Lesser toe deformities such as mallet toe, hammer toe and claw toe are annoying problems not only to patients but also to orthopaedic surgeons because they are not easy to manage or treat. Though they occupy very small portion in whole body, they are notorious for unpredictable surgical results. It can make clinical results better to understand these deformities more comprehensively and to make strategic surgical plan for each target deformity.
Congenital Abnormalities ; Hammer Toe Syndrome ; Humans ; Toes

OBJECTIVE: To determine the optimal injection site in the flexor digitorum longus (FDL) muscle for effective botulinum toxin injection. METHODS: Fourteen specimens from eight adult Korean cadavers were used in this study. The most proximal medial point of the tibia plateau was defined as the proximal reference point; the most distal tip of the medial malleolus was defined as the distal reference point. The distance of a line connecting the proximal and distal reference points was defined as the reference length. The X-coordinate was the distance from the proximal reference point to the intramuscular motor endpoint (IME), or motor entry point (MEP) on the reference line, and the Y-coordinate was the distance from the nearest point from MEP on the medial border of the tibia to the MEP. IME and MEP distances from the proximal reference point were evaluated using the raw value and the X-coordinate to reference length ratio was determined as a percentage. RESULTS: The majority of IMEs were located within 30%-60% of the reference length from the proximal reference point. The majority of the MEPs were located within 40%-60% of the reference length from the proximal reference point. CONCLUSION: We recommend the anatomical site for a botulinum toxin injection in the FDL to be within a region 30%-60% of the reference length from the proximal reference point.
Adult ; Botulinum Toxins* ; Cadaver ; Hammer Toe Syndrome ; Humans ; Tibia

Jacobsen syndrome is a clinical disorder characterized by a deletion of the terminal band 11q23. The features of the syndrome include growth retardation, psychomotor retardation, trigonocephaly, downward slanting palpabral fissures, retrognathia, micrognathia, hammer toes, thrombocytopenia and cardiac abnormalities. The disorder was first observed by Jacobsen in 1973. We herein report a case of Jacobsen syndrome in male premature neonate born with trigonocephaly, facial dysmorphism, cardiac defects and thrombocytopenia. The chromosomal study revealed 46, XY, del(11)(q23). The thrombocytopenia improved spotaneously by 3 months of age. The infant underwent a palliative operation for Tetralogy of Fallot at 11 months of age. A brief review of literature is included.
Craniosynostoses ; Hammer Toe Syndrome ; Humans ; Infant ; Infant, Newborn ; Jacobsen Distal 11q Deletion Syndrome* ; Male ; Retrognathia ; Tetralogy of Fallot ; Thrombocytopenia

Jacobsen syndrome is a clinical disorder characterized by a deletion of the terminal band 11q23. The features of the syndrome include growth retardation, psychomotor retardation, trigonocephaly, downward slanting palpabral fissures, retrognathia, micrognathia, hammer toes, thrombocytopenia and cardiac abnormalities. The disorder was first observed by Jacobsen in 1973. We herein report a case of Jacobsen syndrome in male premature neonate born with trigonocephaly, facial dysmorphism, cardiac defects and thrombocytopenia. The chromosomal study revealed 46, XY, del(11)(q23). The thrombocytopenia improved spotaneously by 3 months of age. The infant underwent a palliative operation for Tetralogy of Fallot at 11 months of age. A brief review of literature is included.
Craniosynostoses ; Hammer Toe Syndrome ; Humans ; Infant ; Infant, Newborn ; Jacobsen Distal 11q Deletion Syndrome* ; Male ; Retrognathia ; Tetralogy of Fallot ; Thrombocytopenia

