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1.
J Pediatr Orthop ; 41(9): e823-e827, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34411052

RESUMO

BACKGROUND: In the pediatric population, chronic ingrown toenails (onychocryptosis) can cause infection (paronychia), debilitating pain, and may be unresponsive to conservative treatments. Following multiple failed interventions, a terminal Syme amputation is one option for definitive treatment of chronic onychocryptosis. This procedure involves amputation of the distal aspect of the distal phalanx of the great toe with complete removal of the nail bed and germinal center, preventing further nail growth and recurrence. METHODS: A retrospective review was performed to determine outcomes of a terminal Syme amputation in the pediatric population. Inclusion criteria included treatment of onychocryptosis involving terminal Syme amputation with a minimum follow-up of 1 year. The medical record was reviewed to assess previous failed treatment efforts, perioperative complications, radiographic outcomes, and the need for additional procedures. RESULTS: From 1984 to 2017, 11 patients (13 halluces) with onychocryptosis were treated with a terminal Syme amputation. There were no intraoperative complications. One hallux had a postoperative infection requiring antibiotics as well as partial nail regrowth following the terminal Syme procedure that required subsequent removal of the residual nail. Following partial nail ablation, the patient had no further nail growth. An additional patient also developed a postoperative infection requiring oral antibiotic treatment. All patients returned to full weight-bearing physical activities within 6 weeks of surgery. CONCLUSIONS: Terminal Syme amputation was successful in treating pediatric patients who have recalcitrant onychocryptosis and paronychia. There was little functional consequence following terminal Syme amputation of the great toe in this patient population, making it an effective salvage procedure. LEVEL OF EVIDENCE: Level IV-retrospective comparative study.


Assuntos
Hallux , Unhas Encravadas , Amputação , Criança , Hallux/diagnóstico por imagem , Hallux/cirurgia , Humanos , Unhas , Unhas Encravadas/cirurgia , Estudos Retrospectivos
2.
Acta Orthop Traumatol Turc ; 55(4): 327-331, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34464308

RESUMO

OBJECTIVE: The aim of this study was to provide anatomic considerations in the first metatarsophalangeal joint (FMPJ) innervation and to evaluate the feasibility of the denervation surgery in the treatment of hallux rigidus. METHODS: In this cadaveric study, 14 fresh frozen cadaveric transtibial amputation specimens was used. For nerve dissection, dorsal and plantar longitudinal incision centered over the FMPJ were performed. Deep peroneal and dorsomedial cutaneous nerves were dissected in the dorsal aspect of the joint. Medial plantar nerve branches, medial and lateral hallucal nerves, were dissected in the plantar aspect of the joint. The presence, number, and location of articular branches to the FMPJ capsule were recorded. Dorsal and plantar incision length for proper dissection were also recorded. RESULTS: Nerve dissection of the 14 specimens revealed the following number of articular branches from the relevant nerves: 14 from dorsomedial cutaneous nerves, 11 from deep peroneal nerves, 6 from medial hallucal nerve, and 5 from lateral hallucal nerve. Dorsal incision mean length was 60.53 (range, 42.48-85.12) mm, and the plantar incision mean length was 88.08 (range, 77.32-111.21) mm. CONCLUSION: Evidence from this study has shown that partial dorsal denervation of the FMPJ may be a technically feasible procedure along with the presence of superficially easily dissected nerves with relatively small incision. LEVEL OF EVIDENCE: Level 5.


Assuntos
Hallux Rigidus , Hallux , Articulação Metatarsofalângica , Cadáver , Denervação , Hallux/cirurgia , Humanos , Articulação Metatarsofalângica/cirurgia
3.
Clin Orthop Relat Res ; 479(12): 2667-2676, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34170867

