Flexor hallucis brevis' trigger point and dry needling treatment: a myofascial pain syndrome perspective on big toe pain.

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Effect of Hallux Valgus Correction with Kinesiology Taping on Hindfoot Position. Pilot Study.

BACKGROUND: Hallux valgus is the most common deformity of the forefoot. It has a multifactorial aetiology, with hindfoot valgus considered one of its causes. The aim of this study was to evaluate hindfoot position and loading pattern after a treatment of Kinesiology Taping (KT) for the mechanical correction of hallux valgus. MATERIAL AND METHODS: The study involved 25 feet with hallux valgus deformity and hindfoot valgus. The hallux valgus angle (HVA) and hindfoot angle were assessed with a 3D scanner. Hindfoot loading pattern was examined with a baropodometric platform while standing and during gait. Measurements were taken on the following three occasions: before and immediately after KT placement as well as after a month of taping. RESULTS: The KT treatment had a significant influence on the hindfoot angle (p<0.001) and HVA (p<0.001) measured while standing and on lateral heel loading in dynamic conditions during gait (p<0.01). CONCLUSIONS: 1. KT decreased HVA and improved hindfoot position while standing in the pilot study participants. 2. KT exerted a corrective influence on the foot loading pattern in patients with hallux valgus and hindfoot pronation. 3. The foot position correction and normalisation of foot loading achieved in the pilot study provide a basis for further research on KT effectiveness in patients with hallux valgus and hindfoot pronation.

A Review of the Phenotype of Synpolydactyly Type 1 in Homozygous Patients: Defining the Relatively Long and Medially Deviated Big Toe with/without Cupping of the Forefoot as a Pathognomonic Feature in the Phenotype.

Synpolydactyly type 1 (SPD1, OMIM 186000) is inherited as autosomal dominant and is caused by HOXD13 mutations. The condition is rare and is known for its phenotypic heterogeneity. In the homozygous state, the phenotype is generally more severe and is characterized by three main features: a more severe degree of syndactyly, a more severe degree of brachydactyly, and the frequent loss of the normal tubular shape of the metacarpals/metatarsals. Due to the phenotypic heterogeneity and the phenotypic overlap with other types of syndactyly, no pathognomonic feature has been described for the homozygous phenotype of SPD1. In the current communication, the author reviews the literature on the phenotypes of SPD1 in homozygous patients. The review documents that not all homozygous patients show a severe hand phenotype. The review also defines the "relatively long and medially deviated big toe with/without cupping of the forefoot" as a pathognomonic feature in the phenotype. Illustration of this feature is done through a demonstrative clinical report in a multigeneration family with SPD1 and HOXD13 polyalanine repeat expansion. Finally, the pathogenesis of the clinical features is reviewed.

Direct muscle electrical stimulation as a method for the in vivo assessment of force production in m. abductor hallucis.

In vivo assessment of the force-generating capacity of m. abductor hallucis (AbH) is problematic due to its combined abduction-flexion action and the inability of some individuals to voluntarily activate the muscle. This study investigated direct muscle electrical stimulation as a method to assess isometric force production in AbH about the 1st metatarsal phalangeal joint (1MPJ) at different muscle-tendon lengths, with the aim of identifying an optimal angle for force production. A 7 s stimulation train was delivered at 20 Hz pulse frequency and sub-maximal (150% motor threshold) intensity to the AbH of the left foot in 16 participants whilst seated, and with the Hallux suspended from a force transducer in 0°,5°,10°,15° and 20° 1MPJ dorsal flexion. Reflective markers positioned on the foot and force transducer were tracked with 5 optical cameras to continuously record the force profile and calculate the external 1MPJ joint flexion moment at each joint configuration. A parabolic relationship was found between AbH force production and 1MPJ configuration. The highest 1MPJ joint moments induced by electrical stimulation were found between 10° and 15° of Hallux dorsal flexion. However, the joint angle (p < 0.001; η2 = 0.86) changed significantly across all but one 1MPJ configurations tested during the stimulation-evoked contraction, resulting in a significant change in the corresponding external moment arm (p < 0.001; η2 = 0.83). Therefore, the changes in joint geometry during contraction should be accounted for to prevent an underestimation of the resulting joint moment. We conclude that direct muscle electrical stimulation combined with dynamometry offers a robust method for standardised assessment of AbH sub-maximal isometric force production.

