• Archives of Reconstructive Microsurgery
• /
• v.20 no.1
• /
• pp.64-67
• /
• 2011

Reconstruction of the distal portion of the great toe has always represented a difficult problem to surgeons. There are many methods of flap reconstruction described for foot defects, but none for tip of the great toe. We report a case of reconstruction of the great toe using a homodigital reverse pedicle island flap method. A 25-year-old man had a crushing injury at the distal phalanx of the left great toe. A homodigital reverse pedicle island flap was raised from the dorso-medial aspect of the proximal phalanx of the great toe based on the distal dorsal arcade. The flap covered the exposed distal phalanx and stump was closed without shortening. He made an uncomplicated recovery and when seen 6 months later he had a good cosmetic and functional result. A homodigital reverse pedicle island flap is described for the reconstruction of the distal part of the great toe. It involves only a single stage procedure with minimal donor site morbidity and provides a good cosmetic results.

• Archives of Reconstructive Microsurgery
• /
• v.11 no.1
• /
• pp.19-28
• /
• 2002

From 1994-2001, 25 mutilated digits were reconstructed with immediate toe-to-hand transfer in acute hand injury in 21 patients. There were 15 cases of great toe-to-hand transfer(partial great toe transfer 8 cases, modified wrap-around procedure 2 cases, and trimmed great toe transfer 2 cases) for thumb reconstruction, 2 cases of second toe transfer for index reconstruction, and 4 cases of simultaneous two toe-to-hand transfer(great toe & second toe transfer 1 case, bilateral second-toe transfer 2 cases, combined second & third toe transfer 1 case) for reconstruction of multiple digit amputations. Two cases of emergency exploration(2/25, 8%) were successfully salvaged. The incidence of emergency exploration and postoperative infection was not significantly different from that of the elective toe-to-hand transfer cases. Duration of industrial insurance coverage was 225 days, which is much shorter than that of elective cases. Among 43% of patients maintained their original job even after injury and immediate toe-to-hand transfer. The subjective satisfaction self- assessment scores of aesthetic appearance and function on the new reconstructed thumb were 80 and 88 in average, respectively, over a total score of 100. These were higher than those of reconstruction of other digits, but lower than those of elective reconstruction. The donor site after harvest of the great toe was mostly unsatisfied in a view of appearance. Immediate toe-to-hand transfer provides many advantages over elective procedure in acute hand injuries such as single stage reconstruction, shortened convalescent period, early return to work and efficient socio-economic factor. Furthermore because there were no significant differences in success rate, frequency of complications or ultimate functional result, immediate toe-to-hand transfer is a safe and reliable procedure in case of limited indications for acute digits loss.

• Archives of Plastic Surgery
• /
• v.37 no.4
• /
• pp.457-460
• /
• 2010

Purpose: The great toe presents a reconstructive challenge for plastic surgeons. The big toe has much importance not only for the gait and the stability, but also for appearance aspects. Few reports have documented the reconstruction of big toe defects and we report a unique case of free flap reconstruction technique. Methods: A 41-year-old man with right great toe open fracture with soft tissue necrosis was referred from the orthopedic surgery department. On physical examination, there was the skin necrosis circumferentially and the fratured bone was severely fragmented. The metatarsophalangeal (MTP) joint of the big toe was intact. After the wound debridement, we harvested the innervated anterolateral thigh flap and transposed to the defected area. After five months, we finally retouched the flap by the dorsal defatting and distal debulking. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. He has remained asymptomatic for eight months without any recurrence such as the osteomyelitis. Finally, he kept the normal gait and posture with weight bearing on the reconstructed great toe and foot. Conclusion: The anterolateral thigh flap is described for the reconstruction of the great toe. It involves two stage procedure with the minimal donor site morbidity and provides a good cosmetic result.

• Anatomy & Biological Anthropology
• /
• v.30 no.2
• /
• pp.61-65
• /
• 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
• /
• v.13 no.2
• /
• pp.138-141
• /
• 2009

Purpose: Regardless of potential and actual complications, the sesamoidectomy either tibial side or fibular side or both, had been used as a surgical option for various pathologic conditions. The objective of this cadaveric study was to identify the changes of range of motion of great toe after sesamoidectomy. Material and Methods: Eight fresh cadaver legs were used. The angular changes of the hallucal articulations were measured by traction of the flexor hallucis longus tendon at the proximal border of fibro-osseous tarsal tunnel and by traction of the extensor hallucis longus tendon at the superior border of inferior extensor retinaculum. The measurement started at neutral position and proceeded to the maximum for respective tendons. After sesamoidectomy either partial or total, same procedures were repeated and the angular changes were measured. Results: In flexion of great toe, there were significant metatarsophalangeal angular differences at 1 cm traction in total sesamoidectomy and lateral sesamoidectomy. In extension of great toe, there were significant metatarsophalangeal angular differences at more than 2 cm traction in total sesamoidectomy. In other measurements, there were no significant angular changes of the hallucal articulations. Conclusion: The sesamoidectomy resulted in change of motion of great toe. Statistical analysis showed that the significant increases in the initial flexion and maximal extension occurred with total sesamoidectomy and the significant increase in the initial flexion occurred with lateral sesamoidectomy.

