998 results on '"Toes pathology"'
Search Results
2. An 18-Year-Old Man With a Great Toe Lesion.
- Author
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Bramson B, Kashefsky H, and Kashefsky E
- Subjects
- Humans, Male, Adolescent, Toes pathology
- Abstract
Competing Interests: Potential conflicts of interest . The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
- Published
- 2024
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3. Extraskeletal chondroma of the toe in a child with DICER1 tumor predisposition syndrome: support for a dominant negative mechanism.
- Author
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Pelletier D, Sabbaghian N, Chong AL, Priest JR, Elsheikh Ahmed Y, Fox GP, Fabian MR, and Foulkes WD
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- Humans, Child, Male, Germ-Line Mutation, Female, Toes pathology, Ribonuclease III genetics, DEAD-box RNA Helicases genetics, Genetic Predisposition to Disease, Chondroma genetics, Chondroma pathology
- Abstract
DICER1 tumor predisposition syndrome is a pleiotropic disorder that gives rise to various mainly pediatric-onset lesions. We report an extraskeletal chondroma (EC) of the great toe occurring in a child who, unusually, carries a germline "hotspot" missense DICER1 variant rather than the more usual loss-of-function (LOF) variant. No heterozygous LOF allele was identified in the EC. We demonstrate this variant impairs 5p cleavage of precursor-miRNA (pre-miRNA) and competes with wild-type (WT) DICER1 protein for pre-miRNA processing. These results suggest a mechanism through which a germline RNase IIIb variant could impair pre-miRNA processing without complete LOF of the WT DICER1 allele., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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4. Erythematous Flaky Rash on the Toe.
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Friske SK, Wiggins CJ, Carrigg AB, Bohlke AK, and Seervai RNH
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- Humans, Male, Female, Erythema diagnosis, Erythema pathology, Diagnosis, Differential, Exanthema diagnosis, Exanthema etiology, Exanthema pathology, Foot Dermatoses diagnosis, Foot Dermatoses pathology, Toes pathology
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- 2024
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5. Navigating diagnostic challenges-distinguishing malignant melanoma and clear cell sarcoma of soft tissues: a case report and review of the literature.
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Abdouh S, Boujguenna I, Soleh A, Abkari I, and Rais H
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- Humans, Male, Adult, Diagnosis, Differential, Neoplasm Recurrence, Local, Amputation, Surgical, Diagnostic Errors, Immunohistochemistry, Toes pathology, Sarcoma, Clear Cell diagnosis, Sarcoma, Clear Cell pathology, Melanoma diagnosis, Melanoma pathology, Soft Tissue Neoplasms diagnosis
- Abstract
Background: Within the spectrum of melanocytic-differentiated tumors, the challenge faced by pathologists is discerning accurate diagnoses, with clear cell sarcoma of soft tissues standing out as a rare and aggressive neoplasm originating from the neural crest. Accounting for 1% of all soft tissue sarcomas, clear cell sarcoma of soft tissues poses diagnostic complexities, often misidentified owing to its phenotypic resemblance to malignant melanoma. This chapter delves into the intricacies of clear cell sarcoma of soft tissues, its epidemiology, characteristic manifestations, and the imperative need for a comprehensive diagnostic approach involving immunohistochemical and molecular analyses., Case Presentation: A compelling case unfolds as a 25-year-old male from Morocco, initially misdiagnosed with malignant melanoma, experiences tumor recurrence on the second toe. With no history of trauma or familial neoplasia, the patient's clinical journey is explored, emphasizing the importance of detailed clinical examinations and radiological assessments. The chapter elucidates the histopathological findings, immunohistochemical spectrum, and the correlation between clinical parameters and diagnostic inference, ultimately leading to metatarsal amputation. This clinical vignette highlights the multidimensional diagnostic process in soft tissue neoplasms, emphasizing the synergistic role of clinical, radiological, and histopathological insights., Conclusion: The diagnostic challenges inherent in melanocytic-differentiated tumors, exemplified by the rarity of soft tissue clear cell sarcoma, underscore the essential role of an integrated diagnostic approach. This concluding chapter emphasizes the perpetual collaboration required across pathology, clinical medicine, and radiology for nuanced diagnostic precision and tailored therapeutic strategies. The rarity of these soft tissue malignancies necessitates ongoing interdisciplinary engagement, ensuring the optimization of prognosis and treatment modalities through a comprehensive understanding of the diagnostic intricacies presented by clear cell sarcoma of soft tissues., (© 2024. The Author(s).)
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- 2024
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6. Nail-preserving excision of glomus tumor in the second toe: Case report and literature review.
- Author
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Park YU, Han J, and Seo YW
- Subjects
- Humans, Female, Adult, Nails surgery, Toes surgery, Toes pathology, Pain, Glomus Tumor diagnostic imaging, Glomus Tumor surgery, Skin Neoplasms surgery, Nail Diseases diagnosis, Nail Diseases surgery
- Abstract
Introduction: This case report describes the diagnosis of a glomus tumor in the second toe of a 38-year-old female, followed by surgical treatment utilizing a transungual approach to preserve the nail. This study highlights the diagnostic challenges and surgical strategies to treat such tumors while preserving nail integrity., Patient Concerns: Pain occurred once a week, but over time, it increased, and just before seeking medical attention, she experienced pain more than 5 times a day. The pain worsened when cold water touched her toe., Diagnosis: We observed a slight hump indicating nail plate deformity, and the patient exhibited severe pinpoint tenderness (positive Love test) in the affected area. Color duplex ultrasound was performed for further investigation, revealing a hypervascular hypoechoic nodule measuring 0.5 cm in size at the nail bed of the right second toe., Intervention: The surgery was performed under digital nerve block anesthesia using a modified transungual nail-preserving approach for the excision of the glomus tumor., Outcomes: The pain that was reported prior to the surgery has improved postoperatively, and the recovery has been uneventful without any other complication., Conclusion: This paper provides a comprehensive examination of a rare glomus tumor in the second toe, elucidating both diagnostic intricacies and treatment modalities. It emphasizes the dual necessity of achieving total tumor excision while also considering aesthetic outcomes. The insights presented herein are intended to serve as valuable guidance for clinicians confronted with similar clinical scenarios, underlining the delicate interplay between effective tumor management and the preservation of cosmetic integrity., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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7. Digital Gangrene as a Paraneoplastic Manifestation of Peripheral T-cell Lymphoma Not Otherwise Specified Type.
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Madhuram GS, Geetha T, Bharathiraja G, Arunkumar P, Prabagar M, and Subramaniam K
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- Humans, Male, Middle Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cyclophosphamide therapeutic use, Doxorubicin therapeutic use, Vincristine therapeutic use, Prednisone therapeutic use, Gangrene etiology, Gangrene diagnosis, Lymphoma, T-Cell, Peripheral diagnosis, Lymphoma, T-Cell, Peripheral complications, Fingers pathology, Paraneoplastic Syndromes diagnosis, Paraneoplastic Syndromes etiology, Toes pathology
- Abstract
Background: Peripheral T cell lymphoma (PTCL), not otherwise specified (NOS) is a heterogenous group of predominantly nodal T cell lymphomas that generally presents with lymphadenopathy with or without extra nodal involvement. Acral vascular syndrome clinically presents as digital ischemia with Raynaud's phenomenon and acral cyanosis. Although, this condition is commonly associated with connective tissue disorder, smoking and vasculitis, its association with lymphoid malignancy is very rare. Here, we present a case report of a patient with digital gangrene of all toes and fingers as a presenting symptom of PTCL-NOS., Case Description: A 62 year old male presented with digital ischemia associated with pain, low grade fever, loss of appetite and significant weight loss of 6 kilograms over a period of 3 months. On examination, he was found to have bilateral inguinal and axillary lymph nodes with gangrenous changes over toes and fingers but peripheral pulses were palpable. On evaluation he had anemia, elevated ESR and CRP. CT angiogram revealed thinned out digital arteries with multifocal areas of narrowing. Patient was screened for other causes of digital gangrene and was tested negative for ANCA, ANA, cryoglobulins and viral markers. Lymph node biopsy with IHC was suggestive of peripheral T-cell lymphoma-NOS and was started on CHOP regimen. Lymph nodes size decreased and gangrenous changes resolved., Conclusion: Though digital ischemia is a rare paraneoplastic presentation of lymphoma, it should be considered if there is a rapid progression of gangrene. Early initiation of chemotherapy may result in the reduction of further progression of digital gangrene and thus prevent permanent disability. In our patient, progression of gangrene was prevented even though it was an aggressive variant of T cell lymphoma., (© Journal of the Association of Physicians of India 2024.)
