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Congenital curved nail of the fourth toe (CNFT) is a rare nail deformity. We report a case of CNFT with thickening and hyperkeratosis at the hyponychium and peripheral nail bed that was successfully treated using a novel surgical technique. A 7-year-old Japanese boy had a clawed nail with thickening and hyperkeratosis at the hyponychium and peripheral nail bed on his bilateral fourth toes. His chief complaint was pain. The nails of the bilateral fourth toes curved plantarly and exhibited thickening and hyperkeratosis of the hyponychium and peripheral nail bed. A surgical approach was planned to improve the condition. The distal phalanges that deviated and formed a point toward the nail bed were partially shaved, and a soft tissue flap was created in the finger pad and shifted to cover the distal phalanges. The dorsal side of the distal phalanges was covered by the nail bed flap. Recurrence has not been observed for 3 years after surgery. There is limited evidence supporting surgical approaches for CNFT. This approach may be an effective treatment option for CNFT with thickening of the nail bed.

Fibro-osseous pseudotumor of the digit is an unusual benign tumor that appears on the extremities. A 45-year-old, human immunodeficiency virus–positive man presented with a painful lesion on the tip of the fourth toe of his right foot. The tumor was completely excised without any connection to the underlying bone being observed, although the phalanx had to be extirpated. Histopathology confirmed the diagnosis of fibro-osseous pseudotumor. At the follow-up visit, 12 months later, no abnormalities were found.

To reveal the diversity of Indonesian bent-toed geckos, we pay attention to Kalimantan (Borneo)—an island which has received less attention than other Indonesian islands such as Sumatra, Java, Sulawesi, the Moluccas, and the Lesser Sunda archipelagos. About 30 years after Hikida (1990) described three new Cyrtodactylus from Borneo, four more species were described, namely C. limajalur and C. muluensis in 2019, and C. hantu and C. miriensis in 2021, all by Davis et al. Through examination of the collection at MZB and three addition specimens collected from Tawau, we found several undescribed species, one of which we describe here. This new species is easily differentiated from all other congeners by the combination of the following characters: maximum SVL of at least 65.8 mm; no tubercles on dorsal surface of upper arm; tubercles present in the ventrolateral body folds; 28–30 paravertebral tubercles; 17–20 longitudinal dorsal tubercle rows; 39–46 ventral scale rows at midbody; 17–19 subdigital lamellae on fourth toe; precloacal pit with 5–7 pores in males arranged in a wide Λ-shape but absent in females; no enlarged transverse median subcaudals; paired dark brown semilunar-shaped markings on the upper nape. Further study is needed to reveal its molecular phylogenetic position and biogeographical history.

Macrodactyly is a rare congenital disorder affecting the digits of hands and feet. It is often distressing for both parents and children. Surgical options range from soft tissue debulking with or without osteotomy and physeal arrest to simple or ray amputation. Although amputation is generally reserved for the severe progressive variant of macrodactyly and revision surgery, there is controversy regarding whether initial amputation or debulking is the best approach. We present a case of isolated macrodactyly of a minor toe, where debulking showed superior results.

A 63-year-old man suffered from a right foot open fracture (bone loss from the middle of the fifth metatarsal bone) and ultra-long soft tissue loss due to a traffic accident. After emergent surgical debridement, a 15 × 7 cm soft-tissue defect involving two-third of the lateral border of the foot and the lateral half of the fourth toe.

Soft tissue lesions found within the foot and ankle can vary in their origin. Tenosynovial giant-cell tumours (TSGCT) are quoted as rare in their presentation yet also reported to be the sixth most common benign lesion in the foot. This article presents a case report following the patient journey suffering with a TSGCT of the fourth toe. From initial consultation, to further investigation with advanced imaging to a final decision on surgical excision following consideration of conservative management.

Hypertrophic scar formation is a major clinical problem that results in both cosmetic issues and functional loss. The management of a hypertrophic scar varies according to the severity of the sequelae from the scar. We describe a method of treatment in a patient who had a history of multiple debridements due to snake bite resulting in severe contracture of the fourth toe complicated with a hypertrophic scar.