Preliminary Evaluation of a Cycling Cleat Designed for Diabetic Foot Ulcers.

BACKGROUND: Offloading devices for diabetic foot ulcers (DFU) generally restrict exercise. In addition to traditional health benefits, exercise could benefit DFU by increasing blood flow and acting as thermotherapy. This study functionally evaluated a cycling cleat designed for forefoot DFU. METHODS: Fifteen individuals at risk of developing a DFU used a recumbent stationary bicycle to complete one 5-minute cycling bout with the DFU cleat on their study foot and one 5-minute bout without it. Foot stress was evaluated by plantar pressure insoles during cycling. Laser Doppler perfusion monitored blood flow to the hallux. Infrared photographs measured foot temperature before and after each cycling bout. RESULTS: The specialized cleat significantly reduced forefoot plantar pressure (9.9 kPa versus 62.6 kPa, P < .05) and pressure time integral (15.4 versus 76.4 kPa*sec, P < .05). Irrespective of footwear condition, perfusion to the hallux increased (3.97 ± 1.2 versus 6.9 ± 1.4 tissue perfusion units, P < .05) after exercise. Infrared images revealed no changes in foot temperature. CONCLUSIONS: The specialized cleat allowed participants to exercise with minimal forefoot stress. The observed increase in perfusion suggests that healing might improve if patients with active DFU were to use the cleat. Potential thermotherapy for DFU was not supported by this study. Evaluation of the device among individuals with active DFU is now warranted.

[Clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot].

OBJECTIVE: To introduce the clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot. METHODS: Based on the anastomoses between the medial plantar artery of the hallux and the nutritional vein, the flap was designed with the perforator of medial plantar artery adjacent to the first metatarsal bone as the rotation point. The flap axis was along the vein at the medial aspect of the foot between rotation point and medial malleolus. RESULTS: 5 cases were treated with primary healing and complete survival flaps. The patients were followed up for 1-12 months with good match of texture and color. CONCLUSIONS: The venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot can be transpositioned to repair the defect at forefoot.

Hyperbaric oxygen therapy in treating post-ischemic pain caused by polycythemia vera complications: a case report.

One of the complications of polycythemia vera (PV) can be acute thrombotic occlusion. The severity and prolonged duration of this condition can lead to nerve damage. In this case a 34-year-old male had thrombotic occlusions of the popliteal artery, resulting in chronic limb ischemia, which was treated with thrombectomy and amputation of one digit. The administered therapy consisted of hydroxyurea, analgesics, antidepressants and acetylsalicylic acid. When the patient was admitted he suffered from ischemic pain, he had developed an ulcer on his big toe and he was emotionally unstable, with suicidal thoughts. The patient was treated with 14 hyperbaric oxygen (HBO2) treatments in total. There was evident paint relief after four treatments and healing of the ulcerous tissue after three weeks. During the patient's medical examination eight months after the treatment, his condition was still satisfactory, with no presence of pain, ulcer or signs of depression, and with no changes in hemodynamics. This case provides additional evidence to the data for HBO2 use in ischemic pain management.

Clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce the clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot.</p><p><b>METHODS</b>Based on the anastomoses between the medial plantar artery of the hallux and the nutritional vein, the flap was designed with the perforator of medial plantar artery adjacent to the first metatarsal bone as the rotation point. The flap axis was along the vein at the medial aspect of the foot between rotation point and medial malleolus.</p><p><b>RESULTS</b>5 cases were treated with primary healing and complete survival flaps. The patients were followed up for 1-12 months with good match of texture and color.</p><p><b>CONCLUSIONS</b>The venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot can be transpositioned to repair the defect at forefoot.</p>

Utilização do Chong Mai no tratamento de onicomicose de hálux: um estudo de caso / The Chong Mai use in the treatment of onychomycosis in the hallux