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- 2024
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8. Disease aggravation following surgery in a rare patient suspected to Fibrodysplasia (Myositis) ossificans progressiva: a case report.
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Zarei A, Rahimi F, Khadem M, Moradi M, and Rahmani K
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- Female, Humans, Middle Aged, Toes pathology, Bone and Bones pathology, Myositis Ossificans diagnosis, Myositis Ossificans surgery, Ossification, Heterotopic etiology, Ossification, Heterotopic pathology
- Abstract
Background: Fibrodysplasia ossificans progressiva (FOP) as a rare and heritable disorder with the infrequent genetic transmission of the condition is a catastrophic disorder of heterotopic ossification (HO) and a cause of extraskeletal bone formation in humans. Given the lack of effective treatment for this disease, the important point is to avoid aggravating factors such as bone biopsy, surgery, and intramuscular injection., Case Presentation: In this report, we present a 52-year-old female patient, Kurdish ethnic, suspected to FOP who had a surgical intervention on the second toe of the right foot, which subsequently, it caused further deterioration of the disease in the person including necrosis and amputation of the distal phalanx of the second toe., Conclusions: Although, based on our investigation and the available scientific evidence, surgery may a cause for faster progression and worsening of the FOP disorder, but its proof requires further studies., (© 2023. The Author(s).)
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- 2023
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9. [Pretibial myxedema after Graves' disease: A differential diagnosis of lymphedema].
- Author
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Lebreton O, Seddiki R, Abba S, and Vignes S
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- Male, Humans, Female, Diagnosis, Differential, Lower Extremity pathology, Toes pathology, Myxedema diagnosis, Myxedema etiology, Myxedema pathology, Graves Disease complications, Graves Disease diagnosis, Leg Dermatoses diagnosis, Leg Dermatoses etiology, Leg Dermatoses pathology
- Abstract
Introduction: Pretibial myxedema is a rare manifestation of Graves' disease, and pseudotumoral forms may be confused with lower limb lymphedema., Observations: We reported 3 cases of pretibial myxedema in 2 women and 1 man, aged 72, 66, and 49 years, treated for Graves' disease 3, 25 and 32 years previously. Two patients were active smokers. Lymphedema diagnosis of the lower limbs was suspected in the presence of bilateral pseudotumoral lesions of the feet, toes and ankles and the presence of a Stemmer's sign (skin thickening at the base of the 2nd toe, pathognomonic of lymphedema). Lymphoscintigraphy in one case was normal, not confirming lymphedema., Conclusion: Pretibial pseudotumoral myxedema is a differential diagnosis of lower limb lymphedema. This diagnosis is confirmed by questioning the patient about preexisting Graves' disease, the underlying etiology, to decide the appropriate treatment and to encourage cessation of smoking, which is a risk factor for pretibial myxedema., (Copyright © 2023 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2023
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10. Imaging of solitary and multiple osteochondromas: From head to toe - A review.
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Pontes ÍCM, Leão RV, Lobo CFT, Paula VT, Yamachira VS, Baptista AM, and Helito PVP
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- Humans, Magnetic Resonance Imaging, Toes pathology, Exostoses, Multiple Hereditary complications, Exostoses, Multiple Hereditary diagnosis, Bone Neoplasms diagnostic imaging, Osteochondroma complications
- Abstract
Osteochondromas account for 20%-50% of all benign bone lesions. These tumors may present as solitary non-hereditary lesions, which are the most common presentation, or as multiple tumors associated with hereditary conditions. Plain radiography is the imaging method of choice and demonstrates the typical cortical and medullary continuity of the tumor with the underlying bone. Magnetic resonance imaging is often performed to evaluate cartilage cap thickness, which correlates with malignant transformation. Other local complications include compression of adjacent neurovascular bundles, muscles, and tendons, bursitis, tendon tears, stalk fracture, and angular or rotational long bone deformities. Although the imaging features of osteochondromas are largely known, only a few papers in the literature have focused on their main complications and image-based follow-up. This paper aimed to illustrate the main complications of osteochondromas, suggest an image-based algorithm for management and follow-up and discuss differential diagnosis., Competing Interests: Declaration of competing interest The authors have no conflict of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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11. [Carcinoma cuniculatum of toe: report of a case].
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Zheng YH, Guo ZQ, Huang HC, and Li BB
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- Humans, Toes pathology, Carcinoma, Verrucous pathology, Carcinoma, Squamous Cell pathology, Bone Neoplasms, Skin Neoplasms surgery, Skin Neoplasms pathology
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- 2023
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12. Foot Melanoma Localized to Subungual Toe Location Portends Poorer Prognosis.
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Williams ML, Parupia Y, King CM, Dobbs TG, and Peng P
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- Humans, Prognosis, Toes pathology, Melanoma, Cutaneous Malignant, Melanoma surgery, Melanoma pathology, Skin Neoplasms pathology, Nail Diseases surgery, Nail Diseases pathology
- Abstract
Our group previously reported that melanoma of the foot is associated with advanced disease on diagnosis and decreased survival. Lesions localized to the toe appeared to have the worst outcomes. In this study, we both expanded our study to include a 10-year population of patient with invasive melanoma of the foot and ankle and investigated additional factors associated with prognosis. Between January 2007 and December 2016, 211 patients underwent biopsy diagnosis and surgery for invasive melanoma in the BLANK health care system. Demographic, pathologic, staging, and localization characteristics were studied for overall survival. Lesions were localized to dorsal foot, plantar foot, toe (nonsubungual), and toe (subungual) locations. Multivariable analysis found Breslow depth, ulceration, lymph node involvement, and subungual toe location to be associated with poorer survival. Overall survival rate for foot melanoma was 70.6%. Overall survival for nonsubungual toe melanoma was 60.7%, compared to 53.1% for subungual toe melanoma. Of the subungual melanomas, 37.5% of presented as deep lesions with a Breslow depth >4.0 mm. Subungual melanoma was statistically significant for and found to be an independent prognostic factor associated with poorer survival and advanced disease. Based on the results of this study, there should be a low threshold to biopsy suspicious lesions of the toe and foot with particular attention to be dedicated to subungual lesions., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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13. A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms.
- Author
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Exley V, Jones K, O'Carroll G, Watson J, and Backhouse M
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- Male, Humans, Female, Anesthetics, Local, Toes surgery, Toes pathology, Phenol, Recurrence, Randomized Controlled Trials as Topic, Nails surgery, Nails, Ingrown surgery
- Abstract
Background: Ingrown toenails are a common nail pathology. When conservative treatments are ineffective, a surgical approach is often utilised. Despite recent narrative reviews, there is a need for an up-to-date and rigorous systematic review of surgical methods for treating ingrown toenails., Methods: Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails with a follow-up of at least 1 month. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence., Results: Of 3,928 records identified, 36 (3,756 participants; 62.7% males) surgical interventions were included in the systematic review and 31 studies in the meta-analysis. There was very low quality evidence that using phenol with nail avulsion vs nail avulsion without phenol reduces the risk of recurrence (risk ratio [RR] 0.13 [95% CI 0.06 to 0.27], p < 0.001). No favourable effect was observed between chemical or surgical vs conservative management (0.55 [0.19 to 1.61], p = 0.280; 0.72 [0.33 to 1.56], p = 0.410), chemical or surgical vs other (e.g., CO
2 laser, electrocautery) (1.61 [0.88 to 2.95], p = 0.120; 0.58 [0.25 to 1.37], p = 0.220), chemical vs surgical (0.75 [0.46 to 1.21], p = 0.230), surgical vs surgical (0.42 [0.21 to 0.85]), chemical vs chemical (0.19 [0.01 to 3.80], p = 0.280), surgical vs surgical + chemical (3.68 [0.20 to 67.35], p = 0.380), chemical vs surgical + chemical (1.92 [0.06 to 62.30], p = 0.710), local anaesthetic vs local anaesthetic + adrenaline (1.03 [0.22 to 4.86], p = 0.970), chemical timings 30 s vs 60 s (2.00 [0.19 to 21.41]) or antibiotics vs no antibiotics (0.54 [0.12 to 2.52], p = 0.430). Central toenail resection was the only procedure to significantly relieve symptoms (p = 0.001) but data were only available up to 8 weeks post-surgery., Conclusion: Despite the high number of publications, the quality of research was poor and the conclusions that can be inferred from existing trials is limited. Phenolisation of the nail matrix appears to reduce the risk of recurrence following nail ablation, and with less certainty 1 min appears to be the optimum time for application. Despite this being a widely performed procedure there remains a lack of good quality evidence to guide practice., (© 2023. The Author(s).)- Published
- 2023
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14. Calcified Chondroid Mesenchymal Neoplasm: Exploring the Morphologic and Clinical Features of an Emergent Entity With a Series of 33 Cases.