Background The aim of the study was to present a new operative technique for aesthetic and anatomic reconstruction of polysyndactyly of the fifth toe fused with the fourth toe. Methods Surgery was performed in 86 feet in 73 patients with polysyndactyly of the fifth toe fused with the fourth toe. The operation involved polydactyly excision, syndactyly release using an improved dorsal asymmetric gullwing flap for web space reconstruction without skin grafting, and simultaneous correction of valgus deformity and brachydactyly of the toes. The web shape (height and width),scar contracture, and aesthetic outcomes (foot contour and morphology of the reconstructed fifth toe) were assessed using the criterion of D'Arcangelo, Vancouver Scar Scale score, and older children and parent-based satisfactory questionnaire, respectively. Results The patients were followed up for 12 to 36 months. The reconstructed web spaces were slightly deeper than normal, with an hourglass shape and a physiological slope. Valgus deformity was completely corrected without recurrence. The reconstructed fifth toes appeared to be visually lengthened. On the basis of the criterion of D'Arcangelo, the height and width of the webs were good in 76, fair in 10, and poor in none of the feet. The mean Vancouver Scar Scale score was 1.5. All parents and patients were satisfied with the appearance and function. Conclusions Our new operative procedure could achieve aesthetic and anatomic reconstruction of polysyndactyly of the fifth toe fused with the fourth toe with good shape of the reconstructed web space without skin grafting, favorable appearance and axis alignment of the reconstructed fifth toes, and good foot contour.

We report a case of a 55-year-old female with extreme right fourth toe pain of unknown origin that was resistant to conservative care. Resection confirmed invasion of the neuroma into the fourth digit with hypertrophy and herniation of the proper digital nerve. The patient experienced an uneventful recovery with some minor neurogenic symptoms experienced at six months postoperatively that resolved with off-loading padding and heat massage. Complete pain relief was reported at her 12-month review. Isolated neuroma within a toe results in digital pain that may respond to excision.

This is a case report with literature review and discussion of current diagnostic studies and management of a rare case of glomus tumour in the fourth toe of a 36-year-old male patient.

When one or more of the person’s metatarsal bones are unusually small is known as hypoplastic metatarsal or Brachymetatarsia. Metatarsal are 5 miniature bones which present between the tarsal bones and the phalanges of the foot. This may cause significant pain and the toes appear to be short abnormally. Incidence of brachymetatarsia is one in 2,000 people. Women are affected more. Down’s syndrome and other genetic conditions may also increase the incidence of brachymetatarsia. To treat brachymetatarsia surgeons have two choices-corrective footwear or surgery. In the present case we found shortening of fourth toe of both foot in 45 year old male without any complaints or similar familial incidence. Keywords: Brachymetatarsia, Metatarsal hypoplasia, Bilateral 4th toe shortening, Short fourth toes, Congenital brachymetatarsia.

Congenital curved nail of the fourth toe represents an unusual deformity in which the nail of the fourth toe curves in a plantar direction. It is unknown why only this toe is affected; however, the initial descriptions suggest that this is a mesodermal defect. We describe a case of congenital curved nail of the fourth toe associated with bifid uvula. There are only 2 reports mentioning the association of this nail abnormality with cleft palate and/or lip. In our patient, there was an association with bifid uvula that is considered a minor form of palatine fissure. There seems to be an association of congenital curved nail of the fourth toe with cleft palate to different degrees; however, the pathogenesis of the deformity remains unknown.

The first toe-to-hand transplantation was done in 1898 by Nicoladoni. It was a staged procedure and the toe flap was based on a pedicle. With advancement of optical instruments and microsurgeons' skills in 1964 the first microvascular toe-to-hand transplantation on a rhesus monkey was done. The technique's development has not stopped, many authors have modified it to achieve better outcomes for both traumatic and congenital hand defects. The most commonly used toes for transplantation are first, second, and second to third toe block. Well described plantar and dorsal vascular systems for first web space vessels as well as possibility to perform successful perforator anastomosis allows us to improve toe-to-hand transplantation further. There is a paucity of studies on single fourth toe-to-hand transplantation. We performed fourth-toe transplantation for three pediatric patients (mean age, 73 mo) with congenital (n=2) and traumatic (n=1) hand defects. Common plantar digital arteries were used for blood supply to the transplanted toes. No vascular problems occurred, and all transplanted toes survived. Patients and parents are satisfied with functional and esthetic outcomes. Early podometry results show insignificant changes which should not harm the foot in the long-term. We believe the fourth-toe transplantation is a promising method to use to reconstruct congenital or traumatic absence of digits for pediatric population.

Ospreys are renowned for their fishing abilities, which have largely been attributed to their specialized talon morphology and semi-zygodactyly−the ability to rotate the fourth toe to accompany the first toe in opposition of toes II and III. Anecdotal observations indicate that zygodactyly in Ospreys is associated with prey capture, although to our knowledge this has not been rigorously tested. As a first pass toward understanding the functional significance of semi-zygodactyly in Ospreys, we scoured the internet for images of Osprey feet in a variety of circumstances. From these we cross-tabulated the number of times each of three toe configurations (anisodactylous, zygodactylous, and an intermediate condition between these) was associated with different grasping scenarios (e.g., grasping prey or perched), contact conditions (e.g., fish, other objects, or substrate), object sizes (relative to foot size), and grasping behaviors (e.g., using one or both feet). Our analysis confirms an association between zygodactyly and grasping behavior; the odds that an osprey exhibited zygodactyly while grasping objects in flight were 5.7 times greater than whilst perched. Furthermore, the odds of zygodactyly during single-foot grasps were 4.1 times greater when pictured grasping fish compared to other objects. These results suggest a functional association between predatory behavior and zygodactyly and has implications for the selective role of predatory performance in the evolution of zygodactyly more generally.

