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Background: Desmoplastic fibroma is a rare, benign bone tumor that exhibits locally aggressive behavior and typically occurs in the mandible and long bones. Its presence in small bones, particularly in the hallux, is exceedingly rare. Desmoplastic fibroma's unusual presentation in this region often mimics other lesions, such as glomus tumors, and poses significant diagnostic challenges. Case presentation: We present the case of a 38-year-old female with a history of trauma to the affected toe and thyroid cancer, who experienced persistent subungual pain, localized tenderness, and cold hypersensitivity in the hallux. Initial imaging (X-ray and MRI) revealed findings consistent with a glomus tumor, including bone erosion in the distal phalanx. Surgical excision with wide margins was performed due to the patient's cancer history, and histopathology unexpectedly identified the lesion as desmoplastic fibroma. The patient underwent regular follow-up with X-rays over two years, showing complete healing and no recurrence. Conclusions: The case emphasizes the necessity of sending excised specimens for pathological analysis to confirm the diagnosis. Documenting such atypical presentations contributes valuable information to the limited literature on desmoplastic fibroma and aids clinicians in recognizing this rare tumor in unusual locations, potentially improving diagnostic accuracy and management. [ABSTRACT FROM AUTHOR]

Spindle cell lipomas are a rare type of lipoma usually presenting in middle-aged to older men, often located on the posterior neck or shoulder; presentation on the foot is exceptionally uncommon. We report a 24-year-old man with spindle cell lipomas on the hallux of his left foot. He experienced an uneventful recovery after excision of the mass. We discuss clinical, radiologic, and histopathologic features of spindle cell lipomas and we review the differential diagnosis at this anatomic site.

Background: Pain in the hallux metatarsophalangeal joint (MTPJ) is very common, yet the underlying etiology remains unknown. Previous clinical research and biomechanical research has implicated stenosing flexor hallucis longus (FHL) tendonitis as a possible cause. The hypothesis of this study was that treatment solely focusing on alleviating restricted FHL excursion would be beneficial in patients with hallux MTPJ pain. Methods: This is a retrospective study of those treated in the Foot & Ankle Division between January 2009, and December 2018, who were diagnosed with FHL tendonitis with associated pain in the hallux MTPJ. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and outcome was obtained from the electronic medical record. The primary outcome was the improvement in the pain score (visual analog scale [VAS]). The surgical patients were included if their procedure was solely related to the FHL (posteromedial ankle release ± os trigonum resection). The decision to have surgery was analyzed by univariate and multivariable statistics using demographics, comorbidities, and clinical findings as potential factors (P <.05). Results: In 75% (59 of 79 feet), nonoperative treatment of FHL stenosis resulted in a decrease in pain scores that the patients felt was satisfactory. The operative group that had an FHL release showed decreased pain in 90% (18 of 20 feet). Multivariable analysis identified the need for immobilization (OR 9.8, 95% CI 1.8-55.2, P =.009), participating in athletics (OR 8.7, 95% CI 1.8-42.2, P =.007), and higher initial VAS (OR 1.7, 95% CI 1.3-2.3, P <.001) as being associated with the decision for surgery. Conclusion: Previous biomechanical studies have suggested that stenosing FHL synovitis can cause increased intraarticular loading in the hallux MTPJ. The current clinical study supports this hypothesis, demonstrating that treatment focused on relieving restricted FHL excursion can ameliorate pain in the hallux MTPJ in select cases. [ABSTRACT FROM AUTHOR]

Background: Surgery is often needed for resistant plantar diabetic foot ulcers (DFUs) of the big toe. For noninfected ulcers, 2 types of surgery are available: the Keller and the hallux interphalangeal joint arthroplasty (HIPJ-A) procedures. Yet, no evidence synthesis on the outcomes of these procedures has been conducted; thus, this systematic review is an attempt to fill this gap. Methods: Only studies reporting the results of Keller (or its variants) and HIPJ-A (or its variants) procedures for noncomplicated ulcers (Texas 1A/2A, or Wagner I/II) were included. Ulcers located beneath the metatarsal head were excluded. Ultimately, 11 studies were selected for inclusion and were analyzed. The primary outcome was defined as the ulcer healing frequency. The secondary outcomes were mean healing time, ulcer recurrence frequency, ulcer transfer frequency, postoperative infection rate, and revision surgery rate. Results: The overall (combined techniques) weighted healing rate was 94% with a mean healing time of 3.1 ± 0.4 weeks. The ulcer recurrence frequency was 6%, the ulcer transfer frequency 4.5%, the postoperative infection rate 18%, and the revision surgery rate 3.8%. No significant differences were found between both techniques. When compared to standard of care, the odds ratio of ulcer healing frequency was 27.1 (95% CI 1.442-508.174, P =.01) in favor of the Keller arthroplasty with a faster healing time (P =.02). Conclusion: Both surgical offloading procedures are highly effective in treating chronic noncomplicated DFU of the plantar aspect of the hallux along with low complication frequencies. There is a need to fine-tune the indication in relation to the location of the plantar wound with future comparative controlled research studies with far more patients than we could include in this meta-analysis. [ABSTRACT FROM AUTHOR]