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Kallen ME, Michal M, Meyer A, Suster DI, Olson NJ, Charville GW, Perret R, and Gross JM
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- Male, Female, Humans, Middle Aged, Cartilage pathology, Toes pathology, Neoplasms, Connective and Soft Tissue diagnostic imaging, Neoplasms, Connective and Soft Tissue genetics, Chondrosarcoma pathology, Bone Neoplasms diagnostic imaging, Bone Neoplasms genetics, Bone Neoplasms pathology
- Abstract
Calcified chondroid mesenchymal neoplasm is a term proposed for tumors with a spectrum of morphologic features, including cartilage/chondroid matrix formation, that frequently harbor FN1 gene fusions. We report a series of 33 cases of putative calcified chondroid mesenchymal neoplasms, mostly referred for expert consultation out of concern for malignancy. Patients included 17 males and 16 females, with a mean age of 51.3 years. Anatomic locations include the hands and fingers, feet and toes, head and neck, and temporomandibular joint; 1 patient presented with multifocal disease. Radiologic review showed soft tissue masses with variable internal calcification, which occasionally scalloped bone but in all cases appeared indolent/benign. Tumors had a mean gross size of 2.1 cm and a homogenous rubbery to fibrous/gritty tan-white cut surface. Histology demonstrated multinodular architecture with a prominent chondroid matrix and increased cellularity towards the periphery of the nodules. The tumor cells were polygonal with eccentric nuclei and bland cytologic features and showed a variable amount of increased spindled / fibroblastic forms in the perinodular septa. The majority of cases had notable grungy and/or lacy calcifications. A subset of cases demonstrated at least focal areas of increased cellularity and osteoclast-like giant cells. Herein, we confirm the distinct morphologic and clinicopathologic features associated with this entity with the largest series to date, with a focus on practical diagnostic separation from similar chondroid neoplasms. Awareness of these features is critical in avoiding pitfalls, including a malignant diagnosis of chondrosarcoma., Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2023
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15. Verdrehter Kleinzeh - das muss doch wehtun!
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Rüthemann J
- Subjects
- Humans, Toes pathology
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- 2023
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16. Lipomas of the Toes: An Eight-Case Series.
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Hao X, Mirkin G, Freedman DJ, Beiser I, Firestone L, and Grant D
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- Male, Humans, Female, Middle Aged, Adult, Aged, Magnetic Resonance Imaging, Lower Extremity pathology, Toes surgery, Toes pathology, Retrospective Studies, Lipoma diagnostic imaging, Lipoma surgery
- Abstract
Background: Lipomas, derived from adipose tissue, most frequently occur in the cephalic regions and proximal extremities, but rarely in the toes. We aimed to highlight the clinical features, diagnosis, and treatment of lipomas of the toes., Methods: We analyzed 8 patients with lipomas of the toes who were diagnosed and treated during a 5-year period., Results: Lipomas of the toes were equally distributed by sex. Patients ranged in age from 28 to 67 years (mean age, 51.75 years). Six patients (75%) had a single lesion, and all of the patients developed lipomas on the hallux. Most patients (75%) presented with a painless, subcutaneous, slow-growing mass. The duration from symptom onset to surgical excision ranged from 1 month to 20 years (mean, 52.75 months). Lipoma size varied from 0.4 to 3.9 cm in diameter (mean, 1.6 cm). Magnetic resonance imaging showed a well-encapsulated mass with hyperintense signal on T1-weighted images and hypointense signal on T2-weighted images. All of the patients were treated with surgical excision, and no recurrences were found at mean follow-up of 38.5 months. Six patients were diagnosed as having typical lipomas, one a fibrolipoma, and one a spindle cell lipoma, which needs to be differentiated from other benign and malignant lesions., Conclusions: Lipomas of the toes are rare, slow-growing, painless, subcutaneous tumors. Men and women are equally affected, usually in their 50s. Magnetic resonance imaging is the favored modality for presurgical diagnosis and planning. Complete surgical excision is the optimal treatment, with rare recurrence.
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- 2023
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17. Course and outcome of chilblain-like acral lesions during COVID-19 pandemic.
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Blau K, Lehr S, Aschoff R, Al Gburi S, Brück N, Chapsa M, Schnabel A, Abraham S, Jöhrens K, Beissert S, and Günther C
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- Humans, Pandemics, SARS-CoV-2, Toes pathology, Chilblains epidemiology, COVID-19 epidemiology
- Published
- 2023
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18. Undergrowth Of First Toe In PiK3CA-Related Overgrowth Spectrum (PROS).
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Triana P, Sarmiento MDC, Rodriguez-Laguna L, Martinez-Glez V, and Lopez-Gutierrez JC
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- Female, Humans, Male, Class I Phosphatidylinositol 3-Kinases genetics, Mutation, Phenotype, Treatment Outcome, Adolescent, Growth Disorders diagnosis, Growth Disorders genetics, Growth Disorders pathology, Toes pathology
- Abstract
Background: PIK3CA-related overgrowth syndrome (PROS) include a heterogeneous group of disorders characterized by segmental overgrowth secondary to somatic mosaic activating variants in PIK3CA. Segmental undergrowth is more uncommon and has been less studied but pathogenic variants in PIK3CA have also been found. With this in mind, we have noticed a group of patients with PROS that present an undergrowth component associated with their focal overgrowth., Methods: Retrospective review of patients with PROS presenting overgrowth of the lower limb and undergrowth of the ipsilateral first toe was performed., Results: Six patients were included, 4 female and 2 male with a median age of 16.8 years. All patients presented a PROS phenotype with overgrowth of the lower limb and undergrowth of ipsilateral first toe. A PIK3CA pathogenic variant was confirmed in all patients. Patients underwent multiple treatments, currently all are receiving alpelisib with a mean duration of 15.8 months (1-39) and partial response in lipomatosis and vascular anomalies but no response in overgrowth and undergrowth so far., Conclusions: Pathogenic variants in the same gene can create different phenotypes depending on the time and place of the mutation. There is little information regarding opposing phenotpyes in the same patient with PROS. The presence of undergrowth in our series might be explained by genetic, embryogenic, maternal, or placental factors but needs to be further investigated., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2023
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19. Post-vaccination COVID Toes (Chilblains) Exacerbated by Rituximab Infusion Suggests Interferon Activation as Mechanism.
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Qiao JW, Dan Y, Wolf ME, Zoccoli CM, Demetriou TJ, and Lennon RP
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- Humans, Toes pathology, Vaccination adverse effects, Chilblains pathology, COVID-19 prevention & control, Interferons, Rituximab adverse effects, BNT162 Vaccine adverse effects
- Abstract
Coronavirus disease (COVID) toes are pernio-like skin lesions associated with severe acute respiratory syndrome coronavirus 2. We observed pernio-like skin findings presenting after a Pfizer BioNTech vaccine, which significantly worsened after an infusion of rituximab. This suggests that the mechanism for COVID toes is interferon activation. Military providers may avoid unnecessary referrals for this self-limiting condition by anticipating this adverse effect., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2022
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20. Histopathology of persistent long COVID toe: A case report.