Background Brachymetatarsia is a rare congenital or developmental condition that results in a short metatarsal. The condition most commonly affects the fourth metatarsal of young and adolescent females. It does not usually produce a functional problem. However, it may produce a significant cosmetic problem especially in young women. The authors present their experience in gradual distraction of the fourth metatarsal to tackle this problem in adults. Methods That was done using a monolateral frame in 11 feet of female patients with an average age of 23 years. Evaluation depended upon the achievement of the target length, angulation, pain, and satisfaction of the patient. Results There were eight excellent and three good results after an average follow up of 2.6 years. Aside from nine cases of mild pin-tract infection, complications were few and minor. Conclusions We recommend distraction osteogenesis as the treatment of choice for brachymetatarsia of the fourth toe.

The bones of the ostrich feet were formed by the distal extremity of the tarso-metatarsus bone, which had two articular surfaces (trochleae) for the articulation with two digits (III, IV). The first and second toes lacked. The third toe was larger than the fourth one and each consisted of four phalanges. The fourth toe was consisted of 4 phalanges with the absence of the claw. The distal phalanx of the third toe which was had a long tapering cone was enveloped completely in a keratinized long straight claw (dagger-shaped). The gross anatomical description was supported by images (x-rays and skeleton of the feet) and discussed in comparison with other birds species.

Giant cell tumors of the tendon sheath (GCT-TS) are one of the most common tumors of the hand, along with ganglions. However, occurrence in the toes is far less common. Here we present a rare case of GCT-TS at the middle phalanx level of the flexor digitorum longus tendon sheath. Magnetic resonance imaging showed low intensity both on T1 and T2 weighted images. To the best of our knowledge, our case is the first report of a GCT-TS arising at the middle phalanx level of the flexor digitorum longus tendon sheath of the fourth toe. Although GCT-TS are rare in the toe, they must be included in the differential diagnoses of soft tissue tumors arising in the toes.

We describe a new species of Ptychadena from Mutinondo Wilderness in northern Zambia. It has rupicolous tadpoles that develop in a film of water. The species is distinguished on morphology, advertisement call and DNA sequences from other grass frogs and was found to be most closely related to P. broadleyi. It has no contrasting longitudinal bands on the posterior thigh, the foot is longer than half SVL, it has no light triangle on the snout, three phalanges of the fourth toe free of web and the snout has no skin folds. The species should be considered Near Threatened in terms of the IUCN Red List criteria given its limited extent of occurrence and population size.

The concept of bilateral symmetry in organisms involves the division of the body plan along a plane that splits the animal's body into right and left sides that are mirror images of each other. However can this be true for toe lengths and ratios? The present study evaluates the symmetric differences in toe length and toe-length ratios among the three major ethnic groups in Nigeria. A total of 1574 adult Nigerian Hausas (664), Igbos (420) and Yorubas (490) of equal sex were included in the study. Aged between 18-65 years, were randomly selected from various states. Written informed consent was taken from each participant, sample size was determined by proportion, using Cochran formulae for infinite population. A digital Vernier caliper was used to obtain direct linear measurements of the toe length of both feet; hallux (1T), second toe (2T), third toe (3T), fourth toe (4T), and the fifth toe (5T). Ten (10) possible toe-length ratios were also determined and named as follows; 1T/2T, 1T/3T, 1T/4T, 1T/5T, 2T/3T, 2T/4T, 2T/5T, 3T/4T, 3T/5T, and 4T/5T. Data were analyzed using SPSS (IBM ® Armonk, New York, USA) and Minitab V17 (Minitab ® Inc. State College, Pennsylvania) statistical software. Paired-sample t-test was used to evaluate symmetry; Pearson’s Correlation was used for inter-prediction of the toes and ratios. Confidence level was set at 95%; as P-values ≤0.05 were considered significant. The result showed that some of the toe length of both feet were significantly assymetrical among the studied ethnic groups; Hausa males (1T df =1.35 and 5T df =0.55; P

A new dicroglossid frog allied to Bornean Limnonectes kuhlii-like fanged frogs is described from Krayan of East Kalimantan, Indonesia, and Kelabit Highlands of northern Sarawak, East Malaysia based on morphological characteristics. The new species, L. sinuatodorsalis is superficially similar to other Bornean species L. asperatus and L. hikidai in small body size and poorly developed webbing on the fourth toe, but differs from them in several characteristics, especially in dorsal texture. The new species occurs syntopically with Limnonectes cf. kuhlii in both the two known localities, possibly through ecological segregation by large body size difference between them.

