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Abstract Background Amputation of the second toe is associated with destabilization of the first toe. Possible consequences are hallux valgus deformity and subsequent pressure ulcers on the lateral side of the first or on the medial side of the third toe. The aim of this study was to investigate the incidence and possible influencing factors of interdigital ulcer development and hallux valgus deformity after second toe amputation. Methods Twenty-four cases of amputation of the second toe between 2004 and 2020 (mean age 68 ± 12 years; 79% males) were included with a mean follow-up of 36 ± 15 months. Ulcer development on the first, third, or fourth toe after amputation, the body mass index (BMI) and the amputation level (toe exarticulation versus transmetatarsal amputation) were recorded. Pre- and postoperative foot radiographs were evaluated for the shape of the first metatarsal head (round, flat, chevron-type), the hallux valgus angle, the first–second intermetatarsal angle, the distal metatarsal articular angle and the hallux valgus interphalangeal angle by two orthopedic surgeons for interobserver reliability. Results After amputation of the second toe, the interdigital ulcer rate on the adjacent toes was 50% and the postoperative hallux valgus rate was 71%. Neither the presence of hallux valgus deformity itself (r = .19, p = .37), nor the BMI (r = .09, p = .68), the shape of the first metatarsal head (r = − .09, p = .67), or the amputation level (r = .09, p = .69) was significantly correlated with ulcer development. The interobserver reliability of radiographic measurements was high, oscillating between 0.978 (p = .01) and 0.999 (p = .01). Conclusions The interdigital ulcer rate on the first or third toe after second toe amputation was 50% and hallux valgus development was high. To date, evidence on influencing factors is lacking and this study could not identify parameters such as the BMI, the shape of the first metatarsal head or the amputation level as risk factors for the development of either hallux valgus deformity or ulcer occurrence after second toe amputation. Trial Registration: BASEC-Nr. 2019-01791

Background: Amputation of the second toe is associated with destabilization of the first toe. Possible consequences are hallux valgus deformity and subsequent pressure ulcers on the lateral side of the first or on the medial side of the third toe. The aim of this study was to investigate the incidence and possible influencing factors of interdigital ulcer development and hallux valgus deformity after second toe amputation. Methods: Twenty-four cases of amputation of the second toe between 2004 and 2020 (mean age 68 ± 12 years; 79% males) were included with a mean follow-up of 36 ± 15 months. Ulcer development on the first, third, or fourth toe after amputation, the body mass index (BMI) and the amputation level (toe exarticulation versus transmetatarsal amputation) were recorded. Pre- and postoperative foot radiographs were evaluated for the shape of the first metatarsal head (round, flat, chevron-type), the hallux valgus angle, the first–second intermetatarsal angle, the distal metatarsal articular angle and the hallux valgus interphalangeal angle by two orthopedic surgeons for interobserver reliability. Results: After amputation of the second toe, the interdigital ulcer rate on the adjacent toes was 50% and the postoperative hallux valgus rate was 71%. Neither the presence of hallux valgus deformity itself (r =.19, p =.37), nor the BMI (r =.09, p =.68), the shape of the first metatarsal head (r = −.09, p =.67), or the amputation level (r =.09, p =.69) was significantly correlated with ulcer development. The interobserver reliability of radiographic measurements was high, oscillating between 0.978 (p =.01) and 0.999 (p =.01). Conclusions: The interdigital ulcer rate on the first or third toe after second toe amputation was 50% and hallux valgus development was high. To date, evidence on influencing factors is lacking and this study could not identify parameters such as the BMI, the shape of the first metatarsal head or the amputation level as risk factors for the development of either hallux valgus deformity or ulcer occurrence after second toe amputation. Trial Registration: BASEC-Nr. 2019-01791 [ABSTRACT FROM AUTHOR]

Abstract Purpose To evaluate the clinical utility of surgical reconstruction of finger pulp defects using a plantar flap derived from the toes, with vascular anastomosis of the toe-finger artery and the plantar-palmar vein of the finger. Methods Between April 2018 and November 2020, 29 patients with finger pulp defects underwent treatment via the transplantation of pulp tissue from the second toe, with the plantar vein of the toe and the palmar vein of the finger being anastomosed during this procedure. In addition, an anastomosis of the toe and finger artery and nerve was conducted, with a flap size of 1.0 cm * 0.8 cm–2.3 cm * 4.0 cm being used for such repair. Donor tissue sites were closed without introducing deformities or other complications. Results In all patients in the present study, flap tissues survived and did not exhibit evidence of vascular crisis over a mean 16.8-month follow-up period (range 8–24 months). After successful skin flap grafting, they exhibited good elasticity and a soft texture. At three months post-surgery, some patients reported partial recovery of touch sensation in the transplanted tissue, while pain recovery was evident in some patients at 4–6 months post-surgery. No deformities or other complications were observed at the donor site, and the ability of patients to walk normally was not impaired. Conclusion The anastomosis of toe plantar flaps with the palmar vein can facilitate the repair of finger pulp injuries without the need to dissect the dorsal vein of the toe, allowing for the suturing of donor tissue sites without causing any deformities or other complications. This surgical approach can easily be conducted with satisfactory clinical outcomes.