RESUMO

BACKGROUND: Diagnosis and treatment of tendonitis/entrapment of the flexor hallucis longus (FHL) has been sporadically described in the evidence, primarily in the context of dancers and other athletes. Although various nonspecific nonoperative treatments have been described, it is not clear how often they achieve a satisfactory amount of symptom improvement. QUESTIONS/PURPOSES: The present study was designed to address the following questions regarding the nonoperative treatment of FHL tendonitis: (1) In a population of patients where the default management option for FHL tendonitis is a comprehensive nonsurgical approach, what proportion of patients thus treated opted not to have surgery? (2) What factors were associated with a patient's decision to undergo surgery after a period of nonsurgical management? METHODS: The 656 patients included were all those diagnosed with FHL tendonitis who were initially treated nonoperatively in the foot and ankle division between January 2009 and December 2018. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and final outcome were obtained from the electronic medical record. The primary outcome was the decision to have surgery due to unsatisfactory symptom improvement. We compared patients who opted for surgery with those who did not after nonoperative treatment with univariable and multivariable statistics using demographics, comorbidities, and clinical findings as potential risk factors, with p < 0.05. RESULTS: Forty-four percent (180 of 409) of patients decided to forgo surgery after the institution of a specific FHL stretching program. Surgery was more likely in patients with clinical hallux rigidus (OR 2.4 [95% CI 1.16 to 4.97]; p = 0.02) or posteromedial ankle pain (OR 1.78 [95% CI 1.12 to 2.83]; p = 0.01) and less likely in those who completed an FHL stretching program (OR 0.15 [95% CI 0.08 to 0.27]; p < 0.001). CONCLUSION: FHL tendonitis is more common than the previous evidence suggests and frequently occurs in nonathletes. Once it was diagnosed by detection of tenderness anywhere along the tendon, most frequently at the fibroosseous tunnel, nonoperative treatment focused on specific FHL stretching and immobilization in more severe cases reduced the symptoms to the extent that 44% of patients decided that surgery was unnecessary. The key to its diagnosis is awareness that this injury is possible because most patients treated in this study had been previously seen by orthopaedic providers who had not appreciated the presence of the condition, leading to a delay in diagnosis and treatment of more than a year in many patients. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Tratamento Conservador/métodos , Exercícios de Alongamento Muscular , Tendinopatia/terapia , Encarceramento do Tendão/terapia , Adulto , Tratamento Conservador/psicologia , Feminino , Hallux/patologia , Hallux/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/psicologia , Procedimentos Ortopédicos/estatística & dados numéricos , Medição da Dor , Estudos Retrospectivos , Tendinopatia/patologia , Encarceramento do Tendão/patologia , Resultado do Tratamento
4.
J Foot Ankle Surg ; 60(5): 968-972, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34001447

RESUMO

The dorsomedial cutaneous nerve to hallux provides sensation to the dorsomedial aspect of the first metatarsophalangeal joint and hallux. Postoperative damage to the dorsomedial cutaneous nerve to hallux have been reported with the dorsomedial approach and symptoms can be very debilitating. The present study aims to understand how the distance between this nerve and the extensor hallucis longus tendon are affected by the severity of the hallux valgus deformity, at the level of the first metatarsophalangeal joint. We performed a cadaveric study using 35 cadaveric lower extremities (N = 35). Each specimen was classified according to the hallux valgus severity through a 30 kg partial weight-bearing antero-posterior radiograph. Before dissection, the lower extremities' greater saphenous vein was injected with black latex to simplify the distinction between anatomical structures. We concluded that as the hallux valgus angle and the first intermetatarsal angle increase, the distance between the dorsomedial cutaneous nerve to hallux and the extensor hallucis longus tendon also increases, ranging from 12 mm in normal feet to 19 mm in severely deformed feet. Hallux valgus is a three-dimensional deformity that changes traditional surgical landmarks. To avoid harming this nerve, we established a danger zone ranging from 12 mm to 19 mm medial from the extensor hallucis longus tendon, at the level of the first metatarsophalangeal joint. The mid-medial approach to MTP should be preferred as it is out of the danger zone.


Assuntos
Hallux Valgus , Hallux , Articulação Metatarsofalângica , Cadáver , Hallux/diagnóstico por imagem , Hallux/cirurgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Tendões
5.
Foot (Edinb) ; 47: 101802, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33946006

RESUMO

Few studies have reported about isolated contracture in the extensor hallucis longus (EHL) muscle, but none of the EHL muscle contracture after distal tibial physeal injury. Two such cases in 16- and 14-year-old boys who underwent surgeries for distal physeal injury of the tibia at a previous hospital are presented. Extension contracture of the hallux appeared 1-2 months post-surgery. Physical examinations revealed that the extension contracture of the first metatarsophalangeal joint was aggravated in plantar flexion of the ankle due to a tenodesis effect, and magnetic resonance imaging showed atrophy and signal changes in the anterior compartment muscles. This was diagnosed as EHL muscle contracture due to anterior compartment syndrome (ACS) after distal tibial physeal injury. The EHL tendon transfers were performed in both cases, with favorable short-term results. Therefore, the EHL tendon transfer might be preferable in case of the EHL muscle contracture due to partial ACS.


