Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis

Abstract

Summary:The initial location of necrosis may affect the limb salvage rate. This study of 130 patients with chronic toe ulcers or gangrene was performed to assess whether the location of initial necrosis in the toes affected limb salvage prognosis. The patients were divided into 2 groups according to whether the initial necrosis was in the great toe or in other toes. Limb salvage prognosis was determined retrospectively. In the great toe group, the rates of total toe loss and major amputation were 50.0% and 24.4%, respectively. When the initial necrosis was in other toes, these rates were 27.3% and 9.3%, respectively. Great toe necrosis is associated with significantly higher rates of total toe loss (odds ratio = 3.10; P = 0.003; 95% confidence interval, 1.43−6.68) and major amputation (odds ratio = 3.66; P = 0.007; 95% confidence interval, 1.37−9.79). The great toe is supplied by 3 source arteries, whereas the lesser toes are fed by 1 or 2 arteries. Therefore, necrosis initiating from the great toe may reflect the presence of severe vascular disorders. The great toe is also anatomically connected to much of the foot via the tendons. Infection is more likely to spread along these tendons, which may reduce limb prognosis. Thus, the initial location of necrosis may be predictive of limb prognosis.

Foot loading is different in people with and without pincer nails: a case control study

“…The causative factors of pincer nail include hereditary, inappropriate physical forces due to ill-fitting shoes, and inappropriate nail cutting [ 22 – 26 ]. Recent researchers have revealed that mechanical forces may have a particularly pronounced effect on nail configuration and may be involved in nail deformity development [ 7 – 10 ]. Namely, pincer nails may be caused by the lack of upward mechanical forces [ 7 ].…”

“…While it is generally believed that nail shrinkage is an abnormal phenomenon [ 6 ], cumulative research at our hospital has led us to hypothesize that human nails are constitutively equipped with an automatic shrinkage function that allows them to adapt to daily upward mechanical forces. In line with this, we proposed that a pincer nail may be caused by the lack of appropriate mechanical forces on the nail [ 10 ]. At face value, the fact that pincer nails are also often observed among healthy walkers could be seen to contradict the latter hypothesis.…”