PURPOSE: The objective of this study was to examine the clinical results and effectiveness of resection arthroplasty for correction of lesser toe deformity. MATERIALS AND METHODS: From January 2000 to November 2012, 92 cases of resection arthroplasty for lesser toe deformity were reviewed. Hammer toe was the most common type of deformity, accounting for 44 toes (33 patients). Hallux valgus was the most common comorbid illness. Second toe was the most commonly affected toe and proximal interphalangeal joint was the most common location of resection arthroplasty (69 toes, 75.0%). We also analyzed the alignment of phalanges using the last follow-up weight bearing radiographic image. The analysis included clinical evaluation with American Orthopaedic Foot and Ankle Society (AOFAS) score as well as subjective satisfaction. RESULTS: Flexor tenotomy (19 cases) was the most common combined surgery. Floating toe (4 cases) was the most common complication. The last follow-up alignment of phalanges was better than good in 71 toes (77.2%) in anteroposterior view and in 69 toes (75.0%) in lateral view. Sixty one cases (85.9%) resulted in better satisfaction than 'good' and the final average AOFAS score was 87.4. CONCLUSION: Resection arthroplasty is a valuable surgical option for treatment of lesser toe deformity, with high patient satisfaction, easy surgical technique and remarkable correction of deformity.
Ankle ; Arthroplasty* ; Congenital Abnormalities* ; Follow-Up Studies ; Foot ; Hallux Valgus ; Hammer Toe Syndrome ; Joints ; Patient Satisfaction ; Tenotomy ; Toes* ; Weight-Bearing

PURPOSE: To assess the result of staged minimally invasive plate osteosynthesis (MIPO) for distal tibial fracture with an open wound or injured soft tissue. MATERIALS AND METHODS: In 20 patients (mean age, 47.8 year-old) with distal tibial fractures, there were 4 type A fractures and 16 type C fractures based on the AO classification system. Eight of the 20 patients had open fractures. MIPO was performed on average 23.9 days after bridging external fixation. At the final follow-up, we assessed the radiological results of bone union and alignment. Functional results were also evaluated by measuring the degrees of ankle motion and the American Orthopedic Foot & Ankle Society (AOFAS) scores. RESULTS: Seventeen of 20 cases (85%) achieved primary union at an average of 21.3 weeks. There were 3 cases of nonunion requiring a bone graft. The mean AOFAS score was 88.5 (range, 67~92) and the average range of ankle motion was 49.2degrees (plantarflexion: 37.4degrees, dorsiflexion: 11.8degrees). Complication included 2 cases of minor mal-alignment, 1 case of claw toe and 1 case of peroneal neuropathy. Patients over the age of 60 had lower functional results. Additional factors did not affect the final results. CONCLUSION: Staged MIPO may achieve satisfactory results in distal tibial fractures with soft tissue compromise, decreasing deep infections and soft tissue complications.
Animals ; Ankle ; Follow-Up Studies ; Foot ; Fractures, Open ; Hammer Toe Syndrome ; Humans ; Orthopedics ; Peroneal Neuropathies ; Tibial Fractures ; Transplants

PURPOSE: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. MATERIALS AND METHODS: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. RESULTS: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. CONCLUSION: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.
Animals ; Ankle ; Bunion, Tailor's ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux ; Hallux Valgus ; Hammer Toe Syndrome ; Hospitalization ; Humans ; Outpatients ; Toes

OBJECTIVES: Aims were to evaluate foot deformity in patients with rheumatoid arthritis for its types, prevalence, and relation with duration of the disease. METHODS: Inspection, measuring of hallux valgus and calcaneal angle and footprint were done on 256 feet of 128 patients with rheumatoid arthritis. Transverse (metatarsal) arch and longitudinal arch were evaluated by foot printings. RESULTS: 1) The most common type of foot deformities was hallux valgus in 175 of 256 feet(68.4%). Depressed transverse arches were in 169(66.0%), toe deformities including claw toe, hammer toe, curl toe and mallet toe in 125(48.9%), calcaneal valgus in 87(34.0%), callus in 67(26.2%), pes planus in 37(14.5%), and bunion in 25 (9.8%) of 256 feet. 2) Foot involvements as the initial manifestation were seen in 41 (32.0%) of 128 patients with rheumatoid arthritis. A duration of rheumatoid arthritis over 10 years were seen in 37 of 128 patients. In this patients mean number of involved toes per foot was 2.78 which was not statistically significant increase compared to that of all patients, 2.23 (p-value>0.05). Even with absence of foot symptoms in 28 of 128 patient with rheumatoid arthritis, toe deformities were seen in 1.55 toes per foot. And prevalence of hallux valgus, pes planus, depressed transverse arch and calcaneal valgus were 58.9%, 10.7%, 51.8% and 39.3% respectively. CONCLUSIONS: Foot deformities in patients with rheumatoid arthritis were usually inevitable complication. Even in the patients who had no foot symptom, there were foot deformities. So, we think that physicians should pay attention to the foot in all rheumatoid arthritis.
Arthritis, Rheumatoid* ; Bony Callus ; Congenital Abnormalities ; Flatfoot ; Foot Deformities ; Foot* ; Hallux Valgus ; Hammer Toe Syndrome ; Humans ; Prevalence ; Toes