Extraskeletal osteochondroma is a rare benign tumor that occurs predominantly in the soft tissues of the hands and feet. The congenital occurrence of this lesion in children is very rare. We report the case of a 9-year-old male who presented with slowly progressive swelling in his left third web space since birth that was painful with prolonged walking and had displaced his fourth toe further laterally, causing both functional and cosmetic problems. Radiographs and computed tomography revealed a well-circumscribed densely ossified lesion. Excision biopsy of the lesion showed a lobulated extraskeletal osteochondroma. At the end of 1 year of follow-up, the child had had no recurrence. To the best of our knowledge, this is the first report of congenital extraskeletal osteochondroma of the foot in English-language published studies.

This case report concerns a patient with a painful soft-tissue mass on his fourth toe. He was evaluated for this soft-tissue mass and was diagnosed as having tuberous sclerosis. The podiatric physician should be able to evaluate a patient with a lower-extremity complaint and relate whether this complaint may correlate with a systemic disorder. This case report will make the podiatric physician more aware of tuberous sclerosis and the manifestations of the disorder.

Polydactyly is a prevalent birth anomaly observed in the foot, and a number of classification systems have been suggested for this condition. Postaxial (fifth or little toe) polydactyly is the most common type. We encountered an exceedingly rare presentation of foot postaxial polydactyly that, to our inspection, had neither been previously classified nor described in published studies. In the present report, we have described an otherwise healthy 2-year-old female who had presented to our clinic with an isolated, extra little toe on her left foot. Foot radiographs revealed the presence of all 5 metatarsals; however, the fifth metatarsal was blocked and did not give rise to the fifth toe. Instead, the fifth (medial normal) and sixth (lateral extra) toes had originated from a single, separate accessory bud from the fourth metatarsal, and the main fourth metatarsal had given rise to the normal fourth toe. The lateral sixth toe was excised, and a periosteal sleeve of the excised extra toe was used for reconstruction of the lateral collateral ligament. We propose that this heretofore unmentioned presentation of postaxial polydactyly be added to the existing systems of classification of pedal polydactyly. A review of the published data pertaining to pedal polydactyly has also been presented.

Introduction: Hair tourniquet syndrome is rare presentations that are not often encountered in orthopedic OPD’s. The syndrome was recognized long back but there have only been a few published reports in regard to the sequel it follows. The usual case presentation was an infant that had been crying in an inconsolable manner and upon careful examination was found to have a digit or a body part entangled by a hair or a textile thread causing a tourniquet like effect but our case was unique as it was an incidental finding. Case Report: This case reports a 5 months old healthy female child that was accidentally found to have a hair wrapped around her left fourth toe on her regular routine vaccination visit. Conclusion: This presentation is quite different than the presentation usually encountered or those presented previously in literature. The diagnosis of the syndrome requires a high index of suspicion, it may present a diagnostic dilemma therefore through awareness of the condition is important.

A new species of forest dwelling Rock Gecko, Cnemaspis roticanai sp. nov., is described from the upper elevations of Gunung Raya, Pulau Langkawi, Kedah, Peninsular Malaysia. Cnemaspis roticanai is the second species of Cnemaspis described from Pulau Langkawi and is differentiated from all other Southeast Asian Cnemaspis in having a unique combination of color pattern and scale characteristics including keeled subtibials, ventrals, subcaudals, dorsal tubercles, and forearm scales; 25–27 paravertebral tubercles; a median row of enlarged, keeled subcaudals; five or six precloacal, pore-bearing scales in males separated medially by one or two non-pore-bearing scales; 26–29 subdigital lamellae on the fourth toe; no dark, longitudinal gular markings or blotches; no dark shoulder patch enclosing a white to yellow ocellus; and having a yellow to white, prescapular crescent. Cnemaspis roticanai is the latest species in a growing list of new taxa being discovered from the Langkawi Archipelago.

The term ‘AINHUM’ is derived from the African word meaning ‘to saw or cut’. True ainhum otherwise called dactylolysis spontanea is a condition involving soft tissue or digits with constricting rings commonly presenting in fifth toes, usually bilateral. It is to be differentiated from Pseudo-ainhum that occurs secondary to some hereditary and nonhereditary diseases that lead to annular constriction of digits. We report a rare case of true ainhum involving the left fourth toe only. It is a very rare case and a very few were reported worldwide. The highest incidence of ainhum has been reported in South Africa and South America. It is rarely reported in India. Ainhum when diagnosed and treated in early stages can be prevented from progressing to mutilating deformities.

