Validación fisiológica de un modelo de pie humano para estudio de patología de dedo en garra

The standing finite element models allow the study of their biomechanical-structural behavior. Research of this type provides podiatrists with knowledge in improving surgical techniques, thus allowing the exploration of new alternatives in the correction of biomechanical alterations in the lower extremities. Thus, reporting models in the literature with different types of contact in the joints, insertion of soft tissues such as the skin, as well as variation in the properties of the tissues. This research presents two numerical finite element models, healthy foot and claw toe pathology in the second radius. Based on the model of Mancera et al. (2020). The modifications include changes in load and contour conditions to simulate the "midstance" phase with 700 N load. The pathology model presents rotations and adjustments in the main soft tissues involved in the second radius of the foot. The two models were meshed and solved under the same conditions. The results of the simulation of the models are validated with the Costa Bartani and Kite angle. This was performed in the unloaded and loaded foot cases to verify that the model is within the parameters of the healthy foot. The Costa Bartani angle presented the greatest variation, while the Kite angle remained within the range value for a healthy foot. The models proposed during their evaluation show that pathologies that only involve the second radius of the foot affect the aforementioned angles, therefore, the biomechanical-structural behavior of the foot, allowing the study of other pathologies in future work.

Congenital Unilateral Hypertrophy of the Plantar Musculature with Multiple Toe Deformities: A Case Report and Literature Review

Congenital unilateral hypertrophy of the plantar musculature is a rare condition, and to our knowledge, reports of only 14 cases have been previously published. As only one describes a concomitant orthopedic toe deformity, we report our case of abductor hallucis, flexor digitorum brevis, and abductor digiti minimi muscle hypertrophy in combination with hallux valgus and claw toe deformity as well as a laterally abducted fifth toe. Thus, this report presents the rare case of congenital hypertrophy of the plantar musculature associated with complex toe deformities. Moreover, the present article contains a detailed description of our surgical technique as well as a review of the current literature.

Neuropathy, Claw Toes, Intrinsic Muscle Volume, and Plantar Aponeurosis Thickness in Diabetic Feet

Background: The objective of this study was to explore the relationship between claw toe deformity, peripheral neuropathy, intrinsic muscle volume, and plantar aponeurosis thickness using computed tomography (CT) images of diabetic feet. Methods: Forty randomly-selected subjects with type 2 diabetes were selected for each of the following four groups (n = 10 per group): 1) peripheral neuropathy with claw toes, 2) peripheral neuropathy without claw toes, 3) non-neuropathic with claw toes, and 4) non-neuropathic without claw toes. The intrinsic muscles of the foot were segmented from processed CT images. Plantar aponeurosis thickness was measured in the reformatted sagittal plane at 20% of the distance from the most inferior point of calcaneus to the most inferior point of the second metatarsal. Five measurement sites in the medial-lateral direction were utilized to fully characterize the plantar aponeurosis thickness. A linear mixed effects analysis on the effect of peripheral neuropathy and claw toe deformity on plantar aponeurosis thickness and intrinsic muscle volume was performed. Results: Presence of claw toe deformity ( p = 0.008) and presence of neuropathy ( p = 0.039) were both associated with decreased intrinsic muscle volume. Subjects with both neuropathy and claw toe deformity had significantly thicker plantar aponeurosis tissue compared with the other three permutation subgroups ( p < 0.001). A negative correlation was observed between plantar aponeurosis thickness and intrinsic muscle volume ( R 2 = -0.3233, p < 0.001). Conclusions: In subjects with claw toe deformity, there were strong relationships between smaller intrinsic foot muscle volumes and thicker plantar aponeurosis tissue. Intrinsic muscle atrophy and plantar aponeurosis thickening may be related to the development of claw toes.

A Retrospective Study of Claw Toe Repair Combining Partial Proximal Phalangectomy (PPP), Proximal Interphalangeal (PIP) Joint Interpositional Arthroplasty and Kirschner Wire Fixation

Background & Objective: Various operative methods have been used for the repair of claw toe deformities. We present a review of a combination of three operative procedures performed for the correction of this deformity. Methods: A review was conducted examining 105 patient clinical records over a ten year period. Patients who received either one or a combination of the following procedures: Partial Proximal Phalangectomy (PPP), Proximal Interphalangeal Joint (PIP) interpositional arthroplasty, and k-wire fixation were included. Results: Over a ten year span, a total of 86 PPP, 124 PIP and 29 k-wire fixations were performed on 96 patients. Of the 105 clinical cases reviewed, there were only 4 recurrences of claw toe deformity. Early complications included k-wire backout/breakage, reversible avascular toe in the recovery room, and pin site infection. Conclusions: The combination of the three procedures presented, are an optimal operative treatment for the repair of claw toe deformity in various patients. Assessments can be made during surgery to determine if the procedures should be used solely or in combination based on the level of deformity. This customizable technique presented a minimal level of early complications and a low recurrence rate.

Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review

Intramedullary devices have been developed to reduce the problems associated with Kirschner (K)-wire fixation in proximal interphalangeal joint (PIPJ) arthrodesis. The purpose of this systematic review is to compare the surgical outcomes of K-wires versus novel internal fixation devices in PIPJ arthrodesis in claw/hammer toe surgery. The databases searched were PubMed, Scopus, Cochrane, and Embase with keywords “claw toe OR hammer toe” AND “proximal interphalangeal OR PIP” AND “fusion OR arthrodesis.” Clinical trials published in English with evidence levels I, II, and III were included. Five studies, including one randomized controlled trial and four case-controlled studies, were identified to meet the inclusion criteria. Overall, the studies showed promising results in union rates using the novel internal devices compared to K-wires. However, the novel internal devices seem not to present advantages in clinical parameters such as pain levels, patient satisfaction, foot-related function, or surgical complication rates.