Toe deformities

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The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

Lesser toe deformities (LTD) are highly frequent in the gen- eral aging population and may be associated with significant morbidity [1, 2]. These deformities occur gradually, often affect multiple toes, and are regularly associated to hallux abductus valgus (HAV) [3]. The progression of the deform- ity is commonly related to an imbalance between the forces of the extensor and flexor tendons about the proximal or distal interphalangeal joints [4]. Most of the LTD evolve despite podiatric care and lastly require surgical treatment. A Swedish experience based on extensive data registries suggests that almost a quarter of patients undergoing fore- foot surgery had also lesser toe procedures performed [5]. Arthroplasty and arthrodesis are still widely used tech- niques despite their functional squeals [6–10]. The impact of associated surgeries for correction of LTD in terms of complication occurrence and final recovery after HAV is still a matter of controversy.

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Morphology of the Toe Flexor Muscles in Older Adults With Toe Deformities

Morphology of the Toe Flexor Muscles in Older Adults With Toe Deformities

Similarly, the reduction in size of the quadratus plantae and flexor digitorum brevis muscles in the toe deformity group support the findings of previous research, whereby older people with lesser toe deformities had significantly reduced strength of the lesser toes than those without toe deformities [7]. Interestingly it was the intrinsic toe flexor muscles that were smaller in the group with lesser toe deformities, but there was no difference in the size of the extrinsic flexor digitorium longus muscle between the groups. The plantar intrinsic muscles stiffen the joints of the foot and help keep the toes flat on the ground through to the push-off phase of the gait cycle [24, 25]. Conversely, the long flexor muscles cross the ankle joint therefore play a role in plantar flexion of the ankle and power and control gait accelerations [25]. Therefore it is possible that the former foot function is most affected in people with lesser toe deformities. Again, we cannot determine whether these changes in muscle structure and function are a cause or consequence of the deformity. In a foot with a lesser toe deformity, subluxation of the proximal phalangeal joint typically occurs, and this joint malalignment will alter the axis of the intrinsic toe flexors, in turn making them less biomechanically efficient [4, 26]. Alternatively, weak toe flexor muscles may not be able to counterbalance the toe extensors, which will lead to phalangeal joints maintaining an extended resting position, creating the deformity.

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Morphology of the toe flexor muscles in older people with toe deformities

Morphology of the toe flexor muscles in older people with toe deformities

Similarly, the reduction in size of the quadratus plantae and flexor digitorum brevis muscles in the toe deformity group support the findings of previous research, whereby older people with lesser toe deformities had significantly reduced strength of the lesser toes than those without toe deformities [7]. Interestingly it was the intrinsic toe flexor muscles that were smaller in the group with lesser toe deformities, but there was no difference in the size of the extrinsic flexor digitorium longus muscle between the groups. The plantar intrinsic muscles stiffen the joints of the foot and help keep the toes flat on the ground through to the push-off phase of the gait cycle [24, 25]. Conversely, the long flexor muscles cross the ankle joint therefore play a role in plantar flexion of the ankle and power and control gait accelerations [25]. Therefore it is possible that the former foot function is most affected in people with lesser toe deformities. Again, we cannot determine whether these changes in muscle structure and function are a cause or consequence of the deformity. In a foot with a lesser toe deformity, subluxation of the proximal phalangeal joint typically occurs, and this joint malalignment will alter the axis of the intrinsic toe flexors, in turn making them less biomechanically efficient [4, 26]. Alternatively, weak toe flexor muscles may not be able to counterbalance the toe extensors, which will lead to phalangeal joints maintaining an extended resting position, creating the deformity.

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Foot health-related quality of life among elderly with and without lesser toe deformities: a case–control study

Foot health-related quality of life among elderly with and without lesser toe deformities: a case–control study

A total of 100 older adults aged between 65 and 88 years completed the study. The sample comprised 50 (50%) participants with LTD and 50 (50%) participants without any foot conditions. Foot pain, foot function, general foot health, general health, physical activity, social capacity, footwear, and vigor variables (p,0.05) did not show a normal distri- bution, and age, weight, height, and BMI showed a normal distribution (p.0.05). Table 1 shows the sociodemographic and clinical characteristics of the participants. There were no differences for age, height, weight, and BMI between case and control groups (p.0.05). The control group was free of toe deformities.