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Nirenberg MS, Requena L, Santonja C, Smith GT, and McClain SA
- Subjects
- Chilblains pathology, Humans, Male, Middle Aged, Obesity complications, SARS-CoV-2 pathogenicity, Time Factors, Post-Acute COVID-19 Syndrome, COVID-19 complications, COVID-19 pathology, Cyanosis complications, Cyanosis pathology, Thrombosis complications, Thrombosis pathology, Toes pathology
- Abstract
During the 2020 coronavirus (SARS-CoV-2) pandemic, several cutaneous lesions were identified, including pseudo-chilblain, vesicular, urticarial, maculopapular, and livedo/necrosis. A 59-year-old obese man with probable COVID-19 developed painful cyanosis with histopathologic capillary thrombosis of toes, and the cyanosis persisted for nearly 22 months. Shortly after initial exposure to family members with documented SARS-CoV-2, he developed upper respiratory symptoms, yet his anti-SARS-CoV-2 antibody and nasal swab RT-PCR tests were repeatedly negative. Two family members were hospitalized and one of them succumbed with documented SARS-CoV-2 pneumonia within 10 days of exposure. Biopsy specimen of the distal toe 16 weeks after initial exposure showed papillary dermal capillary thrombosis with endothelial swelling, telangiectasia, and peri-eccrine lymphocytic infiltrates resembling pernio. Overall, this is the first case of biopsy specimen of "long COVID toe" following presumed SARS-CoV-2 exposure, with a demonstration of thrombotic vasculopathy, toe cyanosis, and pernio-like pathology., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2022
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21. Extraskeletal Ewing Sarcoma from Head to Toe: Multimodality Imaging Review.
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Wright A, Desai M, Bolan CW, Badawy M, Guccione J, Rao Korivi B, Pickhardt PJ, Mellnick VM, Lubner MG, Chen L, and Elsayes KM
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- Adult, Child, Humans, Multimodal Imaging, Positron Emission Tomography Computed Tomography, Toes pathology, Bone Neoplasms diagnostic imaging, Bone Neoplasms pathology, Neuroectodermal Tumors, Primitive, Sarcoma, Ewing diagnostic imaging, Sarcoma, Ewing therapy
- Abstract
Extraskeletal Ewing sarcoma (EES) is a rare subtype in the Ewing sarcoma family of tumors (ESFT), which also includes Ewing sarcoma of bone (ESB) and, more recently, primitive neuroectodermal tumors. Although these tumors often have different manifestations, they are grouped on the basis of common genetic translocation and diagnosis from specific molecular and immunohistochemical features. While the large majority of ESFT cases occur in children and in bones, approximately 25% originate outside the skeleton as EES. Importantly, in the adult population these extraskeletal tumors are more common than ESB. Imaging findings of EES tumors are generally nonspecific, with some variation based on location and the tissues involved. A large tumor with central necrosis that does not cross the midline is typical. Despite often nonspecific findings, imaging plays an important role in the evaluation and management of ESFT, with MRI frequently the preferred imaging modality for primary tumor assessment and local staging. Chest CT and fluorine 18 fluorodeoxyglucose PET/CT are most sensitive for detecting lung and other distant or nodal metastases. Management often involves chemotherapy with local surgical excision, when possible. A multidisciplinary treatment approach should be used given the propensity for large tumor size and local invasion, which can make resection difficult. Despite limited data, outcomes are similar to those of other ESFT cases, with 5-year survival exceeding 80%. However, with metastatic disease, the long-term prognosis is poor.
© RSNA, 2022.- Published
- 2022
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22. Not only toes and fingers: COVID vaccine-induced chilblain-like lesions of the knees.
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Bassi A, Mazzatenta C, Sechi A, Cutrone M, and Piccolo V
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- Fingers pathology, Humans, SARS-CoV-2, Toes pathology, COVID-19 prevention & control, COVID-19 Vaccines adverse effects, Chilblains chemically induced, Chilblains pathology, Knee pathology
- Published
- 2022
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23. Neurofibromatosis from Head to Toe: What the Radiologist Needs to Know.
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Wang MX, Dillman JR, Guccione J, Habiba A, Maher M, Kamel S, Panse PM, Jensen CT, and Elsayes KM
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- Humans, Radiologists, Toes pathology, Glioma complications, Meningeal Neoplasms, Neurocutaneous Syndromes, Neurofibromatosis 1 complications, Neurofibromatosis 1 diagnostic imaging, Neurofibromatosis 1 genetics
- Abstract
Neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) are autosomal dominant inherited neurocutaneous disorders or phakomatoses secondary to mutations in the NF1 and NF2 tumor suppressor genes, respectively. Although they share a common name, NF1 and NF2 are distinct disorders with a wide range of multisystem manifestations that include benign and malignant tumors. Imaging plays an essential role in diagnosis, surveillance, and management of individuals with NF1 and NF2. Therefore, it is crucial for radiologists to be familiar with the imaging features of NF1 and NF2 to allow prompt diagnosis and appropriate management. Key manifestations of NF1 include café-au-lait macules, axillary or inguinal freckling, neurofibromas or plexiform neurofibromas, optic pathway gliomas, Lisch nodules, and osseous lesions such as sphenoid dysplasia, all of which are considered diagnostic features of NF1. Other manifestations include focal areas of signal intensity in the brain, low-grade gliomas, interstitial lung disease, various abdominopelvic neoplasms, scoliosis, and vascular dysplasia. The various NF1-associated abdominopelvic neoplasms can be categorized by their cellular origin: neurogenic neoplasms, interstitial cells of Cajal neoplasms, neuroendocrine neoplasms, and embryonal neoplasms. Malignant peripheral nerve sheath tumors and intracranial tumors are the leading contributors to mortality in NF1. Classic manifestations of NF2 include schwannomas, meningiomas, and ependymomas. However, NF2 may have shared cutaneous manifestations with NF1. Lifelong multidisciplinary management is critical for patients with either disease. The authors highlight the genetics and molecular pathogenesis, clinical and pathologic features, imaging manifestations, and multidisciplinary management and surveillance of NF1 and NF2. Online supplemental material is available for this article.
© RSNA, 2022.- Published
- 2022
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24. Cytologic analysis of a glomus tumor in the left second toe: Case report.
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Hwang J, McDowell S, Cole B, Huber A, and Reyes MCD
- Subjects
- Aged, Biopsy, Fine-Needle, Diagnosis, Differential, Female, Humans, Staining and Labeling, Toes pathology, Adenoma, Pleomorphic, Glomus Tumor diagnosis, Glomus Tumor pathology
- Abstract
We present a 66-year-old female with a glomus tumor diagnosed by fine-needle aspiration (FNA) at the subungual region of her left second toe. Cytologic findings include cohesive clusters of round, uniform cells with scant cytoplasm. Nuclei were monotonous with fine chromatin. No cellular atypia, nuclear inclusions, mitotic figures, nor nucleoli were identified. Cells were surrounded by thick wisps of magenta colored myxoid material reminiscent of a pleomorphic adenoma. Few spindle shaped cells could be seen near the border of the tumor clusters. Staining was positive for alpha-smooth muscle actin. This case report presents one of few FNA diagnosed glomus tumors., (© 2022 Wiley Periodicals LLC.)
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- 2022
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25. Simultaneous Glomus Tumors of the Third and Fourth Toes: A Case Report.
- Author
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Kimura T, Kubota M, Hattori H, and Saito M
- Subjects
- Female, Humans, Middle Aged, Pain, Toes pathology, Toes surgery, Glomus Tumor diagnostic imaging, Glomus Tumor surgery
- Abstract
Case: A glomus tumor of the toes is rare, and as far as we know, there has been no report of simultaneous occurrence in 2 toes. A 45-year-old woman presented with forefoot pain. Based on imaging findings, glomus tumors of the third and fourth toes were suspected. Tumor resection was performed, and pathological examination confirmed the diagnosis of glomus tumors., Conclusion: In this case, it was difficult to recognize the tumors because they occurred simultaneously in 2 toes. Even for sites where a glomus tumor is rare, it is important to understand the characteristic symptoms through a detailed interview and examination., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B852)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)
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- 2022
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26. A clinicopathological description of COVID-19-induced chilblains (COVID-toes) correlated with a published literature review.