Background: Currently, there is no scientific evidence regarding pain in the anesthetic block of the first toe according to the method of application. However, clinical evidence has highlighted the use of the carpule due to the low pain it causes during the administration of the anesthetic. Most studies on anesthesia and pain, especially using the carpule and distraction methods, belong to the field of dentistry. Objective: To compare the pain and effectiveness between the anesthetic block of the first toe using a carpule and syringe with Frost's H technique and the modified Frost's H technique. Method: A total of 564 subjects were selected and divided into four groups. Subjects were subjected to experimental conditions (randomization through the Random Allocation Software program 2.0), and divided into group 1 = 138 subjects, corresponding to the block with syringe and Frost's H, group 2 = 141 subjects, corresponding to the syringe group and modified Frost's H, group 3 = 141 subjects, corresponding to the carpule group and modified Frost's H, and group 4 = 144 subjects, corresponding to the carpule group and Frost's H. The same researcher generated the random allocation sequence, enrolled the participants, and assigned them to the interventions. Each subject was unaware of the anesthetic procedure assigned by the researcher. Outcome parameters were pain after anesthetic infiltration and its effectiveness. Results: The anesthetic block with carpule showed a lower pain score compared to the anesthetic block with syringe (2.8 vs. 5.3; p < 0.001). However, when analyzing effectiveness, a higher efficacy rate was obtained in the anesthetic blocks performed using the modified Frost's H technique (97.5% vs. 88.1%; p < 0.001). Conclusions: The anesthetic block with carpule and the modified Frost's H technique is less painful and more effective than the traditional anesthetic block. [ABSTRACT FROM AUTHOR]

First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing nonsynchronous bilateral first MTPJ arthrodesis under the care of a single surgeon using a compression screw/locking plate construct. This is a prospectively collected, retrospectively analysed case series of fifty five patients who underwent bilateral nonsynchronous first MTPJ arthrodesis. Clinical and radiological outcomes were assessed preoperatively and at a minimum of two years postoperatively. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the Self-Reported Foot and Ankle Score (SEFAS) and the Sports Questionnaire version 1 (SQ). Postoperative radiographs were used to assess evidence of union and compare both hallux valgus and intermetatarsal angles. Removal of hardware, revision surgery and correction of deformities were also recorded. Fifty five patients were included in the study. There was statistically significant improvements in all five facets of the FAOS (p value < 0.05). The mean postoperative SEFAS was 45.1. In total, patients participated in thirteen different sporting activities. This represented 92 patient specific activities preoperatively and 104 postoperatively. The most common activities were walking, cycling and swimming. Overall, 94.5% (N = 52) of the cohort were satisfied with their return to sport while 98.2% (N = 54) would recommend bilateral first MTPJ arthrodesis. Mean reductions in hallux valgus angles and intermetatarsal angles were noted at 18.87 and 4.69 degrees respectively. There was one non-union in the cohort which required revision surgery. One patient required removal of hardware. Bilateral first MTPJ arthrodesis is a safe and effective surgical option for patients with bilateral first MTPJ pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes and allows patients reliably return to physical activities. [ABSTRACT FROM AUTHOR]

Background: Hallux valgus (HV) is a complex deformity, with many associated risk factors. The flexor hallucis longus (FHL) tendon is a dynamic and potentially deforming force as it bowstrings laterally with HV. We hypothesized that FHL is more laterally inserted in the distal phalanx in cadavers with HV; therefore, it might be also a primary destabilizing force. We aim to compare the FHL distal insertion morphology and its relationship with osseous structures in cadavers with and without HV. Methods: Sixteen cadaver specimens, 8 with HV and 8 without (N-HV) were dissected. We evaluated FHL distal morphology in terms of its insertional footprint location and FHL long-axis position in relation to osseous anatomy. Results: Both the HV and N-HV groups displayed a laterally inserted footprint at the distal phalanx, with the HV group exhibiting median lateral translation of the footprint 6% greater than the N-HV group (P <.01). Both groups also demonstrated a laterally displaced position for the FHL long axis. The median FHL long axis for HV vs N-HV specimens 1 cm proximal to the IP joint was 9% more laterally displaced from the midaxis (P <.01), and at 1 cm proximal to the MTP joint was measured to be 15% more laterally displaced from the midaxis (P <.01). Conclusion: FHL demonstrated an eccentric position in terms of insertion and trajectory in both the HV and N-HV groups, with greater lateralization in specimens exhibiting HV deformity. This eccentricity potentially creates a greater deforming force vector contributing to the development of HV. Clinical Relevance: The etiology and progression of HV deformity may include a lateralized insertion of the FHL tendon. Treatment implications remain unknown at this time. [ABSTRACT FROM AUTHOR]

Arthroscopy of the first metatarsophalangeal joint (1 MTP) has gained increasing attention in the last two decades. Despite numerous studies describing the surgical technique, only a few provide clinical or radiological outcome data. This systematic review aimed to analyze studies presenting objectively measurable clinical outcomes of patients who underwent 1 MTP arthroscopy as the primary procedure, categorizing results by indication pathology. Following PRISMA guidelines, PubMed and Cochrane databases were searched for studies reporting outcomes of primary 1 MTP arthroscopy, regardless of underlying pathology. The selected articles were thoroughly assessed to extract data regarding the demographics of included patients, pathology, preoperative and postoperative clinical and radiological outcomes, complications, and reinterventions. Fourteen articles, involving 405 patients (419 halluces), were included. Common indications were hallux valgus and hallux rigidus. Notably, Hallux Valgus Angle improved from 28.9° to 12.7°, and Intermetatarsal Angle improved from 13.8° to 9.2°, where reported. In hallux rigidus patients, range of motion increased from 25.15° to 71.3° post-surgery. Temporary or permanent sensory loss occurred in 3% of treated halluces, with 4.28% requiring reoperation. Evidence on 1 MTP arthroscopy as the primary procedure is limited. It is most effective for hallux rigidus, while in hallux valgus cases, it can achieve satisfactory angular corrections but has a relatively high recurrence and reoperation rate. Although this technique is generally safe, further research should compare it with traditional surgical approaches to provide comprehensive insights. IV • Evidence on 1 MTP arthroscopy as the primary procedure is limited • Common indications are hallux valgus and hallux rigidus • Good results have been achieved for hallux rigidus • Angular corrections in hallux valgus yield satisfactory results • A relatively high recurrence and reoperation rates were observed in hallux valgus [ABSTRACT FROM AUTHOR]