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Associations between toe grip strength and hallux valgus, toe curl ability, and foot arch height in Japanese adults aged 20 to 79 years: a cross-sectional study

Associations between toe grip strength and hallux valgus, toe curl ability, and foot arch height in Japanese adults aged 20 to 79 years: a cross-sectional study

Structurally, toe deformities, such as hallux valgus, are often found clinically, regardless of patient age or sex. Mickle et al. [7] demonstrated an association between toe deformity and reduced toe flexor strength. A rela- tionship between the toe flexor strength and the medial longitudinal arch (MLA) height has also been reported [8,9]. Weak plantar intrinsic or extrinsic muscles (i.e., toe flexors) that do not provide sufficient dynamic truss support for the MLA may be involved in the underlying aetiology of decreasing foot arch height (FAH) [8]. Headlee et al. [10] reported that repeated isotonic flexion of the metatarsophalangeal joints, through their full range of motion, resulted in navicular drop. A loss of foot intrinsic muscular function due to fatigue has also been reported to result in a loss of structural MLA support [11]. However, some studies have reported that there is no association between TGS and the MLA height [12,13]. Therefore, the association between TGS and FAH remains unclear. Additionally, although some researchers have reported that the range of toe flexion (a factor in toe curl motion) is related to TGS in younger women [9] and in frail, elderly women [13], the associ- ation between TGS and range of toe flexion remains to be clarified in other groups.

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The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome

The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome

Presence of hallux valgus and lesser toe deformities The severity of hallux valgus was determined using the Manchester scale grading system [29]. This measure has good reproducibility (kappa coefficients = 0.80 to 0.89) [29,30] and has been validated against radiographic mea- surements [31]. The degree of deformity was graded on a scale of 0 to 3 (no deformity to mild, moderate and se- vere deformity) based on observation of the participant’s foot in a relaxed bipedal stance. Scores for Manchester scale of hallux valgus were dichotomised where a score of 0 or 1 was categorised as absent, and scores of 2 and 3 were categorised as present for hallux valgus [31]. Manchester scale grades of 2 (moderate deformity) and 3 (severe deformity) were chosen to represent the pres- ence of hallux valgus as previous work by Garrow et al. [29] has shown that raters have little difficulty distin- guishing between mild (score 1) and moderate (score 2) deformity. However, raters have difficulty distinguishing between no deformity (score 0) and mild deformity (score 1). In addition, previous work, using radiographic assessment as the gold standard, has shown that al- though there are significant differences in the mean hal- lux abductus angle between all Manchester scale grades, the total range of values overlaps for the ‘none’ and

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Interrater and intrarater reliability of photoplethysmography for measuring toe blood pressure and toe-brachial index in people with diabetes mellitus

Interrater and intrarater reliability of photoplethysmography for measuring toe blood pressure and toe-brachial index in people with diabetes mellitus

Finding a reliable test to measure the perfusion distal to the ankle is required to adequately assess and treat patients with diabetes and PAD. Damage to the smaller branches of the arteries, known as microvascular disease, is common in diabetes. In particular it is important to understand the severity of microvascular disease distal to the ankle in patients who have active foot ulceration, as it provides the clinician with a greater understanding of healing potential and whether there is an opportunity for the vascular team to improve the flow to the extrem- ity via revascularisation techniques such as angioplasty, arterial stenting or bypass surgery. The ABI is unable to adequately assess these microvascular complications as it measures proximal to the ankle joint encompassing the arterial flow of the anterior and posterior tibial arter- ies and does not identify any occlusion or calcification of vessels distal to this site [13,14]. The concept of measur- ing toe blood pressures and calculating the toe brachial index (TBI) is not new [7]. The measurement of toe pressures using a PPG unit such as the Hadeco Smart- dop is a relatively simple procedure involving a small digital toe blood pressure cuff and PPG probe to capture red blood cells as they pass through the underlying tis- sue. To calculate the TBI, the process is the same as cal- culation of the ABI, with the exception of the ankle

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Gait training with real-time augmented toe-ground clearance information decreases tripping risk in older adults and a person with chronic stroke

