Diagnosis and conservative management of great toe pathologies: a review

Andrews, Nicholas A; Ray, Jessyca; Dib, Aseel G.; Harrelson, Whitt; Khurana, Ankit; Singh, Maninder Shah; Shah, Ashish

doi:10.1080/00325481.2021.1895587

Cited by 9 publications

(16 citation statements)

References 37 publications

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“…Therefore, when considering treatment, especially with pure phalangeal deviation, alignment of the distal toe may prove helpful in the manner bunion surgery can be performed to realign hallux valgus [37]. In theory, this procedure might minimize the trauma that produces nail dystrophy.…”

Section: Further Discussionmentioning

confidence: 99%

Congenital Malalignment of the Great Toenail, the Disappearing Nail Bed, and Distal Phalanx Deviation: A Review

Buttars¹,

Scott²,

Glinka³

et al. 2021

Skin Appendage Disord

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Importance: Congenital malalignment of the great toenail (CMGT) is an idiopathic deviation of the nail apparatus. CMGT predisposes patients to recurrent stress forces, microtrauma, and secondary complications. The purpose of this study was to review the current published photographs to determine the relationship between variants of CMGT and the disappearing nail bed (DNB). Observations: A search in PubMed and Google using the terms congenital malalignment of the great toenail, disappearing nail bed, and lateral nail deviation was performed. Of the 53 photographs found in a total of 35 articles, 23 were disqualified due to low picture resolution or poor angle. The remaining 30 photographs were evaluated. Pure nail malalignment with associated dystrophy and DNB was found in 22 of 30 photographs. Four of 30 cases demonstrated pure deviation of the distal phalanx, with nail dystrophy but minimal DNB. The remaining 4 cases demonstrated a combination of toe deviation and nail unit deviation with varying degrees of DNB. Conclusions and Relevance: DNB was associated with all forms of pure CMGT. Moreover, a variant of malalignment of the distal phalanx was noted in 8 photographs. This has potential implications for further studies and treatment to correct secondary complications.

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Section: Further Discussionmentioning

confidence: 99%

Congenital Malalignment of the Great Toenail, the Disappearing Nail Bed, and Distal Phalanx Deviation: A Review

Buttars¹,

Scott²,

Glinka³

et al. 2021

Skin Appendage Disord

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“…Similar to turf toe, sand toe injuries can be differentiated based on severity: grade I (microtear without loss of continuity of the dorsal capsule), II (partial tear), and III (complete tear) (12).…”

Section: Sand Toementioning

confidence: 99%

First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations

Lim

Liem

2023

Curr Sports Med Rep

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The first metatarsal-phalangeal joint plays a key role for athletes of various disciplines. When an athlete presents for evaluation of pain at this joint, there are several causes that should be considered. The purpose of this article is to review common injuries including turf toe, sand toe, extensor and flexor hallucis longus tendinopathy, sesamoiditis, and metatarsalgia and provide current evidence-based recommendations for diagnosis, management, and return to play considerations. Conditions not specific to athletes like gout and hallux rigidus also are discussed. Mechanism of injury, physical examination, and imaging such as weight-bearing radiographs and point-of-care ultrasound can help with diagnosis. Treatment of many of these injuries begins with nonsurgical management strategies including footwear or activity modification, physical therapy, and select interventions.

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“…Seven major themes were constructed relating to the management of sesamoiditis. These were: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; and (7) referring to other health professionals to find different ways to treat or manage patient symptoms (Fig. 2).…”

Section: Management Of Sesamoiditismentioning

confidence: 99%

“…The exact pain-related physiological mechanisms involved in the development of sesamoiditis have not been established. Clinically, sesamoiditis is simply described as a sudden or insidious onset of localised or diffuse pain on the plantar aspect of the 1MTPJ [ 4 , 7 ]. This can result in substantial physical limitations for patients, including difficulty in weightbearing through the 1MTPJ during the propulsive phase of the gait cycle [ 1 , 2 , 5 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Clinically, sesamoiditis is simply described as a sudden or insidious onset of localised or diffuse pain on the plantar aspect of the 1MTPJ [ 4 , 7 ]. This can result in substantial physical limitations for patients, including difficulty in weightbearing through the 1MTPJ during the propulsive phase of the gait cycle [ 1 , 2 , 5 , 7 , 8 ]. Although the clinical presentation of sesamoiditis has been described in the existing literature, there is a lack of guidance on the assessment and diagnosis of sesamoiditis.…”

Section: Introductionmentioning

confidence: 99%

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The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

Kaur

Carroll

Stewart

2023

Journal of Foot and Ankle Research

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Background Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ). However, there are currently no recommendations or clinical guidelines to support podiatrists in their assessment or management of sesamoiditis. The aim of this study was to explore the views of podiatrists in Aotearoa New Zealand on their approaches to the assessment and management of patients with sesamoiditis. Methods This qualitative study included focus group discussions with registered podiatrists. Focus groups took place online via Zoom and were guided by a detailed focus group question schedule. The questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data. Results A total of 12 registered podiatrists participated in one of three focus groups. Four themes were constructed relating to the assessment of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) referring to other health professionals to find different ways to treat or manage patient symptoms. Conclusion Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience and knowledge of lower limb anatomy. A range of assessment and management techniques are selected based on the practitioners personal preferences, as well as the patient’s social factors, symptomology, and lower limb biomechanics.

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Diagnosis and conservative management of great toe pathologies: a review

Cited by 9 publications

References 37 publications

Congenital Malalignment of the Great Toenail, the Disappearing Nail Bed, and Distal Phalanx Deviation: A Review

Congenital Malalignment of the Great Toenail, the Disappearing Nail Bed, and Distal Phalanx Deviation: A Review

First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

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