Assuntos
Contratura , Hallux , Contratura/etiologia , Contratura/cirurgia , Hallux/cirurgia , Humanos , Masculino , Músculo Esquelético/cirurgia , Tendões , Tíbia
6.
J Am Podiatr Med Assoc ; 111(2)2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33872360

RESUMO

Longitudinal epiphyseal bracket is a rare ossification disorder of the short tubular bones. The affected bone becomes deformed as a result of the bracket. The normal growth pattern cannot occur, and when it affects the first metatarsal bone, hallux varus may develop with the abnormal growth pattern. We present such a 6-year-old patient who had undergone surgery at 6 months of age for hallux varus and polydactyly. The deformity had worsened gradually after the initial operation because of the overlooked longitudinal epiphyseal bracket. The patient was treated with surgical excision of the epiphyseal bracket, with corrective medial open wedge osteotomy and split transfer of the extensor hallucis longus tendon. The result was excellent at the 20-month follow-up. At an early age, patients who present with hallux varus must be checked for the epiphyseal bracket, which can be invisible on radiographs because of the chondral structure. Untreated or overlooked patients with epiphyseal bracket will need revision operations for recurrent deformities.


Assuntos
Hallux Valgus , Hallux Varus , Hallux , Ossos do Metatarso , Criança , Epífises/diagnóstico por imagem , Epífises/cirurgia , Hallux/diagnóstico por imagem , Hallux/cirurgia , Hallux Varus/diagnóstico por imagem , Hallux Varus/etiologia , Hallux Varus/cirurgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Radiografia
7.
J Am Podiatr Med Assoc ; 111(1)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33690810

RESUMO

Although sprains of the hallux metatarsophalangeal (MTP) joint ligaments occur in barefooted martial arts athletes, few studies discuss the surgical treatments for lateral collateral ligament damage. We report herein a case of lateral collateral ligament repair for chronic hallux MTP joint instability. A 21-year-old male collegiate sumo wrestler injured his left hallux by snagging it on a sumo straw bale at 14 years of age. After entering university (4 years after the injury), he could no longer put weight on his foot at the left hallux; his athletic performance deteriorated, and he was referred to our department by his doctor. He had instability in the MTP joint of the left hallux, and magnetic resonance imaging revealed a tear in the attachment of the lateral collateral ligament to the metatarsal bone. Conservative treatment, such as taping, did not improve the symptoms; thus, surgery was performed, which consisted of passing a strong suture attached to the capsular ligament through a burr hole made in the metatarsal bone and fixing it to the burr-hole wall using an anchor. Postoperatively, the patient's joint instability improved, and he returned to competitive wrestling 4 months after surgery. He was able to put weight on his left hallux, and his athletic performance improved. The follow-up period after surgery was 2 years. In competitive sumo wrestling, hallux weakness and joint instability lead to a significant reduction in performance. Thus, ligament repair is an effective treatment for hallux MTP joint instability that cannot be treated by conservative means.


Assuntos
Hallux Valgus , Hallux , Instabilidade Articular , Ligamentos Laterais do Tornozelo , Articulação Metatarsofalângica , Adulto , Hallux/cirurgia , Humanos , Instabilidade Articular/cirurgia , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Universidades , Adulto Jovem
8.
Pediatrics ; 147(3)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33563770