Gait training with real-time augmented toe-ground clearance information decreases tripping risk in older adults and a person with chronic stroke

young participants to both increase MTC and decrease variabil- ity (Tirosh et al., 2013). This gait-specific movement information (i.e., ground clearance at MTC) represents a general class of information provided by an external source, which supplements the performer’s intrinsic, task-specific sensory information. The effectiveness of such “augmented information” for changing movement-related characteristics is well known in motor behav- ior research and the proposal that augmented information of kinematic variables could be used to optimize motor performance has also been long-established (Newell et al., 1983). A further con- sideration in designing the present experiment was that motor learning is operationally defined not only by the “relative per- manence” of performance in a later retention condition (e.g., Salmoni et al., 1984; Sparrow and Summers, 1992) but also evi- dence of transfer of training from one action, to another similar but unpracticed movement. In this paper we measured gait cycle characteristics and toe height at MTC in both limbs, i.e., both the trained and untrained limb, to determine any evidence of transfer to the untrained foot’s movement characteristics.

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Prevention and Management of Positional Skull Deformities in Infants

Prevention and Management of Positional Skull Deformities in Infants

tient had a typical rounded head at birth and after a few weeks or months has parallelogram deformity and occipital flattening, the diagnosis of deforma- tional plagiocephaly should be made. On the other hand, if the head has occipital flattening at the time of birth, the diagnosis of lambdoid craniosynostosis should be considered. Like deformational plagio- cephaly, lambdoid craniosynostosis produces a flat occiput on one side of the head and prominence on the contralateral side, and deformation may become more severe with time. The degree of frontal asym- metry is generally less but similar in pattern to de- formational plagiocephaly, which is frontal promi- nence ipsilateral to occipital flattening. The pattern of other associated features, however, almost always differs from deformational plagiocephaly. Specifi- cally, the ear ipsilateral to the flattened occiput is typically posterior and displaced inferiorly when compared with the contralateral ear. The posterior basal skull also is tilted with the mastoid process in this region unusually prominent. Facial deformity typically is minimal, if present at all. However, in very rare instances, the deformities seen with lam- boid craniosynostosis may be similar to those of deformational plagiocephaly. 9

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Prisoners Education Trust

Prisoners Education Trust

For those who can’t yet read, the learning process, without patient one-to-one mentoring, can quickly become an embarrassing, patronising and generally off- putting experience. In some prisons being a mentor is a full-time job; in others it is voluntary and desperately unsupported by staff. When there is a community of mentors who share their ideas and frustrations with each other and an Education Department or Induction Programme that identifies those in need, Toe by Toe can thrive.

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The Manufacturing Process Of Robo-Kidz-Toe

The Manufacturing Process Of Robo-Kidz-Toe

Then, I would like to thank my friend, Ng Chun Hong. He taught me a lot about the skills of soldering and knowledge of electronic components. Samuel Lim Li Kiang, the person who helped me finished the time study of assembling the Robo-Kidz-Toe. Lastly, I would like to thank my friends who were willing to spend their time to help me when I am in trouble and in need of their help.

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Orbit Deformities in Craniofacial Neurofibromatosis Type 1

Orbit Deformities in Craniofacial Neurofibromatosis Type 1

METHODS: We retrospectively reviewed CT and MR imaging abnormalities of the orbit in 31 patients (18 male, 13 female; mean age, 14 years; age range 1– 40 years) with craniofacial NF1. RESULTS: Orbital abnormalities were documented in 24 patients. Six had optic nerve gliomas with enlarged optic canals. Twenty had PNFs in the orbit or contiguous to the anterior skull. The posterior orbit was distorted by encroachment from an expanded middle cranial fossa in 13 patients, and 18 had enlargement of the orbital rim. Other changes included focal decalcification or remodeling of orbital walls adjacent to PNFs in 18 patients and enlargement of cranial foramina resulting from tumor infiltration of sensory nerves in 16. These orbital deformities were sometimes progressive and always associated with orbital infiltration by PNFs. CONCLUSION: In our patients with craniofacial neurofibromatosis, bony orbital deformity occurred frequently and always with an optic nerve glioma or orbital PNF. PNFs were associ- ated with orbital-bone changes in four patterns: expansion of the middle cranial fossa into the posterior orbit, enlargement of the orbital rim, bone erosion and decalcification by contiguous tumor, and enlargement of the cranial foramina. Orbital changes support the concept of secondary dysplasia, in which interaction of PNFs with the developing skull is a major component of the multifaceted craniofacial changes possible with NF1.