- Author
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Kolivras A, Thompson C, Pastushenko I, Mathieu M, Bruderer P, de Vicq M, Feoli F, Harag S, Meiers I, Olemans C, Sass U, Dehavay F, Fakih A, Lam-Hoai XL, Marneffe A, Van De Borne L, Vandersleyen V, and Richert B
- Subjects
- Adolescent, Adult, Aged, Biopsy methods, COVID-19 metabolism, COVID-19 virology, Chilblains diagnosis, Chilblains virology, Child, Diagnosis, Differential, Eccrine Glands pathology, Eccrine Glands ultrastructure, Eccrine Glands virology, Endothelium pathology, Endothelium ultrastructure, Endothelium virology, Female, Humans, Livedo Reticularis pathology, Male, Microscopy, Electron methods, Middle Aged, Prognosis, Prospective Studies, Purpura pathology, SARS-CoV-2 genetics, Skin pathology, Toes virology, Young Adult, COVID-19 complications, COVID-19 diagnosis, Chilblains etiology, Chilblains pathology, Toes pathology
- Abstract
Background: The abundance of publications of COVID-19-induced chilblains has resulted in a confusing situation., Methods: This is a prospective single-institution study from 15 March to 13 May 2020. Thirty-two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT-scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy., Results: COVID-19-induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work-up in this study ruled-out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases., Conclusion: This study provides further clinicopathologic evidence of COVID-19-related chilblains. Negative PCR and antibody tests do not rule-out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis)., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2022
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27. Acquired Digital Fibrokeratoma of the Toe.
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Gara S, Zaouak A, Brahim EB, Jouini R, Fenniche S, and Hammami H
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- Foot pathology, Humans, Lower Extremity pathology, Male, Middle Aged, Toes pathology, Toes surgery, Keratosis diagnosis, Keratosis pathology, Keratosis surgery, Skin Neoplasms pathology
- Abstract
Acquired digital fibrokeratoma is a rare and benign fibrous tumor; it is usually asymptomatic, and frequently arises from the fingers. The diagnosis is easily confirmed by pathologic evaluation. However, in some cases, it may be misdiagnosed as other benign conditions, mainly adnexal tumors and common warts, especially when located on the foot and toes. In this article, we report the case of a 45-year-old man who presented to our clinic for an acquired growth over the plantar surface of the second right toe. The tumor had evolved for 1 year and affected the patient's activities and mobility. On examination, the lesion was a dome-shaped, firm tumor with keratotic distal changes and a broad base attached to the overlying skin. Pathologic assessment was consistent with the diagnosis of acquired digital fibrokeratoma, ruling out other causes of abnormal growth. The tumor was completely excised with surgery, with excellent outcomes and no recurrence at follow-up. Although acquired digital fibrokeratoma is a rare condition, mostly located on the distal upper extremities and fingers, it should be considered in the differential diagnosis of plantar soft-tissue tumors. Surgical management remains the mainstay of treatment.
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- 2021
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28. BCOR-CCNB3 Sarcoma with Prominent Rhabdoid Cells Mimicking Rhabdomyoblasts: Expanding the Morphologic spectrum of BCOR-CCNB3 Sarcoma.
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Cai Z, Duncan D, Li R, Thomas J, and Zhu H
- Subjects
- Adolescent, Cyclin B genetics, Diagnosis, Differential, High-Throughput Nucleotide Sequencing, Humans, Magnetic Resonance Imaging, Male, Proto-Oncogene Proteins genetics, Repressor Proteins genetics, Rhabdomyosarcoma pathology, Sarcoma genetics, Sarcoma pathology, Sarcoma surgery, Toes diagnostic imaging, Toes surgery, Biomarkers, Tumor genetics, Oncogene Proteins, Fusion genetics, Rhabdomyosarcoma diagnosis, Sarcoma diagnosis, Toes pathology
- Abstract
BCOR-CCNB3 sarcoma (BCS) is a rare recently defined undifferentiated sarcoma that predominantly affects children and young adults. The diagnosis of this tumor is difficult due to the highly variable morphology and nonspecific immunophenotype. Emerging data suggest that patients with BCS show response to Ewing sarcoma-based treatment regimen, thus correct diagnosis is of clinical relevance. In this study, we report a case of BCS arising from the big toe of a 15-year-old male patient. The tumor had a prominent population of rhabdoid cells with bright eosinophilic cytoplasm mimicking rhabdomyosarcoma. The tumor cells were focally positive for desmin and myogenin, and negative for CD99. Next-generation sequencing showed the presence of BCOR-CCNB3 gene fusion. BCS with prominent rhabdoid cells has not been described before. This study further expands the morphologic spectrum of BCS.
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- 2021
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29. Terminal osseous dysplasia with pigmentary defects and cardiomyopathy caused by a novel FLNA variant.
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Rumping L, Wessels MW, Postma AV, van Schuppen J, van Slegtenhorst MA, Saris JJ, van Tintelen JP, Robertson SP, Alders M, Maas SM, and Deprez RHL
- Subjects
- Cardiomyopathies complications, Cardiomyopathies pathology, Child, Preschool, Female, Fingers pathology, Genes, X-Linked genetics, Genetic Diseases, X-Linked complications, Genetic Diseases, X-Linked pathology, Humans, Infant, Limb Deformities, Congenital complications, Limb Deformities, Congenital pathology, Mutation genetics, Osteochondrodysplasias complications, Osteochondrodysplasias pathology, Phenotype, Pigmentation Disorders complications, Pigmentation Disorders pathology, Sequence Deletion genetics, Toes pathology, X Chromosome Inactivation genetics, Cardiomyopathies genetics, Filamins genetics, Fingers abnormalities, Genetic Diseases, X-Linked genetics, Genetic Predisposition to Disease, Limb Deformities, Congenital genetics, Osteochondrodysplasias genetics, Pigmentation Disorders genetics, Toes abnormalities
- Abstract
Terminal osseous dysplasia with pigmentary defects (TODPD), also known as digitocutaneous dysplasia, is one of the X-linked filaminopathies caused by a variety of FLNA-variants. TODPD is characterized by skeletal defects, skin fibromata and dysmorphic facial features. So far, only a single recurrent variant (c.5217G>A;p.Val1724_Thr1739del) in FLNA has found to be responsible for TODPD. We identified a novel c.5217+5G>C variant in FLNA in a female proband with skeletal defects, skin fibromata, interstitial lung disease, epilepsy, and restrictive cardiomyopathy. This variant causes mis-splicing of exon 31 predicting the production of a FLNA-protein with an in-frame-deletion of 16 residues identical to the miss-splicing-effect of the recurrent TODPD c.5217G>A variant. This mis-spliced transcript was explicitly detected in heart tissue, but was absent from blood, skin, and lung. X-inactivation analyses showed extreme skewing with almost complete inactivation of the mutated allele (>90%) in these tissues, except for heart. The mother of the proband, who also has fibromata and skeletal abnormalities, is also carrier of the FLNA-variant and was diagnosed with noncompaction cardiomyopathy after cardiac screening. No other relevant variants in cardiomyopathy-related genes were found. Here we describe a novel variant in FLNA (c.5217+5G>C) as the second pathogenic variant responsible for TODPD. Cardiomyopathy has not been described as a phenotypic feature of TODPD before., (© 2021 The Authors. American Journal of Medical Genetics Part A published by Wiley Periodicals LLC.)
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- 2021
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30. Angiosarcoma presenting as unexplainable unilateral leg pain and purpuric toes.