This report presents a unique case of checkrein deformities in both halluces following isolated intramuscular sarcoidosis, a rare occurrence given the infrequent musculoskeletal involvement in sarcoidosis. Typically resulting from flexor hallucis longus tendon entrapment by scar tissue post-trauma, the checkrein deformity reported in this paper presented with unusual metatarsophalangeal joint flexion and interphalangeal joint extension during ankle dorsiflexion. A 49-year-old woman with a history of intramuscular sarcoidosis presented with a great toe deformity and discomfort while wearing shoes, leading to a diagnosis of dynamic deformity, possibly attributed to tendon tethering by sarcoidosis. Surgical treatments, including abductor hallucis muscle intratendinous tenotomy, flexor hallucis longus Z-plasty lengthening, Weil osteotomy, and Kirschner wire fixation, significantly improved the functional scores and patient discomfort. This report underscores the importance of recognizing dynamic deformities and the potential for rare diseases, such as sarcoidosis, to cause such conditions, highlighting the need for careful diagnosis and tailored surgical intervention for atypical checkrein deformities. [ABSTRACT FROM AUTHOR]

Resumen: Antecedentes: La medición del resultado posterior a la cirugía, típicamente se basa en resultados radiológicos postoperatorios y escalas clínico/funcionales; sin embargo, en la actualidad hay un creciente interés por considerar al grado de satisfacción del paciente (que incluyen aspectos subjetivos) como parte del éxito de la cirugía de antepié. Objetivo: Determinar si el mostrar una fotografía de la apariencia preoperatoria mejora la satisfacción en los pacientes postoperados de antepié. Materiales y métodos: Se realizó un estudio observacional, transversal, analítico, en la unidad de pie y tobillo de nuestro centro. Se incluyeron 120 participantes entre 18 y 90 años, que fueron sometidos a cirugía de antepié. Se comparó el grado de satisfacción mediante el cuestionario PSQ-10 entre un grupo de pacientes que recibió, en su control postoperatorio a los 3 meses, una imagen del aspecto preoperatorio del pie y aquellos que no la recibieron. Resultados: El grado de satisfacción total fue del 78,33% a los 3 meses de la intervención. El 93,6% de los pacientes que recibieron la fotografía, estaban satisfechos en el control postoperatorio, mientras que en el grupo control fue del 86,2% con una p = 0,218. Conclusión: El grado de satisfacción en los pacientes sometidos a cirugía de antepié no está asociado a la presentación de la fotografía preoperatoria. Abstract: Background: Postoperative outcome measurement typically relies on postoperative radiological results and clinical-functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. Objective: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. Material and methods: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our center. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. Results: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p-value of 0.218. Conclusion: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.

La couverture des pertes de substance de l'hallux est indispensable pour la préservation de la fonction locomotrice. Elle est accessible à des solutions locales, à privilégier pour les défects de petite taille. Nous présenterons le cas d'un patient traité par lambeau de cross-toe pour une exposition de l'articulation interphalangienne proximale de l'hallux après fracture ouverte. Le résultat fonctionnel de ce lambeau fiable et simple était très satisfaisant, avec une cicatrisation et une reprise de la marche rapides. Reconstruction of hallux soft-tissue defects is essential for the locomotor function. Some regional flaps are available and have to be preferred in case of small defect. Here, we present the case of a patient treated by a cross-toe flap in order to cover an exposed hallux proximal interphalangeal joint, after an open fracture. The functional outcome of this reliable and easy flap was very satisfying, with quick wound healing and resumption walk. [ABSTRACT FROM AUTHOR]

Objectives: This study quantifies hallucal metatarsal (Mt1) and second metatarsal (Mt2) polar second moment of areas (J) in hominoids and cercopithecoids to address three questions. Which catarrhines have more rigid Mt1s versus Mt2s? Is asymmetry in medial metatarsal rigidity (e.g., Mt1 > Mt2) different among taxa? Does asymmetry in medial metatarsal rigidity correlate with relative intrinsic hallucal muscle mass across species. Materials and Methods: J was calculated from CT images in 345 specimens and compared between groups: Pan, Gorilla, Pongo, hylobatids, cercopithecines, and colobines. Differences between the Mt1 and Mt2 within groups were assessed using paired t tests. Log10‐transformed Mt1:Mt2 J ratios were used to assess asymmetry in rigidity and inter‐group comparisons were made. Additionally, correlations were performed between species means of log10‐transformed Mt1:Mt2 J ratios and species means of relative intrinsic hallucal muscle mass. Results: African ape and hylobatid Mt1s are significantly more rigid than their Mt2s. Rigidity in medial metatarsals are more variable in Pongo, but most individuals have stronger Mt2s. Greatest variation is observed in cercopithecoids, with some species having consistently stronger Mt1s or Mt2s, but the majority show no bias for either. Log10‐transformed Mt1:Mt2 J ratios are significantly correlated with relative intrinsic hallucal muscle mass; taxa with more rigid Mt1s have more developed muscle. Discussion: Differences between metatarsals in rigidity do not correlate with previously documented regional differences in peak plantar pressure during weight support. Rather, asymmetry in metatarsal rigidity, specifically Mt1 > Mt2, reflect adaptations of larger intrinsic hallucal musculature capable of producing greater hallucal grasping force. [ABSTRACT FROM AUTHOR]