RESUMO

A previously healthy 15-year-old boy from a rural county in the southeastern United States was evaluated in the emergency department with fever and worsening toe pain in the absence of trauma. He initially presented to his primary care physician 4 weeks before with upper respiratory symptoms and was treated with corticosteroids for presumed reactive airway disease. His respiratory symptoms resolved. One week after this presentation, he developed fever and right great toe pain and presented to an outside hospital. Inflammatory markers were elevated. MRI confirmed a diagnosis of osteomyelitis with associated periosteal abscess. He was treated with intravenous antibiotics and drainage of the abscess. Ten days after his discharge from the outside hospital, he developed fever and had increasing drainage of the toe and pain refractory to oral pain medications. He presented to our facility for further evaluation. Repeat MRI and inflammatory markers corroborated his worsening disease, and he was admitted to the hospital for intravenous antibiotics and underwent serial surgical debridement. He developed painful subcutaneous nodules on his lower extremities and was found to have lung abnormalities on chest radiograph. A multispecialty team collaborated in the management of this patient and unveiled a surprising diagnosis.


Assuntos
Abscesso/microbiologia , Blastomicose/diagnóstico , Febre/microbiologia , Hallux , Osteomielite/microbiologia , Dor Intratável/etiologia , Doenças dos Trabalhadores Agrícolas/microbiologia , Amputação , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Blastomyces/isolamento & purificação , Blastomicose/complicações , Daptomicina/uso terapêutico , Progressão da Doença , Hallux/cirurgia , Humanos , Itraconazol/uso terapêutico , Masculino
9.
Foot Ankle Surg ; 27(4): 389-394, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32513611

RESUMO

BACKGROUND: Flatfoot is a frequent skeletal deformity in childhood that can be minimally invasively treated by arthroereisis. QUESTION: Does the motion of juvenile flexible flatfoot normalize after arthroereisis? METHOD: Pedographic measurements were obtained from 39 patients preoperatively, six months postoperatively and compared to a healthy group. The footprints were divided into 8 areas. The selected parameters were: contact area and force-time-integral. RESULTS: After surgery, a load shift from the medial to the lateral areas was detected under the midfoot and forefoot. The force-time-integral under the hallux normalized. However, under the lateral midfoot, the postoperative force-time-integral was significantly higher than in the control group. SIGNIFICANCE: The study shows that arthroereisis is able to correct the medially displaced load distribution of juvenile flexible flatfoot. However, further investigations are required to find out if the higher punctual loading under the lateral midfoot may cause problems in the long term.


Assuntos
Artrodese/métodos , Parafusos Ósseos , Pé Chato/diagnóstico por imagem , Pé Chato/cirurgia , Hallux/diagnóstico por imagem , Hallux/cirurgia , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Resultado do Tratamento , Caminhada , Adulto Jovem
10.
Foot Ankle Surg ; 27(4): 381-388, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32505511

RESUMO

BACKGROUND: The prevalence of osteoarthritis of the hallux metatarsophalangeal joint (MTPJ) is 1 in 40 people over the age of 50. Surgical treatment options for MTPJ arthritis include joint preservation, joint resurfacing, and arthrodesis. Hallux MTPJ implants have evolved over the past several decades, but are associated with various complications. The aim of this study was to examine the MAUDE database to determine reported adverse events for hallux MTPJ implants. MATERIALS AND METHODS: The US Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was reviewed from 2010 to 2018 to review voluntary reported adverse event reports for approved implants within the United States. We recorded the type of adverse event and excluded duplicate reports and those extracted from already published literature. RESULTS: Among 64 reported hallux MTPJ implant adverse events, the most common modes of adverse events were component loosening (34%), infection (14.1%), component fracture (9.4%), inflammation (9.4%), and allergic reaction (7.8%). Regarding implant type, Cartiva SCI had the highest percentage of adverse events (23.4%), followed by Arthrosurface ToeMotion (20.3%), Ascension MGT (12.5%), Arthrosurface HemiCAP® (10.9%), Futura primus (9.4%), and Osteomed Reflexion (6.3%). There was an increase in reported adverse events after 2016. The MAUDE database does not report the total incidence of implant insertion. CONCLUSION: Our study of the MAUDE database demonstrated that component loosening and infection are the most common modes of adverse events for hallux MTPJ implants. Cartiva accounted for one-fourth of the implant-related adverse events during our study period, followed by ToeMotion, and Ascension MGT implants. Continued reporting of adverse events will improve our understanding on short and long-term complications of various hallux MTPJ implants. LEVEL OF EVIDENCE: Level IV; Case Series from Large Database Analysis; Treatment Study.


