• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.153-158
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• 2014

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

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.508-511
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• 2011

Purpose: Blue toe syndrome consists of blue or purplish toes in the absence of a history of obvious trauma, serious cold exposure, or disorders producing generalized cyanosis. It is a life-threatening and still underrecognized disease. It can be commonly occurred by vascular surgery, invasive cutaneous procedures or anticoagulant therapy. Our case is presented of blue toe syndrome related to atheromatous embolization that was presumably triggered by angio CT. Methods: A 69-year-old man presented with the suddenly developed pain, cyanosis and livedo reticularis of the toes in right foot. Dorsalis pedis pulses were palpable. He had been performed a diagnostic angio CT 1 month earlier. Angio CT revealed diffuse aortic atheromatous plaque in lower abdominal aorta and both common iliac artery. One month after angio CT, he visited our clinic. There was no visible distal first dorsal metatarsal artery and digital artery of right first toe in lower extremity arteriography. A diagnosis was established of blue toe syndrome. Because his symptom was aggravated, we performed the exploration of the right foot. After exposure of first dorsal metatarsal artery, microsurgical atheroembolectomy was done. Results: There were no postoperative complications. After three months the patient had no clinically demonstrable problems. Conclusion: Patient with blue toe syndrome is at high risk of limb loss and mortality despite treatment. Blue toe syndrome produces painful, cyanosed toes with preserved pedal pulses. It needs to be aware of blue toe syndrome. Careful history should reveal the diagnosis. Treatment is controversial, however, most believe that anticoagulation therapy should be avoided.

• Korean Journal of Applied Biomechanics
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• v.29 no.3
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• pp.185-196
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• 2019

Objective: The aim of this study was to suggest correct and effective way of squat through biomechanical analysis variables on the change of the toe-out angle. Method: 7 high school male weightlifter (age: $17.57{\pm}0.53yrs$, height: $174.0{\pm}3.93cm$, weight: $81.0{\pm}9.17kg$, 1RM: $164.29{\pm}20.7kg$) participated in this study. Results: Angle of the hip joint at E2 was smaller than toe-out angle was in $20^{\circ}$ than in $0^{\circ}$ (p<.05). Angular velocity of the foot joint at E1 and E3 was quicker that in $10^{\circ}$ than in $30^{\circ}$ (p<.05). Anterior-posterior stability index was greater that toe-out angle was in $30^{\circ}$ than in $0^{\circ}$ (p<.05). In average iEMG of flexion phase, VM of right, left leg showed high activity at toe-out angle $30^{\circ}$. In average iEMG of flexion phase, extension phase and in peak iEMG, RF of right leg, VM and VL of left leg showed high activity at all of the toe-out angles. In average iEMG of flexion phase, extension phase and in peak iEMG, all of the muscles activity of right leg showed high in $10^{\circ}$ and low in $0^{\circ}$, $30^{\circ}$. Conclusion: It is judged that setting the toe-out angle $10^{\circ}$ in squat help to efficiently use muscles and ensure stability.

• The Journal of Korean Physical Therapy
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• v.34 no.1
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• pp.12-17
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• 2022

Purpose: Ankle dorsiflexion is an essential element of normal functions, including walking, activities of daily living and sport activities. The tibialis anterior (TA) muscle functioned as a dorsiflexor and as a dynamic stabilizer of the ankle joint during walking and jumping. This study aimed to compare TA muscle thickness using ultrasonography according to the four different toe and ankle postures for the selective TA strengthening exercise. Methods: This study were recruited 26 (males: 15, females: 11) aged 20-30 years, with no injury ankle and calf in the medical history, had normal dorsiflexion and inversion range of motion (ROM). The thickness of the TA muscle was measured by ultrasonography in the four different toe and ankle postures: 1. Ankle dorsiflexion with all toe extension and ankle inversion (ITEDF); 2. Ankle dorsiflexion with all toe flexion and ankle inversion (ITFDF); 3. Ankle dorsiflexion with all toe extension and neutral position (NTEDF); 4. Ankle dorsiflexion with all toe flexion and neutral position (NTFDF). One-way repeated analysis of variance (ANOVA) and Bonferroni correction were used to confirm the significant difference among conditions. The level of statistical significance was set at α=0.01. Results: TA muscle thickness with ITFDF was significantly greater than in any other ankle positions, including ITEDF, NTFDF, and NTEDF (p<0.01). Conclusion: Among the four toe and ankle postures, isometric contraction in ITFDF postures showed the greatest increase in thickness of TA rather than ITEDF, NTEDF, and NTFDF postures. Based on these results, ITFDF can be recommended in an efficient way to selectively strengthen TA muscle.

• ETRI Journal
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• v.42 no.1
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• pp.46-53
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• 2020

Gait analysis is an effective clinical tool across a wide range of applications. Recently, inertial measurement units have been extensively utilized for gait analysis. Effective gait analyses require good estimates of heel-strike and toe-off events. Previous studies have focused on the effective device position and type of triaxis direction to detect gait events. This study proposes an effective heel-strike and toe-off detection algorithm using a smart insole with inertial measurement units. This method detects heel-strike and toe-off events through a time-frequency analysis by limiting the range. To assess its performance, gait data for seven healthy male subjects during walking and running were acquired. The proposed heel-strike and toe-off detection algorithm yielded the largest error of 0.03 seconds for running toe-off events, and an average of 0-0.01 seconds for other gait tests. Novel gait analyses could be conducted without suffering from space limitations because gait parameters such as the cadence, stance phase time, swing phase time, single-support time, and double-support time can all be estimated using the proposed heel-strike and toe-off detection algorithm.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.1
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• pp.103-108
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• 2011