IntroductionWith a growing aging population, the focus on the health and well-being of older adults, especially in preventing falls, becomes crucial. This 3 month study, initiated in July 2022, aimed to assess the impact of a nutrition and exercise program in senior daycare centers in Chuncheon, South Korea.MethodsA 3 month study, beginning in July 2022, included 204 older adults from 10 senior daycare centers in Chuncheon, South Korea. Randomly assigned to intervention or control groups, the intervention involved nutrition, daily toe exercises, or both. Control centers received interventions post-measurements. Pre- and post-intervention analyses used paired t-tests and multiple linear regression, assessing metrics like toe grip strength for significance. While 204 were initially enrolled, the analysis included 151 participants due to dropouts.ResultsParticipants, with a mean age of 83.3 years (43.1% aged ≥ 85 years), exhibited mild to moderate cognitive impairment and multiple chronic illnesses. Health data indicated that 37.3% were obese, and the average BMI was 24.0 kg/m2. Both the intervention and control groups showed significant improvements in toe grip strength post-intervention. Specifically, the exercise-only and combined exercise-nutrition groups demonstrated significant differences in hallux strength compared to the control group after adjusting for age and gender.ConclusionThe study showed that a basic nutrition and exercise program increased toe strength in older adults with chronic diseases, including mild cognitive impairments. This intervention holds potential to prevent muscle strength decline and reduce fall risks in older individuals. As the first of its kind in Korean senior daycare centers, it emphasizes the need for future research and standardized programs for senior daycare users.

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Background: Postoperative outcome measurement typically relies on postoperative radiological results and clinical–functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. Objective: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. Material and methods: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our centre. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. Results: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p value of 0.218. Conclusion: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs. Resumen: Antecedentes: La medición del resultado posterior a la cirugía típicamente se basa en resultados radiológicos posoperatorios y escalas clínico/funcionales; sin embargo, en la actualidad hay un creciente interés por considerar al grado de satisfacción del paciente (que incluyen aspectos subjetivos) como parte del éxito de la cirugía de antepié. Objetivo: Determinar si el mostrar una fotografía de la apariencia preoperatoria mejora la satisfacción en los pacientes posoperados de antepié. Materiales y métodos: Se realizó un estudio observacional, transversal y analítico, en la unidad de pie y tobillo de nuestro centro. Se incluyeron 120 participantes entre 18 y 90 años, que fueron sometidos a cirugía de antepié. Se comparó el grado de satisfacción mediante el cuestionario PSQ-10 entre un grupo de pacientes que recibió, en su control posoperatorio a los tres meses, una imagen del aspecto preoperatorio del pie y aquellos que no la recibieron. Resultados: El grado de satisfacción total fue de 78,33% a los tres meses de la intervención. De los pacientes que recibieron la fotografía, 93,6% estaban satisfechos en el control posoperatorio, mientras que en el grupo control fue de 86,2% con una p = 0,218. Conclusión: El grado de satisfacción en los pacientes sometidos a cirugía de antepié no está asociado a la presentación de la fotografía preoperatoria.

Turf toe is characterized by sprain or disruption of the plantar capsuloligamentous structures of the first metatarsophalangeal joint and usually occurs due to injury during contact sports such as rugby and American football. The clinical presentation typically includes pain, swelling, and ecchymosis at the plantar surface of the first metatarsophalangeal joint, with associated weakness during push off. Diagnostic evaluation involves thorough physical examination, stressing of ligaments, and imaging with radiographs and magnetic resonance imaging. Treatment is based on classification, but is generally conservative, with surgical management being reserved for patients who fail to improve with non-operative methods. Chronic injuries may be associated with worse outcomes, and therefore early diagnosis and treatment is vital. [ABSTRACT FROM AUTHOR]

Joint arthroplasty of the first metatarsophalangeal (MTP) joint is an accepted surgical option for patients with hallux rigidus. However, this procedure has been reported to have a high complication rate and unpredictable survivorship. Implant arthroplasty failure is a devastating complication that results in significant osseous defect with altered biomechanics of the foot. Commonly, salvage options are limited to arthrodesis with bone grafting. However, outcomes are rarely reported. The purpose of this study is to investigate the fusion rates of first metatarsophalangeal joint arthrodesis after conversion from failed implant arthroplasty. A systematic review of electronic databases to find reports of conversion arthrodesis after failed implant arthroplasty was performed. Six studies involving a total of 76 patients with a weighted mean age of 54.9 met the inclusion criteria. Out of the 6 included articles, the nonunion rate was 16.5% at a weighted mean follow-up of 48.1 months. The nonunion rate in the current report is higher than reported nonunion rates of primary arthrodesis. More prospective studies with consistent and standard outcome measures are needed to further determine the success rate of this salvage procedure. Levels of Evidence: 4, Systematic Review of Level 4 Studies [ABSTRACT FROM AUTHOR]

O trabalho tem como objetivo descrever o caso de uma paciente que sofreu queimadura química no hálux esquerdo. Paciente com onicocriptose foi submetida a tratamento com ácido fênico, evoluindo com necrose, odor fétido e secreção purulenta. Após avaliação médica, diagnosticou-se queimadura de terceiro grau infectada, sendo submetida, a princípio a abordagem não cirúrgica, e posteriormente a realização de retalho cutâneo Keystone para fechamento da lesão com recuperação completa após dois meses. Concluiu-se, com tal estudo, que o uso de ácidos pode evoluir com queimaduras químicas graves, comprometendo a função e viabilidade do dedo. Ademais, em feridas profundas, retalho Keystone mostra-se boa alternativa local com rápida recuperação.