Assuntos
Artrodese/instrumentação , Artroplastia de Substituição/instrumentação , Bases de Dados Factuais , Hallux Rigidus/cirurgia , Hallux/cirurgia , Prótese Articular/efeitos adversos , Articulação Metatarsofalângica/cirurgia , Osteoartrite/cirurgia , United States Food and Drug Administration , Adulto , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Falha de Prótese/etiologia , Infecções Relacionadas à Prótese/etiologia , Resultado do Tratamento , Estados Unidos/epidemiologia
11.
Foot Ankle Surg ; 27(5): 588-591, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32595019

RESUMO

The hallux interphalangeal joint (HIPJ) is anatomically stable in the transverse plane. Therefore, chronic varus instability of this joint is an extremely rare condition. For symptomatic patients, surgical reconstruction of the lateral collateral ligament is a mobility-sparing option. To date, only lateral collateral ligament reconstruction using autograft tendon has been reported. We present a case of bilateral chronic varus instability of HIPJ in a Taekwondo player, who underwent lateral collateral ligament reconstruction using Achilles tendon allograft.


Assuntos
Aloenxertos , Hallux/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Articulação do Dedo do Pé/cirurgia , Tendão do Calcâneo/cirurgia , Autoenxertos , Humanos , Masculino , Transplante Autólogo/métodos , Transplante Homólogo/métodos , Resultado do Tratamento , Adulto Jovem
12.
Foot Ankle Surg ; 27(5): 528-534, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32653409

RESUMO

BACKGROUND: This study aimed to define the patient acceptable symptom state (PASS) for the American Orthopaedic Foot & Ankle Society score (AOFAS) following hallux valgus surgery. METHODS: 548 patients underwent hallux valgus surgery and had AOFAS assessed preoperatively, 6 months and 2 years postoperatively. Responses to an anchor question were used as external criterion in receiver operating characteristics (ROC) analyses to define PASS thresholds. RESULTS: In total, 429 patients (78.3%) reported their current state as acceptable. Areas under the curve (AUC) for ROCs were 0.71-0.81 for all analyses. PASS threshold was 88.5 at 2 years (sensitivity 64%, specificity 85%). Sensitivity analyses revealed that the threshold was robust. CONCLUSIONS: Patients with an AOFAS of 88.5 consider their postoperative symptom state to be acceptable. This knowledge will enable clinicians to identify patients who have attained a satisfactory functional status after hallux valgus surgery.


Assuntos
Hallux Valgus/cirurgia , Hallux/cirurgia , Articulação Metatarsofalângica/cirurgia , Procedimentos Ortopédicos , Projetos de Pesquisa , Sociedades Médicas , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Sensibilidade e Especificidade , Resultado do Tratamento , Estados Unidos
13.
Foot Ankle Surg ; 27(5): 539-542, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32694077

RESUMO

BACKGROUND: Hallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery. METHODS: A retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients' preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered. RESULTS: Median PCS significantly improved from 49 to 53 (p < 0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively. CONCLUSION: Three groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health. LEVEL OF EVIDENCE: III.


Assuntos
Artrodese/métodos , Hallux Valgus/cirurgia , Hallux/cirurgia , Articulação Metatarsofalângica/cirurgia , Osteotomia/métodos , Qualidade de Vida , Feminino , Seguimentos , Hallux Valgus/complicações , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Metatarsalgia/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
Clin Podiatr Med Surg ; 38(1): 17-29, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220742

RESUMO

In the diabetic and peripheral vascular disease population there is a high risk of further amputation following a primary amputation. Amputation surgery is often approached negating the biomechanics of the lower extremity leading to complications or additional surgery. Implementing appropriate tendon balancing of stump and applying orthoplastic techniques will improve outcomes. This article introduces the basic techniques to a wider audience of foot and ankle surgeons. Specifically, this article is intended to be a descriptive guide for the use of tendon balancing and intrinsic muscle advancements in the various levels of foot amputations.