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Intelligent Tic-Tac-Toe Bot

Intelligent Tic-Tac-Toe Bot

The robot is developed to play exciting tic-tac-toe game into physical intelligent product. The robot will be a strong opponent to human because Tic-Tac- Toe Bot is an intelligent robot that programmed with “not to lose” algorithm. Hence, this robot also can draw the shaped whether “O” shape or “X” shape and detect the opponent shape in order to play the game.

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The DEP domain containing protein TOE 2 promotes apoptosis in the Q lineage of C  elegans through two distinct mechanisms

The DEP domain containing protein TOE 2 promotes apoptosis in the Q lineage of C elegans through two distinct mechanisms

We generated two additional alleles of toe-2 – gm407 and gm408ok2807 – using a TAL effector nuclease (TALEN)-mediated genome-editing approach (Wood et al., 2011) and saw that these mutants also had extra A/PVMs, at a frequency similar to that seen in the original gm396 mutant (Fig. 1D). The gm407 allele contained an in-frame six base-pair deletion that removed the codons for phenylalanine residue 84 and lysine residue 85, residues that are found within the DEP domain. The phenotype of this deletion, together with the changes caused by the gm396 allele, suggests that the DEP domain is important for TOE-2 function. We generated the gm408 allele in an ok2807 mutant, and it contained an 8 bp deletion that caused a frame shift, replacing phenylalanine residue 84 with the amino acid sequence LHIRAQKI. This sequence was followed by a premature stop codon, suggesting that this allele is a molecular null. We placed the gm408ok2807 allele over the deficiency mnDf52, which uncovers the toe-2 locus, and observed extra and missing A/PVM-like neurons in 44% and 4% of lineages scored (n=50), respectively, a penetrance that is not significantly different from what we observe in gm408ok2807 homozygous mutants in experiments that were performed in parallel (38% extra and 4% missing A/PVMs, n=50, see Materials and Methods; P>0.5). The similar phenotypes of toe-2 hemizygous and toe-2 homozygous mutants support the hypothesis that gm408ok2807 either severely reduces, or eliminates, toe-2 function.

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Shoes and Leg Braces Integrated System for Abnormal Gait Detection

Shoes and Leg Braces Integrated System for Abnormal Gait Detection

Clinically, patients who suffered from brain injuries such as stroke, brain tumor and aneurysm usually need to go through very long recovery processes to restore or even rebuild their walking abilities. During rehabilitation, part of their muscles and nerves, which are controlled by the injured part of the brain, undergoes malfunction, which tend to make the patients to over-use their uninjured part of the body. This imbalanced using of legs and feet without proper intervention could easily lead to abnormal gaits like toe-in, toe-out and tiptoe walking. Besides those brain-injured patients, many people with bad walking habits could also develop mild to severe abnormal gaits. In these situations, the proposed integrated system would be helpful in abnormal gait routine-monitoring, early-detection, rehab-treatment as well as progress-evaluation.

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How does a short period of exercise effect toe pressures and toe-brachial indices? A cross-sectional exploratory study

How does a short period of exercise effect toe pressures and toe-brachial indices? A cross-sectional exploratory study

pressures was higher post exercise increasing by 5.00 mmHg. Nevertheless, the TBI dropped post exercise, with the median value reducing by 0.07 which represents an 8.86% decrease. All these changes were statistically signifi- cant. Recent research investigating the effect of 5 min of treadmill walking, or a 6 min walk test, in people with di- agnosed PAD and a healthy control group, demonstrated increases in both ankle and toe pressures in those without PAD but an overall reduction in both ABI and TBI (mean drop 0.05 for both) ratios [10]. The current study demon- strated a reduction in TP post exercise, contrary to Kovacs et al. (2018) who demonstrated an increase in TP post ex- ercise. Whilst these directions of change were contrary, they were of a similar magnitude. The TBI however, dropped in a similar fashion to the previous study (0.05 vs 0.07). The difference in directional change in TP between our present study and Kovacs et al. (2018) may have been associated with methodological differences between the studies (e.g. laser Doppler versus photoplethysmography for TP measurements) [10]. However, given the relatively small magnitude of change in both studies, it is unlikely to be of clinical significance, particularly given the relatively wide 95% limits of agreement reported for TP in numer- ous studies previously [22, 23]. Essentially, the two studies both determined that in a population apparently without PAD, the TP will not demonstrate a very large change post exercise and does not result in abnormal TP values.