- Author
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Ho G and Murrell DF
- Subjects
- Bone Neoplasms complications, Bone Neoplasms diagnostic imaging, Fluorodeoxyglucose F18, Hemangiosarcoma pathology, Humans, Intestinal Neoplasms complications, Intestinal Neoplasms diagnostic imaging, Intestine, Small diagnostic imaging, Leg diagnostic imaging, Male, Muscle Neoplasms complications, Muscle Neoplasms diagnostic imaging, Positron Emission Tomography Computed Tomography, Purpura pathology, Radiopharmaceuticals, Hemangiosarcoma complications, Hemangiosarcoma diagnostic imaging, Pain etiology, Purpura etiology, Toes pathology
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- 2021
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31. Bilateral Toe Walking as Presentation of Unilateral Dysplasia Epiphysealis Hemimelica of the Ankle: A Case Report.
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Zhang B, Margalit A, Lee RJ, and Shannon CE
- Subjects
- Child, Femur abnormalities, Gait, Humans, Male, Tibia abnormalities, Toes pathology, Ankle diagnostic imaging, Ankle pathology, Bone Diseases, Developmental surgery
- Abstract
Case: We describe a case of dysplasia epiphysealis hemimelica (DEH) of the anterior tibiotalar joint that presented as toe walking in a 6-year-old boy. Radiographs and magnetic resonance images showed substantial exostosis at the anterior ankle that blocked dorsiflexion. He underwent surgical excision and casting for equinus, restoring ankle range of motion and gait., Conclusion: Although DEH is benign, it can cause major deficits and permanent damage to a joint when neglected. Recognition of subtle presentations of DEH, such as toe walking, is crucial. Early treatment can restore joint motion and prevent deformity and arthritis., Competing Interests: Each author certifies that he or she has no commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B666)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)
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- 2021
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32. Chilblains Associated with Chronic Chikungunya.
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de Oliveira Sá MVB, Carvalho DSAL, and Silva Vasconcelos LR
- Subjects
- Autoimmune Diseases complications, Chronic Disease, Female, Humans, Intensive Care Units, Middle Aged, Toes pathology, Chikungunya Fever complications, Chilblains etiology
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- 2021
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33. Surgical management and postoperative evaluation based on morphological classification in central polydactyly of the foot.
- Author
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Oshima J, Sasaki K, Sasaki M, Aihara Y, Nishijima A, and Sekido M
- Subjects
- Child, Preschool, Esthetics, Female, Humans, Infant, Male, Polydactyly classification, Polydactyly pathology, Retrospective Studies, Surgical Flaps, Toes pathology, Polydactyly surgery, Plastic Surgery Procedures methods, Toes abnormalities, Toes surgery
- Abstract
Purpose: Central polydactyly of the foot is rare, with few reports on surgical methods and treatment indications. In this study, based on the experience of central polydactyly in our department, we will consider morphological classification and describe our treatment plan., Method: In this retrospective study, 11 patients (11 digits) with central polydactyly were identified among 136 patients of polydactyly of the foot (2009-2018). They were classified according to morphologic characteristics: type I, the duplicated digits are independent of each other; type II, digits of the same size are duplicated; and type III, digits of different sizes are duplicated., Results: In morphologic classification, there were 4 cases of type II and 7 cases of type III, but there was no case of type I. For type II, surgery was performed using the Bilhaut-Cloquet (BC) procedure in 2 patients, bone-removing flap (flap) method in 1 patient, and simple ablation in 1 patient. For type III, surgery was performed using the BC procedure in 1 patient, flap method in 3 patients, simple ablation in 2 patients, and ligation in 1 patient with floating type., Conclusion: In order to obtain good cosmetic results in digits of morphologic classifications type II and III, it is necessary to select the surgical approach with careful consideration of every feature., Competing Interests: Conflict of interest None declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
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- 2021
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34. An Autopsy Review: "COVID Toes".
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Yilmaz MM, Szabolcs MJ, Geskin LJ, and Niedt GW
- Subjects
- Autopsy, Humans, Male, Middle Aged, SARS-CoV-2, Toes blood supply, COVID-19 complications, COVID-19 pathology, Thrombosis virology, Toes pathology
- Abstract
Abstract: "Severe acute respiratory syndrome coronavirus-2" (SARS-CoV-2) infection has variable described dermatologic manifestations. "COVID (coronavirus disease) toes" became a hallmark of the disease in young and largely asymptomatic patients, who may have negative test results for SARS-CoV-2. Pernio (chilblains)-like lesions are seen mostly in infected pediatric patients and are purple painful, frequently bilateral, ill-defined plaques with prominent inflammation on histological examination. In contrast to pernio-like presentation in children, critically ill adult patients with SARS-CoV-2 develop "purple" digits that may be sharply demarcated and may demonstrate asymmetric areas of ischemia. These 2 contrasting entities are sometimes grouped together as "COVID toes" due to some similarities in clinical appearance and presentation. Here, we summarize histopathologic examination from an autopsy, including the cutaneous lesions from the affected and normal contralateral toes and correlate them with systemic findings. In contrast to pernio-like lesions, the skin of the affected necrotic toes contained thrombi in vessels without prominent inflammation, suggestive of an embolic event. This is further supported by the clinical history of and autopsy findings of popliteal artery thrombus and multiple subsegmental pulmonary emboli. Our findings suggest that critically ill patients with SARS-CoV-2 have different pathological processes affecting skin at peripheral sites (ie, fingers, toes, ears, and nose), which may be due to thromboembolic events. The skin is a mirror of the body and skin pathology may shed light into overall pathogenesis of systemic illness and processes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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35. Acral lentiginous melanoma with HER2/ErbB2 amplification.
- Author
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Donzel M, Harou O, Skowron F, Dalle S, Descotes F, Balme B, and Lopez J
- Subjects
- Aged, 80 and over, Dermoscopy, Female, Humans, Immunohistochemistry, Melanoma, Cutaneous Malignant, Gene Amplification, Melanoma genetics, Melanoma pathology, Receptor, ErbB-2 genetics, Skin Neoplasms genetics, Skin Neoplasms pathology, Toes pathology
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- 2021
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36. Longitudinal intravital imaging nerve degeneration and sprouting in the toes of spared nerve injured mice.
- Author
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Yeh HY, Lee JC, Chi HH, Chen CC, Liu Q, and Yen CT
- Subjects
- Animals, Female, Intravital Microscopy trends, Longitudinal Studies, Male, Mice, Mice, Inbred C57BL, Mice, Transgenic, Neurons, Afferent chemistry, Intravital Microscopy methods, Nerve Degeneration pathology, Neuralgia pathology, Neurons, Afferent pathology, Toes innervation, Toes pathology
- Abstract
Neuropathic pain is pain caused by damage to the somatosensory nervous system. Both degenerating injured nerves and neighboring sprouting nerves can contribute to neuropathic pain. However, the mesoscale changes in cutaneous nerve fibers over time after the loss of the parent nerve has not been investigated in detail. In this study, we followed the changes in nerve fibers longitudinally in the toe tips of mice that had undergone spared nerve injury (SNI). Nav1.8-tdTomato, Thy1-GFP and MrgD-GFP mice were used to observe the small and large cutaneous nerve fibers. We found that peripheral nerve plexuses degenerated within 3 days of nerve injury, and free nerve endings in the epidermis degenerated within 2 days. The timing of degeneration paralleled the initiation of mechanical hypersensitivity. We also found that some of the Nav1.8-positive nerve plexuses and free nerve endings in the fifth toe survived, and sprouting occurred mostly from 7 to 28 days. The timing of the sprouting of nerve fibers in the fifth toe paralleled the maintenance phase of mechanical hypersensitivity. Our results support the hypotheses that both injured and intact nerve fibers participate in neuropathic pain, and that, specifically, nerve degeneration is related to the initiation of evoked pain and nerve sprouting is related to the maintenance of evoked pain., (© 2021 Wiley Periodicals LLC.)
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- 2021
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37. A novel EZH2 gene variant in a case of Weaver syndrome with postaxial polydactyly.