• Journal of the Ergonomics Society of Korea
• /
• v.18 no.1
• /
• pp.109-120
• /
• 1999

The characteristics of Korean women's foot shape were extracted by analyzing foot measurements. 14 measurements were measured from foot outline and 12 conventional measurements were taken on the right foot of 386 Korean women from 18 to 86 years. The results indicate that women's foot shape is changed with aging. The young subjects' feet were longer than the foot length of older subjects. The metamorphosis angle of the women over age 45 was greater than the measurement of women under age 45. The typical Korean women's foot shapes characterized by cluster analysis were (1) small foot with little deformity on great toe, (2) wide foot with big deformity on great toe, and (3) thick and narrow foot with moderate deformity on great toe. These results indicate that the foot height and the degree of deformity on great toe are needed to be considered in developing the shoe last for Korean women. The specialized shoe last needs to be developed for elderly.

• Journal of Korean Foot and Ankle Society
• /
• v.16 no.1
• /
• pp.70-72
• /
• 2012

Stress fractures of the proximal phalanx of the great toe are rare. This fractures have been associated with halux valgus deformity in most reports. We performed open reduction and internal fixation with distal chevron osteotomy for the stress fracture of the proximal phalanx of the great toe in a basketball player with hallux valgus, and obtained successful bony union and rapid return to sports.

• The Journal of Korean Physical Therapy
• /
• v.22 no.1
• /
• pp.47-51
• /
• 2010

Purpose: The purpose of this study was to determine whether there are any differences, with and without a toe spreader (TS), in dynamic foot pressure distribution in children with spastic diplegic cerebral palsy. Methods: Dynamic foot pressure recording using the RSscan system were obtained during walking in 12 participants (male=7, female=5) with and without TS. Mean force was measured for four different plantar regions; great toe, forefoot, midfoot, hindfoot. Displacement of center of pressure (COP), velocity of COP displacement and stance time were also measured during gait. Results: TS walking exhibited statistically significant decrease of mean force under great toe and forefoot (p<0.05), compared with a barefoot walking. Also, TS walking exhibited statistically significant increase of antero-posterior displacement of COP (p>0.05). Conclusion: These findings indicate the potential clinical utility of toe spreader to correct dynamic foot pressure during stance phase in children with spastic diplegic cerebral palsy.

• Archives of Reconstructive Microsurgery
• /
• v.13 no.1
• /
• pp.7-13
• /
• 2004

Purpose: The purpose of this study was to present the clinical analysis of the results and our experience of the replantation surgery of the great toe. Materials and Methods: Between March 1995 and December 2002, twelve great toes, amputated from the distal phalanx to proximal phalanx were replanted. The complete types were 5 cases and incomplete types were 7 cases. The guillotine injuries were 4 cases and the crushing injuries were 8 cases. Results: Replantation in eleven out of the twelve amputations survived. The cases of revision were 3 cases due to venous thrombosis. Patients were followed up for a mean period of 2.2 years. The mean total active motion of the first MTP joint was $80^{\circ}$. The fusion of IP joint was carried in 7 cases due to the amputation of the IP joint level. The shortening of the replanted great toes was present, with average 0.9cm. The two point discrimination was 7-8mm except 2 cases with loss of nerve. Conclusion: Although replantation of the great toe remains to be controversial, replantation of the great toe should be considered in well-motivated patients because successful replantation regains an important component of the foot and good functional, cosmetic results.

• Archives of Plastic Surgery
• /
• v.34 no.5
• /
• pp.587-592
• /
• 2007

Purpose: In case of postburn flexion contracture of the fingers, skin graft, geometrical relaxation techniques, local flap, and free flap have been used. Among these procedures, full-thickness skin grafts from the inguinal area are widely used to reconstruct a postburn flexion contracture in the fingers. But there are many esthetic and functional problems in this procedure. Especially, hyperpigmentation of the skin-grafted fingers poses a troublesome problem, particularly in the patients who have dark colored skin. To solve the problem, we have used pulp graft which was harvested from the lateral aspect of great toe. In the present study, we report pulp graft, with which we have obtained a good result in the treatment of postburn flexion contracture of the fingers. Methods: Between September of 2004 and August of 2006, great toe pulp graft was performed to 20 sites of 15 patients. After release of the postburn flexion contracture using Z-plasty, the composite tissue (pulp) harvested from the lateral aspect of great toe was grafted on the raw surface. Moisture dressing with ointment and foam dressing material was performed. Stratum corneum of the graft got stripped off in two to four weeks after pulp graft. The color of the pulp graft was slightly reddish, then it became similar to the adjacent tissue. Results: There was complete take in all the patients who were treated with pulp graft. Great toe pulp graft provided similar color and texture to the adjacent skin, high rate of graft take, and left only a minimal scar at donor site. Conclusion: Thick keratin layer and inelastic nature of the pulp make this type of the graft much easier and simpler, and ensure a better take. Pulp graft is useful method for the reconstruction of the postburn flexion contracture in fingers.