Este trabalho caracterizou-se por um estudo de caso, no qual pudemos verificar a aplicabilidade do vaso extraordinário Chong Mai no tratamento da onicomicose no hálux. Embora as alterações ungueais não caracterizassem a queixa principal da paciente fomos motivados pela oportunidade de testar esta aplicabilidade. O tratamento acupuntural foi realizado por um período de quatro meses no qual foi possível verificar uma significativa melhora, não só dos sintomas que caracterizavam sua queixa principal, mas acima de tudo da aparência da unha do hálux.(AU)

This study was characterized by a case study in which we could verify the applicability of the extraordinary vessel Chong Mai in the treatment of onychomycosis of the hallux. White nail changes do not charaterize the main complaint of the patient were motivated by the opportunity to test this applicability. Acupunctural treatment was carried out for a period of four months in which we observed significant improvement, not only of the symptoms that was charaterized as their main complaint, but above all the appearance of the nail of the hallux.(AU)

Lateral collateral ligament reconstruction for chronic varus instability of the hallux interphalangeal joint.

Chronic varus instability of the hallux interphalangeal joint is a rare injury, and only a few reports of this injury have been published. In some studies, this injury has been related to taekwondo. Taekwondo is an essential martial art in the Korean military. We have described a case of varus instability of the hallux interphalangeal joint in a professional soldier who had practiced taekwondo for 5 years and the surgical outcome after reconstruction of the lateral collateral ligament with the fourth toe extensor tendon.

Rare open hallux interphalangeal joint dislocations sustained in combatives training: a case series.

Hallux interphalangeal joint dislocations are a very rare occurrence, and open medial dislocations of the hallux interphalangeal joint, to our knowledge, have not been previously reported in the literature. We report two open medial dislocations, one with fracture, that were sustained within a year of each other at the same military installation. Both patients presented were active duty soldiers that were involved in barefoot combatives and caught their hallux in the fold of the mats while simultaneously experiencing a "twisting force" applied to their foot by their combatives partner. Each soldier required surgical intervention and healed uneventfully, able to return to full activities in an average of 10 weeks with no residual pain. Two injuries of this rarity occurring with the same mechanism of injury within a year at the same military base raise concerns about the surface and shoegear being used for combatives training. The initial analysis of these two separate but similar cases points to the fact that injuries to the foot and toes may be reduced by using seamless mats and/or wearing closed-toed shoes (wrestling style) during combatives training.

[Application of the pulsed low-frequency electrostatic field in the early rehabilitative treatment of patients following surgery for the correction of valgus deformation of the first toe].

This paper describes the method and results of application of the pulsed low-frequency electrostatic field (PLFESF) to the lower extremities of the patients who underwent surgical treatment for the correction of valgus deformation of the first toe. The efficiency of the method used in the early period of rehabilitative treatment was estimated at 93.3% compared with 96.7% in the patients who were managed by the same therapy in combination with polyoxdonium.

First metatarsophalangeal hemiarthroplasty for hallux rigidus.

There is a paucity of objective information in the literature about first metatarsophalangeal (MTP) hemiarthroplasty. The authors postulate that it is a reasonable treatment option for severe hallux rigidus in selected patients. Twenty-two elective first MTP hemiarthroplasties were performed on 20 patients that met the inclusion criteria. Pre- and postoperative evaluations were done using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) pain score, range of motion (ROM) measurements, and radiographs. Average ROM and dorsiflexion improved by 15° and 8°, respectively. VAS pain scores improved from 5 to 2.5 after six weeks. Painless ambulation occurred after six weeks, with maximum improvement by six months. After 24 months, two patients had pain at the surgical site interfering with function, leading to an unsatisfactory result that required conversion to arthrodesis. First MTP hemiarthroplasty for severe hallux rigidus can be considered an alternative to fusion in properly selected patients who wish to maintain a functional range of motion.

[Therapeutic effect of impulse low-frequency electrostatic field on the local hemodynamics in the lower extremity after surgery for the correction of valgus deformity of the first toe].