Introducción: Los hemangiomas son neoplasias benignas que se originan de células endoteliales; rara vez resultan malignos. El síntoma más común es el dolor, porque el hemangioma comprime un tronco nervioso cercano o un nervio directamente. Presentamos un caso de hemangioma en una región muy poco frecuente. Se trata de una mujer de 35 años que presentaba una tumoración friable, de coloración marrón, dolorosa, en la región distal del hallux, con aumento de tamaño en los últimos meses. Se realizó la exéresis completa de la tumoración. El diagnóstico anatomopatológico fue hemangioma capilar. No se observó recidiva luego de 36 meses de seguimiento. Conclusión: Frente a estas neoplasias, se recomienda la exéresis de la pieza y su posterior estudio. Nivel de Evidencia: IV

Hallux strength is associated with sports performance and balance across the lifespan, and independently predicts falls in older adults. In rehabilitation, Medical Research Council (MRC) Manual Muscle Testing (MMT) is the clinical standard for hallux strength assessment, but subtle weakness and longitudinal changes in strength may go undetected. To address the need for research-grade yet clinically feasible options, we designed a new load cell device and testing protocol to Quantify Hallux Extension strength (QuHalEx). We aim to describe the device, protocol and initial validation. In benchtop testing, we used eight precision weights to apply known loads from 9.81 to 78.5 N. In healthy adults, we performed three maximal isometric tests for hallux extension and flexion on the right and left sides. We calculated the Intraclass Correlation Coefficient (ICC) with 95% confidence interval and descriptively compared our isometric force–time output to published parameters. QuHalEx benchtop absolute error ranged from 0.02 to 0.41 (mean 0.14) N. Benchtop and human intrasession output was repeatable (ICC 0.90–1.00, p < 0.001). Hallux strength in our sample (n = 38, age 33.5 ± 9.6 years, 53% female, 55% white) ranged from 23.1 to 82.0 N peak extension force and 32.0 to 142.4 N peak flexion, and differences of ~10 N (15%) between toes of the same MRC grade (5) suggest that QuHalEx is able to detect subtle weakness and interlimb asymmetries that are missed by MMT. Our results support ongoing QuHalEx validation and device refinement with a longer-term goal of widespread clinical and research application. [ABSTRACT FROM AUTHOR]

Continuous compression implants (nitinol staples) are gaining popularity secondary to their lower profile, less demanding technique, and less surgical dissection. Biomechanical support exists; however, clinical data is limited in the foot/ankle. This study's purpose is to determine the efficacy of nitinol staples to achieve stable, bony healing in Akin osteotomies and examine their clinical outcomes, complications, re-operations, and pain scores. We performed a retrospective chart review on 90 patients (93 osteotomies) who underwent an Akin osteotomy using a nitinol staple over a 2-year period. Radiographs were randomized and independently reviewed by 3 blinded foot and ankle surgeons. Osteotomies were deemed healed if greater than 50% of the osteotomy contained bridging bone, partially healed as less than 50% bridging bone, and nonunion as no healing, broken hardware, or loss of reduction. Visual analog scale pain scores were analyzed. Radiographic union was seen in 98.9% of Akin osteotomies (92/93), with no loss of reduction or broken staples (0/95). Only 3.2% (3/93) of patients returned to the operating room unplanned: 1 infection (1.1%), 1 symptomatic hardware removal (1.1%), and 1 traumatic disruption of fixation (1.1%). Postoperative pain scores were significantly lower than preoperative. Staples are lower profile and technically less demanding compared to headed screws, plates, and tension band constructs. They offer continuous compression of the osteotomy and are rigid enough to maintain reduction. Based on the findings of this paper, the use of staples provides robust and stable fixation for Akin osteotomies and has low complication and high healing rates. [ABSTRACT FROM AUTHOR]

Introduction: Bösch osteotomy (BO), which is a first metatarsal subcapital osteotomy stabilised with a K-wire, is a surgical option to correct hallux valgus (HV). The aim of this study was to assess the long-term clinical and radiographic results in a cohort of patients treated at our institution with such osteotomy. Methods: In this retrospective monocentric single-surgeon cohort study, we included 58 HVs (46 patients) who underwent HV correction by BO and were followed at a minimum of 7 years. The range of motion (ROM), the American Orthopaedic Foot and Ankle Society's Forefoot scale (AOFAS-FS) and the Visual Analogic Scale (VAS) for pain were recorded. On weightbearing radiographs, the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), the Distal Metatarsal Articular Angle (DMAA), and the Lateral Sesamoid Position (LSP) were measured and compared with pre-operative values. The complication rate and first metatarsophalangeal joint stiffness were also assessed. Results: At a mean follow-up of 10 ± 2 (7–17) years, mean ± standard deviation AOFAS-FS and VAS were 89 ± 11 (67–93) and 2.1 ± 2.8 (0–7) points, respectively. In 42 (72%) cases there was no limitation in the choice of footwears. Radiographically, we found a significant improvement in the HVA (from 33.9° ± 6.7 to 18.8° ± 5.6, p < 0.001), in the IMA (14.2° ± 3.1 to 9.4° ± 2.7, p < 0.001), in the DMAA (from 30.3° ± 6.8 to 11.5° ± 5.1, p < 0.001) and in LSP (median value from 3 to 1, p < 0.001). In 36 (62%) cases the ROM was greater than 75° while in 22 (38%) it ranged between 30° and 75°. Minor complications occurred in six (10%) cases, which did not require any further surgery at the longest follow-up. Conclusion: Bösch technique provided satisfactory clinical and radiographic outcomes in the treatment of hallux valgus which persisted at a mean 10-year follow-up. The complication rate did not differ from more recent techniques described in literature. Level of evidence: Level IV, retrospective cohort study. [ABSTRACT FROM AUTHOR]