- Author
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Turkkahraman D, Sakarya ANP, and Randa NC
- Subjects
- Abnormalities, Multiple diagnostic imaging, Abnormalities, Multiple pathology, Adolescent, Child, Congenital Hypothyroidism complications, Congenital Hypothyroidism diagnostic imaging, Congenital Hypothyroidism pathology, Craniofacial Abnormalities complications, Craniofacial Abnormalities diagnostic imaging, Craniofacial Abnormalities pathology, Fingers diagnostic imaging, Fingers pathology, Hand Deformities, Congenital complications, Hand Deformities, Congenital diagnostic imaging, Hand Deformities, Congenital pathology, Humans, Male, Polydactyly complications, Polydactyly diagnostic imaging, Polydactyly pathology, Toes diagnostic imaging, Toes pathology, Abnormalities, Multiple genetics, Congenital Hypothyroidism genetics, Craniofacial Abnormalities genetics, Enhancer of Zeste Homolog 2 Protein genetics, Fingers abnormalities, Hand Deformities, Congenital genetics, Polydactyly genetics, Toes abnormalities
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- 2021
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38. Clinical Observation and Data to Advance COVID-19 Knowledge.
- Author
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Ayello EA and Sibbald RG
- Subjects
- COVID-19 complications, Chilblains diagnosis, Foot Diseases diagnosis, Humans, Toes pathology, COVID-19 pathology, COVID-19 Testing statistics & numerical data, Chilblains virology, Foot Diseases virology, Toes virology
- Published
- 2021
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39. A Review of COVID-19 Chilblains-like Lesions and Their Differential Diagnoses.
- Author
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Sachdeva M, Mufti A, Maliyar K, Lara-Corrales I, Salcido R, and Sibbald C
- Subjects
- COVID-19 complications, Chilblains pathology, Chilblains virology, Diagnosis, Differential, Fingers pathology, Humans, Skin Diseases pathology, Skin Diseases virology, Symptom Assessment, Toes pathology, COVID-19 diagnosis, Chilblains diagnosis, Skin Diseases diagnosis
- Abstract
General Purpose: To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Identify the population most often affected by COVID toes.2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions., Competing Interests: Acknowledgment: Dr Lara-Corrales is part of the Pediatric Dermatology Research Alliance COVID-19 Response Task Force, a collaboration between the Society for Pediatric Dermatology and the Pediatric Dermatology Research Alliance. She has also disclosed ongoing financial relationships with Abbvie & Sanofi Genzyme as well as past relationships with Johnson & Johnson, Avicanna, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Pierre Fabre, Regeneron, Clementia, and Valeant. Dr Sibbald has disclosed past financial relationships with Novartis, Pfizer & Sanofi Genzyme. Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity. The remaining authors, faculty, staff, and planners, including spouses/partners (if any), in any position to control the content of this CME/NCPD activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies relevant to this educational activity., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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40. Association of Higher Hydroxychloroquine Blood Levels With Reduced Thrombosis Risk in Systemic Lupus Erythematosus.
- Author
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Petri M, Konig MF, Li J, and Goldman DW
- Subjects
- Adult, Antirheumatic Agents therapeutic use, Chromatography, Liquid, Female, Fingers blood supply, Fingers pathology, Gangrene epidemiology, Humans, Hydroxychloroquine therapeutic use, Logistic Models, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction epidemiology, Protective Factors, Pulmonary Embolism epidemiology, Stroke epidemiology, Tandem Mass Spectrometry, Toes blood supply, Toes pathology, Venous Thrombosis epidemiology, Antirheumatic Agents blood, Hydroxychloroquine blood, Lupus Erythematosus, Systemic drug therapy, Thrombosis epidemiology
- Abstract
Objective: Hydroxychloroquine (HCQ) has a primary role in the prophylaxis and treatment of systemic lupus erythematosus (SLE) and may be protective against thrombosis in SLE. Optimal weight-based dosing of HCQ is unknown. This study was undertaken to examine the usefulness of HCQ blood monitoring in predicting thrombosis risk in a longitudinal SLE cohort., Methods: HCQ levels were serially quantified from EDTA whole blood by liquid chromatography-tandem mass spectrometry. The mean HCQ blood levels calculated prior to thrombosis or until the last visit were compared using t-tests between patients with and those without thrombosis. Pooled logistic regression was used to analyze the association between rates of thrombosis and HCQ blood level. Rate ratios (RRs) and 95% confidence intervals (95% CIs) were calculated., Results: In 739 patients with SLE, thrombosis occurred in 38 patients (5.1%). The mean ± SD HCQ blood level was lower in patients who developed thrombosis versus those who did not develop thrombosis (720 ± 489 ng/ml versus 935 ± 580 ng/ml; P = 0.025). Thrombosis rates were reduced by 13% for every 200-ng/ml increase in the most recent HCQ blood level (RR 0.87 [95% CI 0.78-0.98], P = 0.025) and by 13% for mean HCQ blood level (RR 0.87 [95% CI 0.76-1.00], P = 0.056). Thrombotic events were reduced by 69% in patients with mean HCQ blood levels ≥1,068 ng/ml versus those with levels <648 ng/ml (RR 0.31 [95% CI 0.11-0.86], P = 0.024). This remained significant after adjustment for confounders (RR 0.34 [95% CI 0.12-0.94], P = 0.037)., Conclusion: Low HCQ blood levels are associated with thrombotic events in SLE. Longitudinal measurement of HCQ levels may allow for personalized HCQ dosing strategies. Recommendations for empirical dose reduction may reduce or eliminate the benefits of HCQ in this high-risk population., (© 2020, American College of Rheumatology.)
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- 2021
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41. Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic.
- Author
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Discepolo V, Catzola A, Pierri L, Mascolo M, Della Casa F, Vastarella M, Smith G, Travaglino A, Punziano A, Nappa P, Staibano S, Bruzzese E, Fabbrocini G, Guarino A, and Alessio M
- Subjects
- Adolescent, Female, Hospitals, Humans, Italy, Lymphocytes metabolism, Male, Pandemics, Prospective Studies, SARS-CoV-2, Skin blood supply, Toes blood supply, COVID-19, Chilblains etiology, Chilblains pathology, Skin pathology, Toes pathology, Vascular Remodeling
- Abstract
Importance: Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive., Objective: To examine the association of chilblain-like lesions with SARS-CoV-2 infection., Design, Setting, and Participants: This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy., Main Outcomes and Measures: Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy., Results: Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions., Conclusions and Relevance: This study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis. These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection. Ongoing studies will help clarify the etiopathogenic mechanisms.
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- 2021
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42. 'Blue toes' following vaccination with the BNT162b2 mRNA COVID-19 vaccine.
- Author
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Davido B, Mascitti H, Fortier-Beaulieu M, Jaffal K, and de Truchis P
- Subjects
- BNT162 Vaccine, Humans, RNA, Messenger, Vaccination, COVID-19 prevention & control, COVID-19 Vaccines adverse effects, Toes pathology
- Published
- 2021
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43. Subungual Osteochondroma in a Pediatric Patient.
- Author
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Ricardo JW, Chikeka I, Umans H, and Lipner SR
- Subjects
- Adolescent, Bone Neoplasms pathology, Bone Neoplasms surgery, Curettage, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging, Osteochondroma pathology, Osteochondroma surgery, Toes diagnostic imaging, Toes pathology, Toes surgery, Bone Neoplasms diagnosis, Osteochondroma diagnosis
- Published
- 2021
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44. [29-year-old female patient with acute painful bullae on fingers and toes].
- Author
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Muehlenberg K, Hauröder B, and Pech O
- Subjects
- Adult, Female, Humans, Acute Pain virology, Blister diagnosis, Blister pathology, Blister virology, COVID-19 complications, Fingers pathology, Toes pathology
- Abstract
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
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- 2021
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45. Management of acute lesser toe pain.
