A new surgical procedure for hallux limitus treatment: Double-V osteotomy on the base of the proximal phalanx of the hallux.

The purpose of this study was to evaluate the effectiveness of the new Double-V osteotomy of the first metatarsophalangeal joint (1MPJ) in patients with hallux limitus (HL).A study of 66 patients was performed, 33 patients were treated Cheilectomy and 33 were treated Double-V. All patients underwent an assessment of the passive mobility of the 1MPJ before the procedure, reevaluated 12 months later evaluating dorsiflexion, plantarflexion, and patients status using both the American Orthopaedic Foot and Ankle Society (AOFAS) for Hallux Metatarsophalangeal-Interphalangeal Scale.In comparing the improvement achieved regarding the increase of mobility obtained with surgical treatment, the feet operated with procedure Double-V gained significant degrees of movement increased in all analyzed parameters (P < .05). We achieved 13.33° more than average in dorsiflexion motion and 2.12° more than average in plantarflexion with regard to the feet that were operated with Cheilectomy procedure. Double-V scores on the AOFAS scale improved significantly (P = .000) 91.48 points postoperative, while with the following Cheilectomy only 79.30 points.This new surgical technique, easy to perform and with low complexity in surgical execution and a minimum of complications, produces better clinical and functional results that Cheilectomy alone.

Giant Glomus Tumor and Neuroma in the Fifth Ray A Case Report.

We present the case of a patient with a glomus tumor that was atypical because of its large size and histologic characteristics. It was located in the dorsal-distal zone of the fifth ray of the left foot and was associated with a neuroma under the fifth metatarsal head. Although the pain (of a neurologic type) was attributed to the neuroma, the unknown nature and evolution of the dorsal lesion (glomus tumor) made surgical treatment necessary. Surgery, together with compensating treatment of the functional alterations of the patient's feet (pronation of the subastragalar joint, supination of the forefoot, and fifth metatarsal overload syndrome), resolved the case.

Intravascular myopericytoma in the heel: case report and literature review.

Intravascular myopericytoma (IVMP), regarded as a variant of myopericytoma, is a rare tumor. Very few cases have been described, none in the foot.The first case of IVMP located in the heel of the foot is described in this article. A literature review is reported of all cases of IVMP published in the English literature.A 48-year-old man possessed an IVMP on the heel of the right foot. The physical examination and histopathological and ultrasound studies are described. The literature review yielded 5 cases of IVMP, 2 of which were in the thigh and 1 each in the oral mucosa, the periorbital region, and the leg.The possibility that these lesions may be malignant suggests that the histopathological study of vascular tumors should include immunohistochemical tests.

Multiple interdigital neuromas: a retrospective study of 279 feet with 462 neuromas.

Morton's neuroma is a common pathologic entity that, traditionally, was considered to be an isolated tumor that rarely affected more than 1 interdigital space. However, in recent years, multiple neuromas have become more common in our day-to-day practice. The objective of the present study was to assess the frequency with which Morton's neuroma appears in the different interdigital spaces. A retrospective study was performed of 279 feet that had been surgically treated for Morton's neuroma using a dorsal approach during a 9-year period (from January 2003 to December 2011), with an ultrasound scan taken preoperatively and histopathologic analysis performed afterward. From the 279 treated feet, 462 interdigital neuromas were surgically removed. Of the 279 feet, 97 (34.8%) displayed isolated neuromas, and 182 (65.2%) were treated for multiple neuromas. Regarding the neuromas that were treated as isolated lesions, 74.2% were located in the third space. For the feet affected by multiple interdigital neuromas, 100% had a neuroma in the third space and 98.9% in the second. The incidence of multiple interdigital neuromas can be considered frequent. The assessment, therefore, of interdigital neuromas of the foot should include, at a minimum, the second and third interdigital spaces.

Biphalangeal/triphalangeal fifth toe and impact in the pathology of the fifth ray.

BACKGROUND: Having reviewed the studies on the biphalangeal fifth toe, we have observed a great disparity of data depending on the research center. We have investigated the frequency of biphalangeal toes and also its handedness. We have also analyzed the relationship of pathological deviations of fifth toe with this feature and with the fifth metatarsal. METHODS: We performed a descriptive prospective study, which analyzed 2494 feet (1247 people) with bilateral dorsoplantar radiographs. We studied the number of phalanges of the fifth toe, the deviations in the sagittal and transverse plane, and the state of the fifth metatarsal phalangeal joint. RESULTS: After analyzing the data we found the presence of biphalangeal fifth toe in 46.3% of the feet, presenting this feature bilaterally in 97.4% of them. A statistically significant higher percentage of pathological toes was found in people with triphalangeal fifth toe (pathological in 29.91%) than in the biphalangeal toes (pathological in 15.60%). We found that these differences are accentuated in the alterations of the fifth toe in the sagittal plane. CONCLUSIONS: It is almost 4 times more likely to suffer a fifth hammer toe if the fifth toe is triphalangeal (OR = 3.98 to p = 0.000). Alterations in the coronal plane of the fifth toe are associated with tailor's bunion (p = 0.000). We did not find any significant differences regarding the need for surgery of the fifth toe of the biphalangeal (39.1%) versus triphalangeal toes (60.9%). CLINICAL RELEVANCE: There may be an association between pathologic deviations and bigger mobility of the triphalangeal fifth toes. However, biphalangeal fifth toes show bigger rigidity leading to smaller accommodation inside the shoe, which may lead to less painful feet and decreased proportion of surgery.

Plasma corticotropin-releasing factor in depressed patients before and after the dexamethasone suppression test.

BACKGROUND: Plasma cortisol, beta-endorphin, corticotropin, corticotropin-releasing factor, and salivary cortisol concentrations, resting and after ingestion of 1 mg of dexamethasone, were investigated in depressed patients and controls. METHODS: Fourteen outpatients from the psychiatric department diagnosed with depressive disorder (ICD-10 Classification) participated in the study. The comparison group consisted of 12 healthy volunteers from the hospital staff. All hormones were measured using direct iodine-125 radioimmunoassay, except corticotropin-releasing factor, which included a sample preextraction and concentration step. RESULTS: The basal plasma cortisol and corticotropin-releasing factor levels in depressive disorder were significantly higher than in the healthy group. After dexamethasone administration, corticotropin-releasing factor plasma values decreased significantly in the depressed group, but showed no significant changes in the controls. In depressive disorder baseline values correlated significantly for salivary cortisol and plasma cortisol, salivary cortisol and plasma corticotropin-releasing factor and plasma corticotropin and beta-endorphin. Similar correlations were found in the healthy subjects, except for salivary cortisol and plasma corticotropin-releasing factor. CONCLUSIONS: These findings indicate that the increased corticotropin-releasing factor plasma concentrations demonstrated in depressive disorder reflect the hypothalamic corticotropin-releasing factor hypersecretion evidenced in this illness. Therefore, measurements of plasma corticotropin-releasing factor levels can be considered a reliable tool for investigating the role of this peptide in the pathophysiology of depression.