy with a plantar plate repair using a pull-out technique...
September 2012: Foot and Ankle Clinics
Satoshi Yamaguchi, Yasuhito Tanaka, Yasushi Shinohara, Akira Taniguchi, Takahisa Sasho, Kazuhisa Takahashi, Yoshinori Takakura
OBJECTIVE: The purpose of this study is to compare the anatomy of rheumatoid hallux valgus with that of idiopathic hallux valgus from the standpoint of joint-preserving surgery. METHODS: One hundred forty-eight feet of 81 rheumatoid patients were included. Feet with idiopathic hallux valgus and normal feet were compared as controls. Weight-bearing dorsoplantar radiographs of the feet were taken of each patient. A two-dimensional coordinate system was defined on the radiographic image, and 19 anatomic points of the forefoot were measured...
July 2013: Modern Rheumatology
Khalid Shirzad, Carter D Kiesau, James K DeOrio, Selene G Parekh
Lesser toe deformities are caused by alterations in normal anatomy that create an imbalance between the intrinsic and extrinsic muscles. Causes include improper shoe wear, trauma, genetics, inflammatory arthritis, and neuromuscular and metabolic diseases. Typical deformities include mallet toe, hammer toe, claw toe, curly toe, and crossover toe. Abnormalities associated with the metatarsophalangeal (MTP) joints include hallux valgus of the first MTP joint and instability of the lesser MTP joints, especially the second toe...
August 2011: Journal of the American Academy of Orthopaedic Surgeons
Tarek A Aly, Weam Mousa, Sameh Elsallakh
Hallux valgus is a complex progressive deformity affecting the forefoot. The main pathologic anatomy concerns the first metatarsophalangeal joint, including a varus or medial deviation of the first metatarsal and pronation deformity in the longitudinal axis. The goal of this study was to evaluate a series of consecutive patients over a 2-year period after a scarf osteotomy of the first metatarsal. A scarf osteotomy was performed on 31 consecutive patients with moderate to severe hallux valgus deformity (intermetatarsal angle, 13-22°; hallux valgus angle, 20-44°)...
January 1, 2011: Orthopedics
Vinod Kumar Panchbhavi, Jinping Yang, Santaram Vallurupalli
BACKGROUND: The flexor digitorum longus (FDL) tendon is harvested for use in the reconstruction of dysfunctional adjacent tendons such as the posterior tibial and the Achilles tendons. The approach to harvest the FDL tendon in the midfoot region is through an incision along the medial border of the foot. This approach involves dissection quite deep in the foot across neurovascular structures in the vicinity placing them at risk. The purpose of this cadaver study was to test the feasibility and safety of a minimally invasive technique, and also to define the relevant topographical surface and deeper surgical anatomy...
January 2008: Foot & Ankle International
H R Umans, E Elsinger
This article reviews the normal anatomy of the plantar plate and surrounding support structures at the lesser metatarsophalangeal joints, and demonstrates degenerative change and rupture using high resolution MR imaging of the forefoot. The etiology of plantar plate and collateral ligament degeneration and rupture, most commonly occurring at the second metatarsophalangeal joint, is discussed as it relates to chronic synovitis and instability. Both conservative and surgical treatment options are discussed.
August 2001: Magnetic Resonance Imaging Clinics of North America
L S Barouk
At first, scarf osteotomy can be technically demanding. The aim of the author has been to develop an efficient technique, make it easier and more accurate, and to achieve immediate reproducibility of results. Neither the skin incision nor the length of the osteotomy result in postoperative edema, whereas the strong fixation enables very early functional recovery. Complications are rare and avoidable. The sum of the scarf's advantages results in a reliable surgical procedure. The scarf osteotomy is extremely versatile, because it allows a wide range of fragment displacement...
September 2000: Foot and Ankle Clinics
J T Deland, I H Sung
UNLABELLED: The development of a medial crossover second toe (second toe crossing over the first toe) is not a rare clinical condition. It often occurs in the setting of hallux valgus, although not exclusively so. The resulting displacement of the second toe can cause pain in shoes, with surgical correction being problematic. The pathologic anatomy of this condition has not been fully described. In an effort to better understand it, dissection of a cadaveric specimen with a full crossover toe is presented...
May 2000: Foot & Ankle International
Mizel, Yodlowski
Pain in the region of the lesser metatarsophalangeal joints (often termed metatarsalgia) is a common complaint. It can be due to a variety of causes, and accurate diagnosis is essential for effective treatment. Understanding the anatomy and functions of the extrinsic and intrinsic musculature and the plantar plate, ligaments, and fat pad is important in evaluating metatarsophalangeal joint disorders. Claw toe is a hyperextension deformity of the metatarsophalangeal joint in combination with a hammer toe. Pathologic changes involving an isolated metatarsophalangeal joint may be due to monarticular synovitis...
May 1995: Journal of the American Academy of Orthopaedic Surgeons
Y G Chen, P A Cook, M A McClinton, R A Espinosa, E F Wilgis
Successful free tissue transfer requires detailed knowledge of the pertinent microvascular anatomy of the donor site. The lesser toe proximal interphalangeal joints are a source of vascularized autologous tissue. In 20 adult cadaver feet, the arterial anatomy of the second, third, and fourth toes was studied using colored latex and India ink injection. The second, third, and fourth dorsal metatarsal arteries produced small or absent dorsal digital arteries in 72.5% of distal dissections. The proper digital arteries were 0...
March 1998: Journal of Hand Surgery
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