This study focuses on the assessment of the mechanical effect produced by Morton's extension as an orthopedic intervention in patients with bilateral foot pronation posture, through a variation in hindfoot and forefoot prone-supinator forces during the stance phase of gait. A quasi-experimental and transversal research was designed comparing three conditions: barefoot (A); wearing footwear with a 3 mm EVA flat insole (B); and wearing a 3 mm EVA flat insole with a 3 mm thick Morton's extension (C), with respect to the force or time relational to the maximum time of supination or pronation of the subtalar joint (STJ) using a Bertec force plate. Morton's extension did not show significant differences in the moment during the gait phase in which the maximum pronation force of the STJ is produced, nor in the magnitude of the force, although it decreased. The maximum force of supination increased significantly and was advanced in time. The use of Morton's extension seems to decrease the maximum force of pronation and increase supination of the subtalar joint. As such, it could be used to improve the biomechanical effects of foot orthoses to control excessive pronation. [ABSTRACT FROM AUTHOR]

Foot conditions such as hallux valgus and pes planus cause altered load across the metatarsals. We performed a retrospective review of 98 patients who had foot radiographs performed at our institution for forefoot pain. The patients were divided into two groups based on their age and whether they had normal or altered foot alignment. We found that there is a mild increase in the intramedullary thickness of the third metatarsal in patients with hallux valgus (HV) and HV with pes planus (PP), which we postulate to be due to altered biomechanics and relative decrease in load on the third metatarsal. [ABSTRACT FROM AUTHOR]

Purpose: Morphological differences between the two primary great toe flexors - flexor hallucis longus (FHL) and flexor hallucis brevis (FHB) - likely drive differences in how these muscles contribute to functional toe flexor torque production. The aim of the study was to investigate FHL and FHB activation in two isometric toe flexion tasks - one called a "toe-pushing" task with the metatarsophalangeal (MTP) joints dorsiflexed and the interphalangeal (IP) joints in neutral and another called a "toe-gripping" task with the MTP joints in neutral and flexed IP joints. Methods: Twenty participants' FHL and FHB muscles were instrumented with intramuscular electromyography electrodes. Muscle activation was normalized to a maximum voluntary contraction and compared between the two isometric toe flexor force production tasks. Results: Overall, participants utilized these two toe flexors completely differently in the two tasks. In the toe-gripping task, the FHL was activated to a much greater extent than the FHB. In fact, 18 our of 20 participants activated FHL at more than 70% maximum voluntary contraction and half of participants activated FHB at less than 10%. In contrast, muscle activation during the toe-pushing task appeared more reliant on the FHB for most participants. Conclusions: Different contributions from the FHL and FHB to toe flexor force production in these two tasks are potentially driven by differences in muscle functional length among other factors. These findings help to inform the selection of rehabilitation and training exercises meant to preferentially target intrinsic or extrinsic foot musculature. [ABSTRACT FROM AUTHOR]

Background: Most plantar plate tears of the first metatarsophalangeal joint can be treated successfully by nonoperative means. Primary repair may be indicated to restore continuity of the plantar structures and joint stability. Inadequate or failed nonoperative treatment may cause persistent pain and disability and thereby represent a career-threatening injury to an athlete. The chronic plantar plate tears are difficult both to diagnose and to treat. When surgical treatment is indicated, traditionally a wide plantar or 2 parallel incisions are used. An arthroscopic approach allows for verification and visualization of the injury and, at the same time, repair of the injury. Purpose: To describe findings of plantar plate tears, present a new arthroscopic procedure for plantar plate tear repair, and present the outcomes after surgery. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study on the first 10 patients treated with the arthroscopic technique. The patients underwent surgery between June 2017 and January 2021. Patient data, clinical symptoms and findings, and operative details were obtained from the patient records. Patients were contacted via email to complete patient-reported outcome measures (Manchester Oxford Foot Questionnaire [MOxFQ] and Numeric Rating Scale [NRS] for pain). Results: Four female and 6 male patients with a median age of 24 years (range, 12-44 years) were operated on at a median of 20 months (range, 2-38 months) after injury. Of the 10 patients, 8 had a hyperextension injury of the first metatarsophalangeal joint and 7 had a subtle valgus malalignment of the hallux; 8 patients were injured during sport activity. All patients reported plantar pain at pushoff. All but 1 patient returned to the same level of preinjury activity within 6 months. At a median of 29 months (range, 7-49 months) after surgery, the median MOxFQ score was 6 (range, 0-41) and the median NRS pain score was 0. Conclusion: Arthroscopic plantar plate repair of chronic plantar plate tears resulted in a high rate of return to activity/sport and excellent outcome scores. [ABSTRACT FROM AUTHOR]

