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How many joints does the 5th toe have? A review of 606 patients of 655 foot radiographs
Lawrence Stephen Moulton, Seema Prasad, Robert G. Lamb, Siva P. Sirikonda Foot and Ankle Surgery; 18 May 2012
Quote:
Background
It is a common understanding that the fifth toe has three bones with two interphalangeal joints. However, our experience shows that a significant number have only two phalanges with one interphalangeal joint.
Methods
We identified 676 patients listed as having had a foot radiograph, during an eight week period, of which 606 radiographs were available for the assessment. The radiographs were then assessed counting the number of phalanges in the fifth toe.
Results
The patients consisted of 344 females and 262 males. Bilateral radiographs had been performed in 49 patients. 362 radiographs (55.3%) were found to have 3 phalanges in their 5th toe, with 291 (44.4%) having only two phalanges.
Conclusions
We have demonstrated the presence of two phalanges is a common anatomical variant. This finding has clinical implications with regard to the treatment of deformities of the fifth toe and the type of internal fixation device used.
Well, in a short answer, one of the key characteristics of human evolution is reductionism; both in size and number. The reptilian tarsus has, from memory (gets Wood Jones off the shelf), nine bones; we reduce in number to seven. We also get smaller in the ray department; this is a none-controverversial part of pedal evolution. The digits, in particular the lesser digit, have got so small, that the i/p joints have become, at least to some extent, superfluous. A quick examination of any skeletal collection will show that in many cases, the middle and distal phalanges of the 5th digit are fused. Whether they were always fused, or became fused during life, I wil leave to another. Rob
__________________
Honorary Research Associate, Institute for Human Evolution, University of Witwatersrand
Adjunct Associate Professor (Human and Comparative Anatomy), University of Western Sydney
Fellow of The Centre For Human Biology, The University of Western Australia
"Please God, deliver me whole from Creationists......."
While on the subject of evolutionary changes, I remember hearing in a lecture a few years ago that there is a variation in the number of Posterior Tibial Tendon slips that go to the 3 cuneiforms, the cuboid and the 3 central metatarsal bases. I have never been able to find any documents to that effect. Was I imagining it in the lecture?
__________________ Put on your red shoes and dance the blues away.
Not sure on this - I will dig about. Freddie Wood Jones simply says the same as the conventional wisdom that we all know: " mainly into the navicular, but also every bone in the tarsus with the exception of the talus". However, in the second chapter on muscle morphology (page 148), he does talk about insertion into the metatarsal bases as well. If you are interested (and I am), he talks about homology in the forelimb and suggests that the equivelent muscle is flexor carpi radialis. This is entirely logical insomuch as this then makes peroneus longus a homology of flexor carpi ulnaris - which contains the pisiform bone; and of course peronius longus has a sesamoid in the peroneal groove of the cuboid (sometimes). Thus the pisiform is represented in the foot, at least sometimes. He goes on to hypothesise that the muscle mass of Tib Post has migrated from the femur (Flex Carpi radialis, together with most of the forearm flexors, originates from the humerus). His final comment is that as a muscle, tib post is not prone to much variation. Freddie Wood Jones has to be the definitve work on the subject - but not the only one. You might like to read O J Lewis on the subject. Comparative anatomy, whether forelimb to hindlimb, or through the evolutionary tree, is a fascinating subject to which I have been addicted for 30 years.
__________________
Honorary Research Associate, Institute for Human Evolution, University of Witwatersrand
Adjunct Associate Professor (Human and Comparative Anatomy), University of Western Sydney
Fellow of The Centre For Human Biology, The University of Western Australia
"Please God, deliver me whole from Creationists......."
The Following User Says Thank You to Rob Kidd For This Useful Post:
No S*** Sherlock - tell us something we don't know! Rob
Same journal, a month earlier:
"Foote J, Freeman R, Morgan S & Jarvis A
Surgeon administered regional blocks for day case forefoot surgery
Abstract
Introduction
The aim was to see if as surgeons we were providing safe, efficient and effective, regional blocks for patients undergoing day case, forefoot surgery. We also assessed the costs of, providing this service.
