Psoriatic Onycho-Pachydermo-Periostitis

Psoriatic onycho-pachydermo-periostitis (POPP) is an unfamiliar and poorly recognised condition first described in 1989 by Fournie et al. It is a variant of psoriatic arthritis comprising the triad of onycholysis, soft tissue thickening and radiographically apparent periostitis. Whilst typically affecting the great toe, any of the digits of the hands and feet may be affected. A ‘drumstick’ appearance to the digits of the foot is the most common clinical presentation and can be extremely painful. Nail changes are another hallmark of POPP and can be mistakenly diagnosed as fungal infection leading to lengthy periods of incorrect treatment. In this article, we will outline the clinical presentation, imaging features, pathogenesis and treatment options for POPP. Currently, the existence of POPP is not widely known. Awareness of this unusual condition will allow early appropriate treatment and can aid in the diagnosis of indeterminate seronegative disease.

Acute Polyarticular Gout due to Chronic Kidney Disease

Gout is a crystal deposition disorder that typically presents as an acute flare of the first metatarso-phalangeal joint of the great toe. Rarely gout can present as an acute poly-articular disease with involvement of multiple joints. Evaluation of patients with poly-articular arthropathy with appropriate investigations like uric acid levels, renal function tests and synovial fluid analysis helps in the early diagnosis of poly-articular gout. Immediate treatment with urate lowering agents during the acute flare provides immediate pain relief and prevents progression of disease & bone destruction.

Chronic Paronychia of Great Toe Treated with Excision of Nail Plate along with Surrounding Tissue and Split Thickness Skin Graft: An Observational Prospective Study

Paronychia is an inflammatory condition of alongside of nail of toe or finger. It is seen commonly in housewives and housemaids. Paronychia may be acute or chronic. Majority of patients with acute paronychia respond well to nonsurgical treatment. Patients with chronic paronychia of great toe do not respond to nonsurgical treatment. Patients suffer from chronic pain in finger or toe. Many treatment methods are available for chronic paronychia of great toe. All have merits, demerits, and different outcomes. This study is conducted to find out the outcome of a modified surgical technique in chronic paronychia of great toe of patients. This is a method adopted with a little modification of existing method.This study was conducted among 50 patients of chronic paronychia of great toe, who were between 15 to 55 years of age, from December 2019 to December 2020. These patients were operated and kept on follow-up for 1 year and observed for different outcomes likes skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease. Clinical data was recorded in case record form by examining the patient, asking questions to them, and conducting descriptive analysis. Results in terms of skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease were assessed during follow-up period. Postoperative result showed that 98% of patients had complete wound healing and complete graft take up, acceptance of cosmetic appearance was 94%, recurrence was 2%, and 90% were relieved from chronic pain of disease great toe. It was concluded that this was a better method for treatment of chronic paronychia of great toe.

Congenital Malformation of The Great Toe in Children. Did You Exclude Fibrodysplasia Ossificans Progressiva – FOP.

Background: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare and severely disabling genetic disorder. The worldwide prevalence is approximately 1 per 2 million. Heterozygous mutations in ACVR1/ALK2 gene exist in all sporadic and familial cases of FOP. The primary aim of this study is to describe the clinical course of three children suffering from FOP and followed for fifteen, twenty-two and forty years, respectively Secondary aim is to provide clinical advice on how to diagnose the condition with special reference to the great toes malformation and give current best therapeutic approaches.Results: All three cases characterized with malformed great toes initially followed by progressive loss of mobility for a period from fifteen to forty years. Conventional radiology indicates the diagnosis and RNA/DNA test confirm it.Conclusion: Congenital malformation of the great toes in early childhood may be the first clinical sign of FOP. A devastating disease due to its progressive formation of heterotopic ossifications in soft tissue even after minor injuries. Leading to progressive immobility, skeletal deformities, chronic pain, growth defects and disabling joint stiffness. No curative treatment exists today. Management is symptomatic combined with a prophylactic lifestyle avoiding blunt and pointed trauma including surgery.

Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.