- Author
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Ray J, Andrews NA, Dib A, Harrelson WM, Khurana A, Singh MS, and Shah A
- Subjects
- Acute Disease, Bunion, Tailor's pathology, Bunion, Tailor's therapy, Chronic Pain, Foot Orthoses, Fractures, Bone pathology, Fractures, Bone therapy, Humans, Immobilization methods, Joint Dislocations pathology, Joint Dislocations therapy, Metatarsalgia etiology, Metatarsalgia surgery, Metatarsus abnormalities, Metatarsus pathology, Osteochondritis congenital, Osteochondritis pathology, Osteochondritis therapy, Physical Examination, Metatarsalgia pathology, Metatarsalgia therapy, Toes pathology
- Abstract
Patients with foot pain commonly present to their primary care physicians for their initial management and treatment. These patients and their respective foot or lesser toe pain can present the physician with a complex problem with a long differential list. Depending on the timing of the pain and underlying pathology, these differentials can be divided into acute and acute exacerbation of chronic conditions. This review categorizes the history, physical exam, radiological findings, conservative treatment, and surgical management for each major cause of lesser toe pain, whether acute or chronic. The acute conditions surrounding lesser toe pain in the adult population discussed are toe fractures, toe dislocations, and metatarsal head and neck fractures. The chronic pathologies surrounding lesser toe pain in the adult population evaluated in this review include metatarsalgia, Morton's neuroma, Freiberg infraction, brachymetatarsia, bunionettes, and lesser toe disorders.
- Published
- 2021
- Full Text
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46. COVID Purpura (Toes) Case Series: A Chilblains-Like Vasculopathy.
- Author
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Olsen TG, Shrit MA, Feeser TA, and Wargo JJ
- Subjects
- Adult, Chilblains pathology, Female, Humans, Male, Middle Aged, Purpura pathology, SARS-CoV-2, Vascular Diseases pathology, Young Adult, COVID-19 complications, COVID-19 pathology, Chilblains virology, Purpura virology, Toes pathology, Vascular Diseases virology
- Abstract
Abstract: Biopsies were taken from 4 patients who presented to their dermatologist with violaceous papules and plaques of the dorsal toes (COVID Toes) associated with varying degrees of severe acute respiratory syndrome coronavirus 2 exposure and COVID-19 testing. Major histopathologic findings were lymphocytic eccrine inflammation and a spectrum of vasculopathic findings to include superficial and deep angiocentric-perivascular lymphocytic inflammation, lymphocytes in vessel walls (lymphocytic vasculitis), endothelial swelling, red blood cell extravasation, and focal deposits of fibrin in both vessel lumina, and vessel walls. Interface changes were observed to include vacuolopathy and apoptotic keratinocytes at the basement membrane. Immunostains showed a dominant T-cell lineage (positive for T-cell receptor beta, CD2, CD3, CD5, and CD7). B-cells were rare and clusters of CD123-positive dermal plasmacytoid dendritic cells were observed surrounding eccrine clusters and some perivascular zones. The consistent perieccrine and vasculopathic features represent important pathologic findings in the diagnosis of COVID toes and are suggestive of pathogenetic mechanisms. Clinicopathologic correlation, the epidemiological backdrop, and the current worldwide COVID-19 pandemic favor a viral causation and should alert the physician to initiate a workup and the appropriate use of COVID-19 testing., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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47. Efficacy and safety of condylectomy with minimally invasive surgery in the treatment of interdigital corns of the lesser toes compared to conservative treatment.
- Author
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Marti-Martinez LM, Lorca-Gutierrez R, Sánchez-Pérez SP, Garcia-Campos J, Fernández Ehrling N, and Ferrer-Torregrosa J
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures methods, Podiatry methods, Prospective Studies, Toes pathology, Toes surgery, Treatment Outcome, Callosities therapy, Conservative Treatment methods, Foot Diseases therapy, Osteotomy methods, Podiatry statistics & numerical data
- Abstract
Background: Minimally invasive surgery (MIS) procedures cause less trauma to the patient and might improve recovery. This study aimed to determine the efficacy and safety of condylectomy with MIS to treat interdigital corns of the lesser toes., Methods: This prospective cohort study was conducted in seven podiatry centers. Patients with interdigital corns of the lesser toes, progressing for more than a year, with one or more recurrences in the last year following conservative treatments were eligible. The recruited patients were classified according to their treatment: conservative or surgical (condylectomy with MIS) and were compared. Patient satisfaction, pain, the clinical and functional status of the foot and the appearance of sequelae were assessed at 3 and 6 months after treatment., Results: At 6 months, patients in the surgical treatment group showed no pain on pressure, which significantly differed from the conservative treatment group (p < 0.001). They also improved clinical and functional status of the foot, reaching values comparable to those of the standard population. No paresthesia, joint stiffness or instability, toe malalignment, or corn transfer to a contiguous site resulted from the surgical treatment., Conclusions: Condylectomy with MIS is effective and safe to treat interdigital corns of the lesser toes.
- Published
- 2021
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48. Atypical cutaneous and musculoskeletal manifestation of SARS-CoV-2: 'COVID-19 toes' and spasticity in a 48-year-old woman.
- Author
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Kopacz A, Ludwig C, and Tarbox M
- Subjects
- Analgesics therapeutic use, Blister drug therapy, Blister etiology, Blister pathology, Female, Foot Diseases drug therapy, Foot Diseases pathology, Gabapentin therapeutic use, Humans, Middle Aged, Muscle Spasticity drug therapy, Muscle Spasticity pathology, SARS-CoV-2, Toes pathology, COVID-19 complications, Foot Diseases etiology, Muscle Spasticity etiology
- Abstract
Establishing accurate symptomatology associated with novel diseases such as COVID-19 is a crucial component of early identification and screening. This case report identifies an adult patient with a history of clotting dysfunction presenting with rare cutaneous manifestations of COVID-19, known as 'COVID-19 toes'', previously described predominantly in children. Additionally, this patient presented with possible COVID-associated muscle spasticity of the lower limbs, as well as a prolonged and atypical timeline of COVID-19 infection. The rare occurrence of 'COVID-19 toes'' in this adult patient suggests that her medical history could have predisposed her to this symptom. This supports the coagulopathic hypothesis of this manifestation of COVID-19 and provides possible screening questions for patients with a similar history who might be exposed to the virus. Additionally, nervous system complaints associated with this disease are rare and understudied, so this novel symptom may also provide insight into this aspect of SARS-CoV-2., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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49. Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery.
- Author
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Ohta K, Fukushi JI, Ikemura S, Kamura S, Miyahara HA, and Nakashima Y
- Subjects
- Adult, Aged, Blood Sedimentation, Female, Humans, Male, Middle Aged, Preoperative Period, Toes surgery, Arthritis, Rheumatoid surgery, Orthopedic Procedures adverse effects, Postoperative Complications epidemiology, Toes pathology, Wound Healing
- Abstract
Objectives: Delayed wound healing is one of the most common complications following forefoot surgery in patients with rheumatoid arthritis. We aimed to identify the risk factors for delayed wound healing following rheumatoid forefoot surgery., Methods: Consecutive patients who underwent primary rheumatoid forefoot surgery (86 feet; 53 patients) between April 2008 and February 2019 were retrospectively evaluated. Clinical data, including smoking history, duration of the disease, presence of diabetes mellitus, medication, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein, the surgical procedure performed, and the Japanese Society for Surgery of the Foot (JSSF) scores, were collected., Results: Delayed wound healing was identified in 20 of 86 (23.3%) feet. In univariate analysis, participants showing delayed healing were older at the time of surgery ( p = .04), their ESR was higher ( p = .0006), and their total ( p = .019) and pain ( p = .016) scores on the JSSF Lesser toe scale were lower than those showing normal healing. In multivariable analysis, both the total preoperative JSSF Lesser toe scale score ( p = .0239) and ESR ( p = .0126) remained significant risk factors for delayed wound healing., Conclusions: After rheumatoid forefoot surgery, surgeons should pay more attention to wound care in patients with lower preoperative JSSF Lesser toe score and high ESR.
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- 2021
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50. Acro-ischemic lesions associated with extremely elevated D-Dimer in a child during the COVID-19 pandemic.
- Author
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García-Gil MF, Monte Serrano J, García García M, Pascual-Del-Riquelme JA, and Ara-Martín M
- Subjects
- Biomarkers blood, Child, Humans, Male, COVID-19 blood, COVID-19 pathology, Fibrin Fibrinogen Degradation Products analysis, Skin Diseases, Viral blood, Skin Diseases, Viral pathology, Toes pathology
- Published
- 2021
- Full Text
- View/download PDF
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