Assuntos
Amputação/métodos , Pé/cirurgia , Hallux/cirurgia , Humanos , Ossos do Metatarso/cirurgia , Músculo Esquelético/cirurgia , Retalhos Cirúrgicos , Transferência Tendinosa
15.
J Pediatr Orthop ; 41(1): 51-55, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33027231

RESUMO

BACKGROUND: Open physeal fractures of the distal phalanx of the hallux are analogous to Seymour fractures of the hand. When missed, these injuries can result in long-term sequelae including infection, pain, nail deformity, and physeal arrest. Nevertheless, there is a paucity in the literature regarding optimal surgical treatment for these challenging injuries. We present a novel technique and case series for suture-only stabilization of Seymour fractures of the great toe. METHODS: Billing records were used to identify all children aged 18 years or younger who underwent operative treatment open distal phalanx fracture of the hallux with an associated nail bed injury. Electronic medical records and plain imaging were reviewed to identify mechanism of injury, surgical technique, results, complications, and follow-up. RESULTS: Five boys with a mean age of 10.3 years (range, 5 to 13 y) met inclusion criteria. Forty percent (2/5) of injuries were missed by the initial treating providers. Only 2 patients presented to our institution primarily; 60% (3/5) patients were transferred from other facilities. The mechanism of injury was variable but generally involved "stubbing" the toe. The mean time from injury to surgical treatment was 2.6 days (range, 0 to 6 d). Median follow-up was 2 months (range, 1 to 96 mo). No patient complications (including infection) or reoperations were reported. On follow-up imaging, no physeal bars were evident on patients treated with suture-only technique. CONCLUSIONS: Seymour fracture of the hallux are uncommon, and there is frequently a delay in both presentation and diagnosis. Providers should have increased suspicion for these injuries when a physeal fracture of the great toe is associated with bleeding or nail bed injury. Currently, no consensus exists for treatment of these injuries. Suture-only stabilization represents a simple, reliable alternative to pin fixation. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Traumatismos dos Dedos , Fixação Interna de Fraturas , Hallux , Unhas , Técnicas de Sutura , Criança , Traumatismos dos Dedos/diagnóstico , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Hallux/lesões , Hallux/cirurgia , Humanos , Masculino , Unhas/lesões , Unhas/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Radiografia/métodos , Estudos Retrospectivos
16.
J Am Podiatr Med Assoc ; 110(5)2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33179059

RESUMO

Hallux valgus interphalangeus deformity has been previously reported in the literature following trauma and first metatarsophalangeal joint fusion. However, to the best of our knowledge, hallux varus interphalangeus deformity has not been previously reported. We present the case of a 26-year-old skeletally mature woman who sustained an acute, open hallux varus interphalangeus injury following an osteochondral fracture of the medial head of the proximal phalanx.


Assuntos
Hallux Valgus , Hallux Varus , Hallux , Articulação Metatarsofalângica , Adulto , Feminino , Hallux/cirurgia , Hallux Valgus/diagnóstico por imagem , Humanos , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Osteotomia , Radiografia
17.
Foot Ankle Spec ; 13(5): 415-419, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32924585

RESUMO

Skin cancer is the most common cancer within the United States. Reports estimate that 1 in 5 Americans will develop some form of skin cancer. Eccrine porocarcinoma is a rare type of skin cancer of sweat gland origin. Eccrine porocarcinoma is most commonly found on the lower extremities. Clinically it may appear similar to benign skin lesions and it has significant metastatic potential. The authors present a case report with 22 months' follow-up. It describes a multiyear delay in diagnosis involving 3 specialties, including primary care, dermatology, and wound physical therapy. Information is given on techniques when high-risk cutaneous cancers are suspected or encountered. A multispecialty treatment plan is discussed.Levels of Evidence: Level V.