To explore the clinical outcome of a free great toe nail flap (GTNF) combined with a second toe tissue flap (STTF) for fully shaped finger reconstruction (FSFR). From January 2013 to January 20, 2019, patients with finger defects underwent finger reconstruction using free GTNF combined with an STTF. All 20 fully shaped, reconstructed fingers survived without complications. The average follow‐up time was 44.4 months (range 12‐60 months). The reconstructed fingers had better function and appearance. The length of the fingers was close to normal, and the joint positions were normal. The fingers were able to extend −15° to −5° and flex 40° to 85°. The reconstructed fingers had no pain or numbness, and the function of the feet was restored well. The reconstruction of fully shaped fingers using GTNF combined with an STTF results in better function and appearance. This surgical method is worthy of promotion. This article introduces a new surgical method that is related to finger reconstruction. Finger defects bring psychological and functional regrets to patients and their families. Through this operation, the reconstructed finger is more perfect in appearance and function. I think this technology is very effective and worth promoting. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical utility of surgical reconstruction of finger pulp defects using a plantar flap derived from the toes, with vascular anastomosis of the toe-finger artery and the plantar-palmar vein of the finger. Methods: Between April 2018 and November 2020, 29 patients with finger pulp defects underwent treatment via the transplantation of pulp tissue from the second toe, with the plantar vein of the toe and the palmar vein of the finger being anastomosed during this procedure. In addition, an anastomosis of the toe and finger artery and nerve was conducted, with a flap size of 1.0 cm * 0.8 cm–2.3 cm * 4.0 cm being used for such repair. Donor tissue sites were closed without introducing deformities or other complications. Results: In all patients in the present study, flap tissues survived and did not exhibit evidence of vascular crisis over a mean 16.8-month follow-up period (range 8–24 months). After successful skin flap grafting, they exhibited good elasticity and a soft texture. At three months post-surgery, some patients reported partial recovery of touch sensation in the transplanted tissue, while pain recovery was evident in some patients at 4–6 months post-surgery. No deformities or other complications were observed at the donor site, and the ability of patients to walk normally was not impaired. Conclusion: The anastomosis of toe plantar flaps with the palmar vein can facilitate the repair of finger pulp injuries without the need to dissect the dorsal vein of the toe, allowing for the suturing of donor tissue sites without causing any deformities or other complications. This surgical approach can easily be conducted with satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy, advantages and disadvantages of free second toe in the reconstruction of thumb and finger defects in emergency. Methods From March 2010 to May 2017, 98 patients with thumb and finger defects (105 fingers) were collected. There were 18 cases of thumb, 33 cases of index finger, 31 cases of middle finger and 16 cases of ring finger. Defects or degloving injuries of index finger and middle finger at the same time were found in 9 patients. Eleven cases of defects were distal to the middle of the metacarpal bone, 53 cases were distal to the base of the proximal phalanx, 19 cases were distal to the proximal interphalangeal joint and 15 cases were distal segment. Thirteen cases of nerves were extracted from the proximal end about 3 to 5 cm, and the skin at the proximal end of defects was slightly contused. Twenty-nine cases (31 fingers) were reconstructed with the free second toe, and 69 cases (74 fingers) were reconstructed with the second toe combined with the dorsal foot flap. Regular follow-up after operation was performed to evaluate the appearance, function and condition of the donor site. Results All reconstructed fingers (105 fingers) survived and were followed up for 1 to 3 years. The appearance and functional recovery of the reconstructed fingers were satisfactory. According to the trial standard of the upper limb function evaluation of the Chinese Society of Hand Surgery, 87 cases (92 fingers) were excellent, 9 cases (11 fingers) were good and 2 cases (2 fingers) were poor. The excellent and good rate was 97.9%. No obvious hypertrophic scar and dysfunction was found in the donor site. There was no obvious discomfort in weight-bearing and walking. Conclusion Application of free second toe in the reconstruction of thumb and finger defects in emergency can restore good appearance and function, which is an ideal treatment method. [ABSTRACT FROM AUTHOR]

Double toenail is a rare abnormality that usually affects the fifth toe. It is considered as an inherited condition that may represent an incomplete form of polydactyly. Underlying bone abnormalities should be ruled out. We present a case of a double toenail of the second toe, a location that has not previously been described, with underlying bone involvement noted on ultrasound and plain films. [ABSTRACT FROM AUTHOR]