Brachymetatarsia is considered to be caused by early fusion of the epiphyseal line and it is most commonly found in the fourth metatarsus. Since it is often observed in the fourth toe in women, it is treated to achieve improvement from an aesthetic aspect. We have devised a new metatarsal lengthening operation for brachymetatarsia by a hydroxyapatite graft. First, a full-scale model of the bilateral fourth metatarsi was prepared using three dimensional computed tomography (3D CT) data. Based on this model, a spacer, 10 mm in length, was prepared using hydroxyapatite with a 15 % porosity rate. At present, 3 years have passed since the operation on the left foot, and 2 years and 8 months after the operation, good morphology with no pain or tylomas has been maintained. In X-ray examinations, callus formation has progressed and the metatarsal alignment is good. Since many patients are young women, this method has many advantages as follows: donors are not needed, one-point lengthening is possible, shortening due to postoperative bone resorption does not occur, bone alignment is not damaged, and the time until start of walking is short.

Using thermography, skin temperature was evaluated in a 76-year-old patient with type II diabetes mellitus, presenting with diabetic foot ulceration on the right hallux and a corn on the left fourth toe. Increased skin temperature was observed in both the right hallux and the left fourth toe, though there were no visible clinical signs of infection. Unexpectedly, the high temperature area was seen to extend from the left fourth toe to the ankle. The patient was later diagnosed with osteomyelitis, due to the presence of a high-intensity area on T2-weighted magnetic resonance imaging, suggesting the elevated skin temperature was due to osteomyelitis. Based on these observations, thermography could prove useful for screening for foot ulcers with osteomyelitis.

Herein we describe a new species of the gekkonid genus Cyrtopodion from Dadun, a town between Toksun County and Turpan City, Xinjiang Uygur Autonomous Region, Western China. It differs from congeners in China and adjacent countries by the combination of nostril bordered by rostral, first supralabial, one supranasal, and two subequal postnasals; dorsal tubercles arranged in regular longitudinal rows; 23-26 ventral scales across mid-abdomen; 97-108 scales along the ventrum of body from postmental to cloaca; 18-22 subdigital lamella beneath fourth toe; 8-10 precloacal pores in males; caudal tubercles broadly in contact laterally with each other; a single row of transversally enlarged subcaudals; dorsal bands in waving shape, much thinner than interspaces.

The God creates human body with versatility, in which there is a correlation between the length of particular part of the body and height. Height is one of the four major biological profiles in forensic anthropology to identify a subject. The toe is apart of the body located on the lower limb where there is a toe bone (os phalanx) which is a long bone. An athlete has more nutritional intake and physical activity than non-athletes. The Javanese ethnic is the largest ethnic group in Indonesia. Height may vary based on the respective ethnicity. Senior High School 3 Purwokerto is a high school that has a class of football athletes and non-athletes class. To identify the correlation between the length of toes and height of athletes football and non-athletes of Javanese male students in Senior High School 3 Purwokerto. Analytical observational with cross sectional study design. The research subjects were taken by using simple random sampling method with the total of subjects 72 students. Data was analyzed using parametric correlation Pearson, nonparametric spearman and regression analysis. The result shows that There is a relation on several toes with height on both of the football athletes and non-athletes namely right big toe, right index toe, right middle toe, right fourth toe, left big toe, left index toe, left middle toe and left fourth toe, ranging from low to strong correlation (r = 0, 200-0, 799).There is a relationship between the length of toes and height of football athletes and non athletes of Javanese male in Senior High School 3 Purwokerto.

A new species of Gekko Laurenti is described from Tà Kóu Mountain, an isolated granitic peak in Tà Kóu Nature Reserve, Ham Thuan Nam district, Binh Thuan province, southern Vietnam. The species is distinguished from its congeners by its moderate size, with snout to vent length (SVL) reaching a maximum 107.0 mm; dorsal pattern of 5–8 white vertebral blotches between the nape and sacrum and 6–8 pairs of short white bars on the flanks; 11–14 precloacal pores in males; 14–17 longitudinal rows of smooth dorsal tubercles; and 18–20 broad lamellae beneath the fourth toe. Gekko takouensis sp. nov. is the second endemic gekkonid discovered in the Tà Kóu Nature Reserve, Cyrtodactylus takouensis Ngo & Bauer being the first.