[Purpose] Although hallux function is fundamental in maintaining forward leaning standing posture, the insight into whether noncontact of the hallux with the ground alters the forward limit of stability (LoS) remains unclear. Thus, we aimed to determine the effects of the unilateral hallux noncontact on the forward LoS while standing. [Participants and Methods] This study included 17 healthy young and 17 community-dwelling older adults. The position of the center of pressure during the forward, forward-left, and forward-right LoS was measured using a force platform under two toe conditions: noncontact or contact of the right hallux with the ground. To ensure the noncontact condition, we positioned the right hallux on the second toe by taping. [Results] The forward and forward-right LoS were significantly displaced in the left and backward directions (p<0.032, η 2 >0.14), while the forward-left LoS was significantly displaced in the backward direction (p<0.001, η 2 =0.52). In the noncontact condition, the forward-right LoS exhibited a greater degree of the backward shift than the forward-left LoS (p<0.001, η 2 =0.42). [Conclusion] Noncontact of the unilateral hallux with the ground reduced the LoS in the forward and oblique-forward directions and induced LoS asymmetry., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (2025©by the Society of Physical Therapy Science. Published by IPEC Inc.)

The authors describe an extremely rare case of traumatic fracture of both hallux sesamoid bones, which was treated non-surgically, and the indications, contraindications, and unfavorable outcomes analyzed. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Subungual tumors of the hallux are rare, with a varied spectrum of differential diagnoses, and it may be challenging to reach the correct diagnosis. Depending on the health system where the patient will be treated, the specialist physician may follow different paths in the search for pathological definitions, which may lead to delays in obtaining the diagnosis and even to mistaken results. We present a case of a patient with a subungual tumor of the hallux, which represents the singular process above, aiming to demonstrate relevant differential diagnoses, determining factors for the correct diagnosis, and the importance of pathological elucidation for its proper treatment so that the outcomes for the patient are prevented. Level of Evidence V; Case Report; Expert Opinion.

Onychocryptosis is a frequent nail disease, which most commonly affects the toes. It has some variants, including the little known "Harpoon Nail". The diagnosis is usually clinical, and the treatment is surgical, with different techniques described in the literature. We report the case of a 25-year-old man with a harpoon nail on the left hallux and the surgical method used for treatment with excellent results

Intravascular endothelial hyperplasia, or Masson’s tumor, is a benign vascular lesion with no well-defined pathogenesis.The response to vascular damage is believed to be one of the main reasons for its development. It is a typically painless injury, solitary, with slow evolution. This report aims to describe a case of Masson’s tumor in an unusual place, the hallux nail matrix, and discuss its main characteristics.

Rhagomys is a genus of South American cricetids composed of three living species. They occur in eastern Andean and lowland tropical forests. Since description of this genus more than a century ago, it was treated as an enigmatic form within Sigmodontinae, varyingly thought to be allied to different suprageneric groups, with several scholars highlighting their presumptive autapomorphies. However, this morphologically based controversy was resolved with the advent of molecular data, indicating a weak affiliation to Thomasomyini. Here we resume the anatomical scrutiny of Rhagomys based on new evidence. New data, including CT-scan craniodental exploration and an ICAMER molar analysis, reinforce the uniqueness of this cricetid in the subfamily. In addition, we have enlarged and reworked the genetic data, composed of mitochondrial and nuclear markers, supporting not only the monophyly of Rhagomys , but also its resolution as a distinct branch of the sigmodontine radiation. To accommodate these results, we describe a new tribe for Rhagomys. The recognized clade is the most phenotypically differentiated of the Oryzomyalia and inaugurates a new arboreal morphotype. We hypothesize that Rhagomys has a set of anatomical features used to exploit understory resources by primarily insectivorous mice. [ABSTRACT FROM AUTHOR]

Abstract Background First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. Materials and methods We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. Results Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p

The locomotor behaviors of treeshrews are often reported as scurrying "squirrel‐like" movements. As such, treeshrews have received little attention beyond passing remarks in regard to primate locomotor evolution. However, scandentians vary considerably in habitat and substrate use, thus categorizing all treeshrew locomotion based on data collected from a single species is inappropriate. This study presents data on gait characteristics, positional, and grasping behavior of the northern treeshrew (Tupaia belangeri) and compares these findings to the fat‐tailed dwarf lemur (Cheirogaleus medius) to assess the role of treeshrews as a model for understanding the origins of primate locomotor and grasping evolution. We found that northern treeshrews were primarily arboreal and shared their activities between quadrupedalism, climbing and leaping in rates similar to fat‐tailed dwarf lemurs. During quadrupedal locomotion, they exhibited a mixture of gait characteristics consistent with primates and other small‐bodied non‐primate mammals and demonstrated a hallucal grasping mode consistent with primates. These data reveal that northern treeshrews show a mosaic of primitive mammalian locomotor characteristics paired with derived primate features. Further, this study raises the possibility that many of the locomotor and grasping characteristics considered to be "uniquely" primate may ultimately be features consistent with Euarchonta. Research highlights: This paper explores the extent to which treeshrews should be considered an acceptable model for understanding the origins of primate locomotion.The data presented include an amalgamation of positional behaviors, gaits, and grasping behavior of the northern treeshrews, of which we compare to other treeshrews (Tupaia minor, Tupaia tana) and the fat‐tailed dwarf lemur (Cheirogaleus medius). [ABSTRACT FROM AUTHOR]