This paper reports the results of the measurement of the linear blood flow velocity in the dorsal artery of the foot following surgical treatment. Rheovasographic characteristics of the lower extremity were obtained after the application of a pulsed low frequency electrostatic field (PLFESF) to correct valgus deformity of the first toe. It was shown that treatment with PLFESF significantly improved arterial and venous circulation in the operated leg.

Treatment of osteomyelitis in the feet of diabetic patients by photodynamic antimicrobial chemotherapy.

OBJECTIVE: This article describes two inexpensive photodynamic antimicrobial chemotherapy (PACT) protocols to provide intensive local care on ulcerated feet of diabetic patients with osteomyelitis. BACKGROUND DATA: Patients with this condition generally have poor quality of life. The usual treatment consists of the administration of a cocktail of drugs including anti-inflammatories, promoters of blood circulation, and systemic antibiotics. However, depending on the conditions of the tissues, amputation may be required. Consequently, it is important to develop PACT protocols that can help avoid amputation. MATERIALS AND METHODS: Two PACT protocols were applied to two diabetic patients with osteomyelitis. These protocols were based on several PACT sessions that consisted of: (1) local injection of mixtures of phenothiazines (2% in water) and Hypericum perforatum extract (10% in propylene glycol), and (2) illumination, lasting 10 min, applied to the lesion's interior and exterior using, respectively, an optical fiber and a non-coherent light source. The frequency of PACT was daily or every other day in the beginning, and weekly after tissue recovery begun. The patients were followed clinically and by radiographic testing. RESULTS: Both PACT protocols helped cure these patients who were about to have amputation of their feet. Radiograms showed that bone had healed and that the bone's texture had improved. CONCLUSION: Here we have described efficient and affordable PACT protocols to treat osteomyelitis in the feet of diabetic patients. This treatment modality should be considered by vascular surgeons and by orthopedists to treat osteomyelitis that is resistant to conventional treatments.

Varus instability of the hallux interphalangeal joint in a taekwondo athlete.

The hallux interphalangeal joint is stable in the transverse plane and there have been only a few reports of varus instability of this joint. A case is described of varus subluxation of the hallux interphalangeal joint in a taekwondo athlete and the surgical outcome after reconstruction of the collateral ligament. Taekwondo athletes, who require fast powerful kicks, should be warned about this type of forefoot injury.

The influence of two different types of foot orthoses on first metatarsophalangeal joint kinematics during gait in a single subject.

OBJECTIVE: To quantify the effect of two distinct foot orthotic designs on in vivo multisegment foot and leg motion; in particular, the first metatarsal and first metatarsophalangeal (MTP) joint during gait. METHODS: A 23-year-old man had an excessively pronated foot structure as measured during a clinical orthopedic examination. The Optotrak Motion Analysis System was used to collect three-dimensional position and orientation data from four modeled rigid body segments (hallux, first metatarsal, calcaneus, and tibia) during the stance phase of walking. The subject walked at a self-selected comfortable walking speed, and a minimum of five trials were collected under three different test conditions: no orthosis, semirigid orthosis with a varus post, and a semirigid orthosis with a varus post and a large medial flange. Data were normalized to the stance period, and descriptive statistics were calculated for dependent variables. RESULTS: Both orthotic interventions equally modified first MTP joint motion when compared with the no orthotic condition. First MTP joint dorsiflexion was decreased (>2 SD) with the orthosis during terminal stance phase. This decrease was associated with a concomitant increase in first metatarsal plantar flexion. CONCLUSION: A custom-made semirigid orthosis posted medially and made from a neutral position off-weight-bearing plaster cast can alter motion in the forefoot during the propulsive period by increasing first metatarsal plantar flexion and decreasing excessive first MTP joint dorsiflexion.

Acupuncture-induced galactorrhoea--a case report.

A case of acupuncture-induced galactorrhoea in a healthy subject is described. The acupuncture was performed at a non-traditional site using a periosteal technique and galactorrhoea occurred on two separate occasions. Galactorrhoea following acupuncture has been reported on one previous occasion.