A new species Nyctibatrachus mewasinghi is described from the Malabar Wildlife Sanctuary of Western Ghats of Kozhikode District, Kerala. The new species can be distinguished from known congeners based on small adult size, head equal to or slightly wider than long, less wrinkled dorsal skin with prominent granular projections, absence of dorso-lateral glandular folds, a ridge extending from the lip over the tip of the snout to between the nostrils bifurcate posteriorly producing an inverted ‘Y’, finger and toe discs well developed with dorso-terminal groove, cover rounded distally, third finger disc slightly wider than finger width and fourth toe disc almost equal to or slightly wider than toe width, presence of two palmar tubercles, moderate webbing and thigh, shank and foot almost of equal length. Molecular phylogeny based on two mitochondrial genes (ND1 and 16S rRNA) reveals that the species is genetically distinct from others within the genus, and is a sister taxon to N. athirappillyensis and N. kempholeyensis. Multivariate morphometric analysis clearly distinguishes the new night frog species Nyctibatrachus mewasinghi from N. athirappillyensis and N. kempholeyensis.

A new species of rock gecko of the genus Cnemaspis Strauch is described from Belitung Island, Indonesia. The new species is differentiated from all other species in the Southern Sunda clade (sensu Grismer et al. 2014a) by having a unique combination of characters including: (1) a maximum SVL of 54.1 mm, (2) five or six postmental scales, (3) enlarged submetacarpal scales on the first finger, (4) enlarged submetatarsal scales on the first toe, (5) keeled ventral scales, (6) absence of precloacal pores, (7) absence of enlarged femoral scales, (8) absence of shield-like subtibial scales, (9) caudal tubercles encircling the tail, (10) an interrupted median row of enlarged keeled subcaudals, (11) presence of a distinct furrow on the lateral surface of the tail (12) 22–24 lamellae beneath fourth toe, and (13) two postcloacal tubercles on each side of the tail base.

Although the avian speciesPumiliornis tessellatus Mayr, 1999 is known from two skeletons from the Middle Eocene of Messel in Germany, its phylogenetic affinities remained enigmatic. The new osteological data presented in this study document thatP. tessellatus had an at least semizygodactyl foot, with a very wide basal phalanx of the fourth toe, and lacked an ossified pons supratendineus on the distal tibiotarsus. Compared to the known zygodactyl and semizygodactyl birds, this tiny Middle Eocene species resembles the late Eocene/early Oligocene taxonEocuculus Chandler, 1999. Anew, tentatively referred wing ofEocuculus from the early Oligocene of France is described and compared withPumiliornis.

We describe four new species of anoles (genus Anolis) from the Serranı´a de Tabasara´, westcentral Panama. Two of the new species are most similar in external morphology to a cluster of Central American species that are short-legged (fourth toe of adpressed hindlimb reaches only to tympanum), have a single elongated prenasal scale, smooth ventral scales, and slender habitus, often delicate. They differ from the other species in this cluster by hemipenial morphology and scalation characteristics. One of the new species appears to be most similar to A. pachypus and A. tropidolepis from which it differs by male dewlap coloration and its very small dorsal head scales. The fourth new species appears to be most similar to A. laeviventris from which it differs by its multicarinate head scales, lack of heterogeneous flank scalation, and an overall green coloration. ABSTRACT: We describe four new species of anoles (genus Anolis) from the Serranı´a de Tabasara´, westcentral Panama. Two of the new species are most similar in external morphology to a cluster of Central American species that are short-legged (fourth toe of adpressed hindlimb reaches only to tympanum), have a single elongated prenasal scale, smooth ventral scales, and slender habitus, often delicate. They differ from the other species in this cluster by hemipenial morphology and scalation characteristics. One of the new species appears to be most similar to A. pachypus and A. tropidolepis from which it differs by male dewlap coloration and its very small dorsal head scales. The fourth new species appears to be most similar to A. laeviventris from which it differs by its multicarinate head scales, lack of heterogeneous flank scalation, and an overall green coloration.

A cutaneous horn is a general name for cornified material protruding from skin. On the other hand, polydactyly is a common congenital anomaly of the hand and foot which is characterized by extra finger or toe. A cutaneous horn might mimick polydactyly by resembling an extra toe. Hereby, we present a 72-year-old white Caucasian male with an extra toe-like projection on his fourth toe. Initially, polydactyly was suspected, however a cutaneous horn was also considered. The lesion was surgically removed. The histopathological examination of the specimen revealed hyperkeratosis, and thus confirmed the lesion to be a cutaneous horn.