Methods
63 consecutive patients were recruited prospectively for local anaesthetic block. Blocks were, performed by the orthopaedic team. Efficacy of block was assessed intra-operatively with a visual, analogue score (VAS) of 0–10. Satisfaction with the anaesthetic procedure was also assessed.
Results
Average time to perform the block was 6 min. Mean VAS for knife to skin was 0.44 (95%, confidence 0.07–0.81) and for ankle tourniquet was 1.39 (95% confidence 0.85–1.39). Patients were, highly satisfied with the blocks. No complications were reported.
Conclusions
These blocks are quick and easy to perform by orthopaedic surgeons. They are well, tolerated and effective. They result in considerable cost savings to the Hospital."
Yes that's right folks, a person who operates on feet is perfectly capable of administrating local anaesthetic to allow them to operate on feet! What a revelation.
The Following User Says Thank You to bob For This Useful Post:
"Foote J, Freeman R, Morgan S & Jarvis A
Surgeon administered regional blocks for day case forefoot surgery
Abstract
Introduction
The aim was to see if as surgeons we were providing safe, efficient and effective, regional blocks for patients undergoing day case, forefoot surgery. We also assessed the costs of, providing this service.
Methods
63 consecutive patients were recruited prospectively for local anaesthetic block. Blocks were, performed by the orthopaedic team. Efficacy of block was assessed intra-operatively with a visual, analogue score (VAS) of 0–10. Satisfaction with the anaesthetic procedure was also assessed.
Results
Average time to perform the block was 6 min. Mean VAS for knife to skin was 0.44 (95%, confidence 0.07–0.81) and for ankle tourniquet was 1.39 (95% confidence 0.85–1.39). Patients were, highly satisfied with the blocks. No complications were reported.
Conclusions
These blocks are quick and easy to perform by orthopaedic surgeons. They are well, tolerated and effective. They result in considerable cost savings to the Hospital."
Yes that's right folks, a person who operates on feet is perfectly capable of administrating local anaesthetic to allow them to operate on feet! What a revelation.
What an incredible revelation!!
I wonder if this has been read by a former orthopod named Khan at Walsall Hospital who declared - well over 20 years ago - "You don't have to worry about them (Lees and Liggins, podiatric surgeons) because it is not possible to carry out bunion surgery without general anaesthetic".
Mind you, I'd love to see these 'quick and easy' blocks performed by certain orthopods of my acquaintance. There are others more friendly who are of the opinion (and I have some sympathy with their view) that it is far quicker and easier to carry out surgery under GA, not least because you have a knowledgeable medic at the other end looking after the patient.
All the best
Bill
The Following User Says Thank You to W J Liggins For This Useful Post:
I don't do God, just like I don't do sexuality - its none of my business. However I do talk vestigial. Even a cursory comparison of any ape foot that that of humans shows digital reduction in length, but that does not make them vestigial per se. Most would argue that the mp jts are an important anchor for the plantar aponurosis, windlass and all that; thus I would argue that while the base of the first (proximal) phalanges, as a component of the mp jt have a key role, the rest of the digits are surplus to requirement, including the first. Purely anecdotal evidence suggest this to be the case; of the N=2 cases I have known of traumatic amputation of the first digit, roughly midshaft of the proximl phalanx showed no change to function once the trauma had settled. As a matter of comment, I find your response above, a tad odd.
__________________
Honorary Research Associate, Institute for Human Evolution, University of Witwatersrand
Adjunct Associate Professor (Human and Comparative Anatomy), University of Western Sydney
Fellow of The Centre For Human Biology, The University of Western Australia
"Please God, deliver me whole from Creationists......."
How many joints does the 5th toe have?
Put on your red shoes and dance the blues away. 
Re: How many joints does the 5th toe have?
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