Purpose : The purposes of this study were to compare the muscle activity ratio of tibialis anterior (TA) / extensor digitorum longus (EDL) during the active ankle dorsiflexion in subjects with the normal toe (NT) and the hammer toe (HT). Methods : Nineteen subjects with the NT group and nineteen subjects with the HT group were recruited for this study. The muscle activities of TA and EDL were measured by using surface electromyography (EMG) and the angles of ankle dorsiflexion and eversion of the subtalar joint were measured by using 3-dementional motion analysis during the active ankle dorsiflexion in prone position. Results : The muscle activity ratio of TA / EDL was significantly lower in the HT group compared to the NT group (p<.05). The angle of ankle dorsiflexion was significantly lower in the HT group compared to the NT group (p<.05). Conclusions : These results suggest that muscle imbalance between TA and EDL muscle and decreased ankle dorsiflexion range of motion may contribute to hammer toe deformity. Further studies are needed to confirm that the correcting of this imbalance and the increasing ankle dorsiflexion could improve toe alignment in the subjects with HT.

• Korean Journal of Human Ecology
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• v.12 no.1
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• pp.75-84
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• 2003

The objective of this paper was to analyse the foot type of female university students by the direct and indirect measure of foot and the measures of foot outline. The results were as follow: 1. The length and the width of foot were small and ankle slender and the modification of the big toe slight. 2. The analysis on the 16 measure items revealed five factors; the first factor was related to the width and girth of foot, the second one to the length of foot, the third one to the transformation of the little toe, the fourth one to the height of foot, the fifth one to transformation of the big toe. 3. The grouping on the shape of foot revealed three types. The inline angle of foot was the smallest in average in the type 1, while it appeared to be middle in the other types. The wider foot shapes were grouped as type 2 because their inline and outline angles of foot were the biggest in average. In the type 3, the big toe was curved a lot, since it was the largest in average. 4. From the naked eye measuring method, classification from which toe was popped-out told that Egyptian foot was 30.9%, Greek foot 27.9%. On the other hand, the instrumental method showed that Egyptian foot was 57.3%, Squared foot 35.3% and Greek foot 7.4%. 5. The result from the analysis about the traits of foot shape by the degree of the arch formation of bottom foot, showed that 33.8% had the normal foot, 66.2% slightly flat foot or middle one. There was no one with rigid flat foot. 6. The shoes size they declared were that 240cm was 33.3%, 235cm 18.1% and 245cm 18.1%. The shape of their shoe heel were flat heel(34.8%), cuban heel(25.5%), and narrow straight heel(19.9%); and that of the shoe toe were round toe(25.4%), oval toe(20.4%) and squared toe(20.4%). 7. The discomforting parts when they wear shoes were the little toe(35.4%), the rear of foot(13.9%), and the width of foot(13.9%), which was related to their dislike of shoe with the pointed toe.

• Anatomy & Biological Anthropology
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• v.30 no.2
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• pp.61-65
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• 2017

This report describes a variation of the tendinous slip of the flexor digitorum longus (FDL) for the great toe. In addition, compositions of the long flexor tendons for all five toes were examined. The tendons of the FDL in the foot were investigated in 66 specimens of embalmed Korean adult cadavers. The tendons of the flexor hallucis longus (FHL) and the FDL with the lumbrical muscles were cut at the calcaneus and the metatarsophalangeal joints and were removed en bloc specifically to observe the FDL and the FHL tendons of the great toe. The tendinous slip of the FDL for the great toe was found bilaterally in the foot of a 52-year-old male. Its prevalence was two of 66 specimens (3.0%). The tendinous slip of the FDL for the great toe passed forward the great toe, and it constituted the superficial portion of the long flexor tendon for the great toe. The tendon of the FHL passed forward to constitute the deep portion of the long flexor tendon for the great toe. Thus, both the tendinous slip of the FDL and the tendon of the FHL composed the long flexor tendon for the great toe. The tendinous slip of the FDL and the tendon of the FHL for the great toe were similar in thickness; thus, each tendinous slip of the FDL and the tendon of the FHL were approximately one-half of the long flexor tendon for the great toe in thickness. The present study demonstrated an anatomical variation of the interconnection between the FHL and the FDL tendons, which will be useful for various surgeries and biomechanical research.

• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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• pp.225-233
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• 2013

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

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.63-67
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• 2007

This study was designed to introduce free toe tissue transfer using infiltration method of local anesthetic agent. Four toe pulp tissues were transferred to reconstruct finger tip defect in four patients who were not suitable for general anesthesia. Two flaps taken from the lateral side of the great toe was used for reconstruction of thumb defect and two flaps from the medial side of the second toe for resurfacing of the index and fifth finger. Flap sizes were various from $2.0{\times}2.0\;cm^2$ to $1.6{\times}4.0\;cm^2$. Anesthesia was induced by infiltration of 2% lidocaine hydrochloride (with 1:100,000 epinephrine) with dilution of normal saline in same volume unit, as like as in ordinary digital block. All vessels were anastomosed within 2 cm of distance from the proximal margin of the defect. Whole operative procedures were carried out by one team. All flaps were successfully taken without complication. The average operation time was 4 hours 10 minutes. The amount of anesthetic agent used in whole operative procedures was roughly 4 mL in the toe, 8 mL in the finger, and 12 mL totally. In conclusion, free toe tissue transfer using infiltration method of local anesthetic agent would be good strategy for finger tip reconstruction in the patient not suitable for general anesthesia.