Overlapping fifth toe is a congenital deformity and is characterized by an external rotation of the toe so that it overrides the adjacent fourth toe. Treatment of this condition aims to permanently reposition the fifth toe and includes conservative and surgical techniques. Here we present a case of severe overlapping fifth toe deformity treated with a combination of Z-plasty and a unilobed transposition skin flap technique over a limited surgical area, associated with low morbidity.

Pedal symphalangism is a surprisingly common heritable trait of the human foot. In individuals exhibiting the trait, the joint between the intermediate and distal phalanges of one or more lateral toes never develops, resulting in toes with two phalanges rather than three. This study was undertaken to explore variation in the frequency of pedal symphalangism among groups with widely different geographic ancestry, and to consider the applicability of this trait to skeletal biological distance studies. A total of 460 Euro-American, 191 African-American and 99 Japanese skeletons were examined for presence of pedal symphalangism. The American individuals date to the first half of the 20th c, while the Japanese individuals date to the late 19th and early 20th c. Although the country of ancestry is unknown for most of the American individuals, the Euro-Americans appear to be largely northern European, with roots in Germany, Ireland and Scandinavia, while the African-Americans are primarily descendants of slaves with roots in west African countries such as Nigeria, Benin, Togo, Ghana and Sierra Leone. Frequencies of fifth toe pedal symphalangism were calculated and compared among all three samples and found to be significantly higher in modern Japanese (83.7%) than in either Euro-Americans (46.4%) or African-Americans (44.0%). The Euro- and African-American frequencies were statistically indistinguishable for symphalangism of the fifth toe. In the fourth toe, however, the opposite result was found. The African-American frequency (7.9%) was significantly higher than the Euro-American frequency (2.6%), while no difference was found between the African-Americans and Japanese (11.7%). Since fourth toe pedal symphalangism has never been observed in the absence of fifth toe involvement, some of the same genes are clearly involved in producing the trait in both toes. However, differences in the pattern of fourth and fifth toe expression among the three groups identified in this study suggest that additional genetic or developmental factors may play a role in expression of pedal symphalangism in each of the toes.

A 74-year-old man presented with an 8-year history of an intertriginous lesion on his right foot. He had been treated with several topical and oral antifungal agents, with no improvement. The rest of his medical history was unremarkable. On physical examination, maceration and eroded erythema were seen at the base of the fourth toe. This involved the web space, which was hard on palpation. On the dorsa of the foot, there was a cutaneous retraction with superficial ulceration, and adherences between the fourth and fifth toes (Fig. 1). The rest of the examination was unremarkable. A biopsy of the lesion was taken and sent for histopathological study.

The population of the lygosomine genus Tropidophorus on Sulawesi, Indonesia, is usually referred to as T. grayi Gunther, 1861, a species originally described from the Philippines, or sometimes by a taxonomically unjustified epithet “apulus”. We therefore reexamined the taxonomic status of the Sulawesi Tropidophorus on the basis of newly obtained specimens and available museum materials. Results indicated that this island population is morphologically distinct from T. grayi, and we thus describe it as a new species. This species most resembles T. grayi by sharing a number of characteristics, such as a divided frontonasal, three preanals, and strongly keeled tail scales. However, it differs from the latter by having weaker keels on dorsal body scales, a relatively longer fourth toe with more subdigitals, and male postanal pores in a single row.

Lygosoma nototaenia Boulenger, 1914, and Lygosoma albodorsale Vogt, 1932, previously placed in the genus Sphenomorphus, are redescribed from the three known specimens of each (including two new specimens of the latter species) and transferred to the genus Lipinia. The phenotypically similar genus Scincella is distinguished from Lipinia by an apomorphic feature of the secondary temporal scales. A novel phalangeal condition, shortening of the third phalanx of the fourth toe, is identified in Lipinia cheesmanae and Lipinia longiceps.

1. Charles O. Onyeama, MD*† 2. Karla Vitale, DO*† 3. Kenneth Cochran, MD*† 4. Ginikanwa L. Onyeama† 1. *Cibola Family Health Center, Grants, NM. 2. †Cibola General Hospital, Grants, NM. A 3-month-old boy presents to the emergency department (ED) with a history of fussiness and inconsolable crying throughout most of the day. His mother states that there is no identifiable cause for his discomfort. He is tolerating feeding and does not have any signs of illness, including cough, nasal congestion, fever, or change in stool pattern. As the day has progressed, the infant's fussiness has subsided, but he has developed purplish discoloration and swelling of the fourth right toe. The mother is concerned that something is constricting the toe and has attempted to find the cause but cannot, which has prompted the visit to the ED. The infant was born at term after an uneventful pregnancy. He has remained in good health, receiving appropriate immunizations at birth and at 2 months of age. He was circumcised at birth, has never been hospitalized, and has not undergone any other surgical procedure. He is not taking any medication and has no history of allergies. He is the younger of two children. There are no findings of note in the family history. On physical examination, the infant's vital signs …