The Postpoliomyelitis syndrome (PPS) is characterized by new neuromuscular symptoms such as muscle weakness, joint pain, fatigue, and occasional new neuromuscular impairments. Although the development of PPS shows individual differences, it usually occurs many years after the recovery from an acute paralytic poliomyelitis. The purpose of this study was to investigate the incidence and the clinical features of PPS. The subjects were 33 patients(26 males and 7 females) who had partial recoveries of motor function, ten or more years of functional stabilities, and residual muscle atrophies. The mean age was 36.8?7.7 years with the range of 23 - 59 years. The average onset age of acute poliomyelitis was 2.3 - 1.5 years. The questionnaires asking their current physical conditions and three major categories of PPS symptoms, weakness, fatigue, and pain were used. As the sequelae of poliomyelitis, 66.7% of the subjects showed scoliosis and 39.4% had claw toes. Thirty six percents of the subjects were using orthoses including wheelchair, KAFO, and crutches. According to the questionnaire study, 72.5% of subjects had at least one of the three major symptoms. And 36.4% of them reported all of three categories of PPS symptoms. The onset age of the new neuromuscular symptoms was 34.2?8.3 years which was about 32 years after the original acute poliomyelitis. Further researches to investigate the importance and the impacts of proper managements and to develop educational plans for the PPS including exercise programs, cardiopulmonary and energy-conservation trainings are recommended.
Age of Onset ; Arthralgia ; Crutches ; Fatigue ; Hammer Toe Syndrome ; Humans ; Incidence ; Individuality ; Male ; Muscle Weakness ; Muscular Atrophy ; Orthotic Devices ; Poliomyelitis* ; Postpoliomyelitis Syndrome ; Surveys and Questionnaires ; Scoliosis ; Wheelchairs

PURPOSE: To evaluate the clinical results of acquired claw toe deformities that had been treated with proximal lengthening of the long toe flexor tendons. MATERIALS AND METHODS: Seventeen patients with a claw toe deformity due to contracture of the long flexor tendons were treated with proximal lengthening of the long toe flexor tendons from January 1993 to January 2003 and were followed up for at least 1 year. The average age at the time of the operation was 42 years and the average follow-up period was 34 months. Achilles tendon lengthening was also performed in 14 cases with an equinus deformity. At the final follow-up, a residual toe deformity, toe pain during walking, patient's satisfaction, and limitation of the shoe-wear were assessed. RESULTS: At the final follow up, all cases showed a complete correction of a claw toe deformity, and did not have callosity at the toe tip or dorsal aspect of the toes. Toe pain during walking was found in 1 case, and a limitation of the shoe-wear was noted in 6 cases. At the final evaluation, 10 cases were graded as excellent, 6 good, and 1 fair. There was no recurrence of the claw toe deformity or limitation of the toe motion. CONCLUSION: Proximal lengthening of the long toe flexor tendons is recommended for treating flexible claw toe deformities. The procedure produced excellent results regarding the deformity correction and pain relief.
Achilles Tendon ; Animals ; Callosities ; Congenital Abnormalities* ; Contracture ; Equinus Deformity ; Follow-Up Studies ; Hammer Toe Syndrome* ; Hoof and Claw* ; Humans ; Recurrence ; Tendons* ; Toes ; Walking