Assuntos
Diagnóstico Tardio/prevenção & controle , Porocarcinoma Écrino/diagnóstico , Porocarcinoma Écrino/cirurgia , Hallux/cirurgia , Procedimentos Ortopédicos/métodos , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/cirurgia , Idoso , Amputação/métodos , Porocarcinoma Écrino/diagnóstico por imagem , Porocarcinoma Écrino/patologia , Humanos , Comunicação Interdisciplinar , Extremidade Inferior , Masculino , Equipe de Assistência ao Paciente , Doenças Raras , Biópsia de Linfonodo Sentinela , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Neoplasias das Glândulas Sudoríparas/diagnóstico por imagem , Neoplasias das Glândulas Sudoríparas/patologia , Resultado do Tratamento
18.
Clin Sports Med ; 39(4): 801-818, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892968

RESUMO

Turf toe injuries should be recognized and treated early to prevent long-term disability. The accurate clinical assessment and radiological evaluation of appropriate cases is important. Both conservative and surgical treatments play a major role in getting athletes back to their preinjury level. There are more recent reported case series and systemic reviews that encourage operative treatment as early as possible for grade III turf toe injury. If the patient presents late from a traumatic hallux injury with subsequent degenerative changes or has hallux rigidus from other etiologies, a first metatarsophalangeal arthrodesis should be considered to minimize pain and improve function.


Assuntos
Artrodese , Traumatismos em Atletas/cirurgia , Traumatismos do Pé/cirurgia , Hallux Rigidus/cirurgia , Hallux Valgus/cirurgia , Hallux/lesões , Articulação Metatarsofalângica/lesões , Artrite/etiologia , Artrite/fisiopatologia , Artrite/cirurgia , Traumatismos em Atletas/fisiopatologia , Traumatismos do Pé/etiologia , Traumatismos do Pé/fisiopatologia , Hallux/fisiopatologia , Hallux/cirurgia , Hallux Rigidus/etiologia , Hallux Rigidus/fisiopatologia , Hallux Valgus/etiologia , Hallux Valgus/fisiopatologia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/cirurgia , Resultado do Tratamento
19.
Jt Dis Relat Surg ; 31(3): 610-613, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32962597

RESUMO

Irreducible dislocation of the interphalangeal joint (IPJ) of hallux is a rare injury due to its intrinsic stabile anatomy. Open reduction is the commonly preferred treatment option once closed reduction attempts fail. In this article, we present a 37-year-old male patient with an irreducible dislocation of the IPJ of the hallux treated with Kirschner (K)-wire assisted percutaneous reduction. The patient was symptom free at the sixth month of follow-up. In conclusion, K-wire assisted percutaneous reduction might be an option in the treatment of irreducible dislocation of IPJ of the hallux.


Assuntos
Hallux/cirurgia , Luxações Articulares/cirurgia , Articulação do Dedo do Pé/cirurgia , Adulto , Fios Ortopédicos , Hallux/lesões , Humanos , Masculino , Articulação do Dedo do Pé/lesões
20.
Foot Ankle Int ; 41(12): 1553-1562, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32880193

RESUMO

BACKGROUND: In preaxial polydactyly of the foot, the choice for excision of the lateral or medial hallux is not straightforward, in particular with proximal phalangeal (type IV) and metatarsal (type VI) duplication, because of anatomical characteristics. We evaluated whether medial or lateral hallux excision gives better outcomes in these duplication types, to help clinical decision making. METHODS: Children with type IV or type VI duplication (n=14, age: 4.4-17.2 years), who were operatively treated by excision of the lateral or medial hallux, were assessed for foot function using plantar pressure measurements and clinical examination. Foot aesthetics were scored by the child, an expert, and 10 laypersons, and additional patient-reported outcome questionnaires were obtained. Outcomes were compared between lateral and medial excision, per duplication type. RESULTS: In type IV duplication (n=11), lateral excision showed a better distribution of peak pressure between the hallux and first metatarsal with significantly lower median first metatarsal peak pressure (P = .008). Lateral excision showed more medial hallux deviation (P = .017). Foot aesthetics were not different between excision sides. In type VI duplication (n=12), lateral excision showed a 59% higher hallux peak pressure, larger medial hallux deviation (P = .004), and more reoperations. Foot aesthetics were scored significantly better after lateral excision by experts and laypersons. CONCLUSIONS: Foot function by virtue of plantar pressure was better after lateral hallux excision in type IV and after medial hallux excision in type VI duplication. Surgeons and laypersons perceived the foot as more normal after lateral excision in type VI, whereas children reported no differences. These outcomes can be used in clinical decision making. LEVEL OF EVIDENCE: Level III, therapeutic, comparative study.


Assuntos
Hallux/anormalidades , Hallux/cirurgia , Polidactilia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente
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