Giant cell tumor of the bone is a benign, but locally aggressive, primary bone tumor of unknown origin. It most commonly occurs in the long bones and is only rarely found in the phalangeal bones, such as the distal phalanx of the foot. In our review of English-language published studies, only 4 other cases of giant cell tumor involving the distal phalangeal bone of the foot had been reported to date. We report a case of giant cell tumor arising in the distal phalanx of the fourth toe in a 28-year-old female. Although bisphosphonate therapy was administered, the tumor showed highly aggressive behavior with ulceration of the overlying skin, and the patient underwent phalangeal amputation 1.5 months after diagnosis.

This study was performed to assess the effects of a single 5-minute exposure of 5-fluorouracil (5-FU) applied topically at the time of flexor tendon repair in an attempt to reduce postoperative adhesions. The flexor digitorum profundus tendon to the long and fourth toe of Leghorn chickens was lacerated and primarily repaired using a 2-strand technique. The repair site was then exposed to a single 5-minute application of 5-FU in concentrations of 5, 25, or 50 mg/mL. Legs were casted for 3 weeks. After death the tendon was examined for the work of flexion using a tensile testing machine and examined with light microscopy, scanning electron microscopy, and transmission electron microscopy for morphologic and histologic differences in adhesion formation. Forty-seven chickens were examined. Average work of flexion values were 0.12 J for normal tendon, 0.31 J for operative controls, 0.34 J for the 5 mg/mL group, 0.15 J for the 25 mg/mL group, and 0.19 J for the 50 mg/mL group. The work of flexion was significantly reduced in the 25 and 50 mg/mL groups compared with the operative controls (p =.008 and p =.03, respectively). Histologic sections as graded by a blinded pathologist revealed decreased adhesion formation in all the 5-FU-treated animals (p.008). Histologic examination showed that the highest concentration of 5-FU was not as effective at reducing adhesions as the 25 mg/mL dose. This appeared to be due to increasing inflammatory changes seen around and within the tendons of the 50 mg/mL group. Overall, a single intraoperative application of 5-FU at concentrations of 25 mg/mL appears to be an effective mechanism for reducing postoperative flexor tendon adhesions.

Correction of an overriding fifth toe. Fixed, painful overriding fifth toe without symptoms over the fifth metatarsal head. Peripheral vascular diseases. Soft tissue defects or infection. Pain over head of fifth metatarsal. Flexible deformity. Excision of proximal phalanx of fifth toe after excision of an elliptic skin area through a plantar approach. Correction of malposition during skin closure (dermodesis). Between 1986 and 1997, 24 Ruiz-Mora procedures were done in 20 patients (average age 38 years). Average length of follow-up: 6.6 (1 to 11) years. All patients were satisfied with the result. Two patients complained about the marked shortening of the fifth toe and skin problems caused by it. In 5 patients a hammer toe deformity of the fourth toe developed postoperatively, in 2 patients a symptomless floppy toe developed. Using the Kitaoka score an excellent result was obtained 8 times, a good result 12 times and satisfactory 4 times. No poor result was seen.

Squamous cell carcinoma is a malignant tumor of the squamous epithelium and can occur in many different organs. We present a case of a 61-year-old veteran with metastatic squamous cell carcinoma of the bladder with distal metastasis to the middle phalanx of the fourth toe, which is a rare occurrence in the literature. (J Am Podiatr Med Assoc 99(3): 251–253, 2009)

Multiple toe transplantation has been established as an effective technique for restoring prehensile ability in the metacarpal hand. The combined third and fourth toe transplant is a new toe transplant that has been developed for bilateral metacarpal hand reconstruction. Since 1991, the combined third and fourth toe transplant was added to the armamentarium of toe transplants for metacarpal hands, although its role in metacarpal hand reconstruction has not been described previously. This article introduces the indications for combined third and fourth toe transplant, outlines relevant vascular anatomy, and discusses technical considerations pertaining to toe harvest and transplantation.

I examined directional asymmetry (DA) in the number of subdigital lamellae under the fourth toe (MDA) and in injury frequency (IDA) on the hindlimbs of eight Agamidae. In no species were MDA and IDA statistically significant, neither was there significant sexual dimorphism in MDA. But a strong, positive relationship exists between MDA and IDA, contrasting with the weak positive correlation between the side of injury and the morphologically dominant side in individual lizards. Therefore the relationship between MDA and IDA results from an evolutionary process, probably involving higher survival after injury of the morphologically dominant side. This process suggests functional importance of DA in the frame of evolution caused by unsuccessful predation.