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School Desegregation, Law and Order, and Litigating Social Justice in Alabama, 1954 1973

School Desegregation, Law and Order, and Litigating Social Justice in Alabama, 1954 1973

There were no significant differences across frequencies for the range of motion of the toe marker or hopping area. These results point to the maintenance of a similar hopping boundary across frequencies where the subjects corrected their horizontal displacements by hopping in the opposite direction of the preceding hop. However, there potentially could be an insight to different motor strategies considering the displacements between hops decreased with frequency. The subjects completed a greater number of smaller displacement hops at the higher frequencies within the same range and area as fewer but more ground covering hops at the lower frequencies. This relationship seems to illustrate that either the ability or priority to correct horizontal displacements by hopping in the opposite direction decreased with frequency. The range and area results may have been influenced by the instructions to hop on a central location, the force plate. However, it would seem unlikely since the largest mean hopping area for any condition was 565.03cm 2 (MS) and the total area of the force plate was 1851.28cm 2 . The subjects had the possibility of hopping within a larger area then what they maintained for each frequency.

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Procedural benchmarks for common fabrication details in plate/shell structures

Procedural benchmarks for common fabrication details in plate/shell structures

Extrapolation procedures possibly have their roots in the offshore industry. Certainly in the late 1970s and early 80’s much work in this area was being carried out as part of the United Kingdom Offshore Steels Research project [29]. In fact the driver for such methods would appear to have been experimental strain gauging as a means of determining the toe hot-spot stresses, although they were also being applied to finite element results as well at that time. Indeed refs [14],[15] provide much detail on extrapolation methods for use with strain gauges and finite element modelling … the latter including different guidance for ‘coarse’ meshes as well as ‘fine’. The extrapolation locations for strain gauges and finite elements are also different. The International Institute of Welding clearly has invested a great deal of time and effort on the development and study of such methodologies and the recommendations in these references reflect the practical constraints of time and resources that industry operates under. They represent the most comprehensive guidance available in this area and the concepts outlined therein have found their way into relevant Codes of Practice [12], [13].

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2D Modelling of Earthquake Induced Rockfall from Basaltic Ignimbrite Cliffs at Redcliffs, Christchurch, New Zealand

2D Modelling of Earthquake Induced Rockfall from Basaltic Ignimbrite Cliffs at Redcliffs, Christchurch, New Zealand

The ratio between “Maximum Drop Height to Talus” and “Horizontal Distance” was identified as a key parameter to explain the modelled runout characteristics when compared to field observations. As shown by Section Lines A, B, and E, where the H*/x ratio is low (<0.60 in each case), both the percentage of rocks passing the toe of the slope and the maximum bounce height at the toe compare closely with field observations. In contrast to this, as the H*/x ratio increases above 0.60, so too do the values for the percentage of rocks passing the toe and the maximum bounce height at the same point. A critical point or threshold value appears to occur above H*/x =0.6, and implies that the height of drop from the source area is a fundamental control on runout when modelled in 2D by RocFall™. It is recognised that not all boulders will be sourced from the upper part of the cliff face, but there is a clear implication that future rockfalls form this source area would run out well beyond the existing talus apron base on some section lines.

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Advances in the management of pectus deformities in children

Advances in the management of pectus deformities in children

PE is Noonan syndrome (NS), an autosomal dominant disorder caused by mutations in various genes in the RasMAPK (mitogen-activated protein kinase) pathway [5]. NS is associated with a constellation of distinctive facial features in infancy, combined with short stature, congenital heart disease and pectus deformity [6]. When found separately from NS, pectus excavatum may also be associated with scoliosis and congenital heart defects [2]. Current theories of PE pathogenicity include intrauterine pressure alterations, an intrinsic failure of osteogenesis and/or chondrogenesis, rickets, and abnormalities of the diaphragm resulting in posterior traction of the sternum (with some reports of PE occurring after repair of agen- esis of the diaphragm or congenital diaphragmatic her- nia) [3,7]. Biochemical studies have shown abnormalities in the structure of type 2 collagen in costal cartilage, ab- normal levels of zinc, magnesium and calcium, and a disturbance of collagen synthesis in patients with pectus deformities [7]. The genetics underlying the condition have yet to be definitively determined. In a pedigree ana- lysis of 34 families with PE children, Creswick et al. identified 14 families which demonstrated autosomal dominant inheritance, 4 showed autosomal recessive in- heritance, 6 families exhibited X-linked recessive inheri- tance, and 10 families displayed multiple inheritance pat- terns [7].

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