Hallux pain is a common entity with a differential diagnoses including hallux valgus, hallux limitus/rigidus, and gout and specifically at the interphalangeal joint (IPJ), flexor hallucis longus (FHL) tenosynovitis, and joint arthrosis. An under-recognized source of pain is the os interphalangeus, an ossicle typically located at the plantar aspect of the hallucal interphalangeal joint. This ossicle is radiographically visible in its ossified form in 2–13% of individuals, but can also be present as an ossified or non-ossified nodule in patients. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone in the FHL tendon, it is an ossicle located in the joint capsule of the IPJ and separated from the tendon by a bursa. When the ossicle is absent, the bursa is also absent and the tendon is attached to the joint capsule. Infrequently, the os may be located eccentrically under the first IPJ and reflect persistence of one of the distal phalanx. Rarely, the os interphalangeus may be dorsal to the IPJ. The os interphalangeus is best evaluated on radiographs, ultrasound, and MRI. Pain is a result of altered mechanics with arthrosis or frictional effects with bursitis, tenosynovitis, or intractable plantar keratosis (IPK). The ossicle may also displace into a dislocated IPJ, preventing reduction. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone. This has been found within the plantar joint capsule of the distal hallucal interphalangeal joint and separated from the tendon by a bursa. Uncommonly, the location may be plantar eccentric and reflect persistence of one of the ossification centers of the distal phalanx. Although the ossicle can be imaged with standard AP and lateral radiographs in many cases, in those cases of unexplained pain with no radiographically visible ossicle, and the presence of friction blisters, intractable plantar keratosis (IPK), hyper-extension of the IPJ, hallux limitus/rigidus, or metatarsophalangeal joint (MTPJ) arthrodesis, an MRI or CT should be considered to identify a non-ossified fibrocartilaginous node. This is of particular concern in a patient with a history of underling diabetes mellitus or other metabolic disorders associated with diminished pedal sensation where neurotrophic changes place them most at risk for complications associated with excessive plantar pressure. Pain is a result of altered biomechanics with arthrosis, or frictional effects causing bursitis, tenosynovitis, or IPK. The ossicle may also displace into a dislocated IPJ, preventing reduction. In this article, we will describe the anatomy and imaging appearance of the common os interphalangeus variants and associated complications including frictional effects, arthrosis, and IPK and discuss conservative and surgical management of a symptomatic ossicle. [ABSTRACT FROM AUTHOR]

Lapidus arthrodesis is an established standard procedure to correct various foot surgery problems and hallux limitus, hypermobility of the first ray, hallux abductus valgus, and symptomatic lesser metatarsal. After decades, many fixation methods in the orthopaedic surgery industry have been developed for decreasing complications and improving this technique. The aim of this PRISMA compliant systematic review is to analyse the effectiveness of several lapidus plate systems in foot surgery. We have carried out the first systematic review of the relevant published literature so as to systematically evaluate the scientific knowledge available now on this association, assigning predefined eligibility criteria. Fourteen studies were selected which had an overall of 738 cases. The first tarsal metatarsal joint and hallux valgus were treated by the application of different types of Lapidus plate system. The optimal level of the fixation in these procedures is related with the type and system insertion place of the plate with or without screw in each specific foot disease. There is an insufficient number of studies about the effectiveness of the different types of Lapidus plate system in foot surgery, and there is a need to increase outcomes knowledge on the level of the fixation, sort of the system, and insert place in foot surgery. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options. Methods: we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020. Results: There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures. Conclusion: The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.

La incurvación anterolateral congénita de la tibia asociada con polidactilia (congenital anterolateral tibial bowing associated with polydactyly) es una deformidad extremadamente rara. Solo se han documentado 21 casos en la bibliografía inglesa. Aunque existe una estrecha relación entre la incurvación anterolateral de la tibia, la seudoartrosis congénita de la tibia y la neurofibromatosis tipo 1, la incurvación anterolateral congénita de la tibia asociada con polidactilia es una entidad específica con un pronóstico más favorable. Comunicamos otro caso y también revisamos los casos de este cuadro ya reportados con respecto a las deformidades asociadas, el diagnóstico y el tratamiento. Palabras clave: Incurvación tibial; polidactilia; hallux. Nivel de Evidencia: IV

Subungual exostosis is a relatively rare benign bone tumor that occurs near the distal phalanges of the fingers and toes. Though it is similar to osteochondroma, it can be distinguished by its specific location and lack of communication with the medullary cavity. Although recurrence after surgical excision has been reported, no studies have examined the timing or progression of recurrence, nor have there been reports detailing the chronological imaging findings of recurrent cases. A case of subungual exostosis that recurred rapidly with significant growth shortly after surgical excision is reported. The patient was a 13-year-old boy with subungual exostosis of the fourth toe. Tumor recurrence was observed four weeks after the initial excision, and it gradually enlarged, growing to several times the size of the original tumor three months after surgery. A second procedure was performed approximately four months after the initial procedure, and no recurrence has been observed since. This case represents the first report of the chronological radiographic progression of recurrent subungual exostosis, highlighting the importance of careful follow-up and consideration of early recurrence after excision., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Murata et al.)

Mallet hallux injury typically occurs due to trauma from forced hyperflexion. The injury is commonly an avulsion fracture of the extensor hallucis longus tendon at the distal end of the great toe, but the extensor tendon can also rupture around its insertion into the first distal phalanx. It is rare for both types of injury to occur simultaneously. A mallet toe occurring in the hallux is rarely reported, and there is no established standard treatment method. Here, we present our therapeutic strategy for a case of traumatic avulsion fracture and tendon rupture of the distal phalanx of the hallux.