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      Anatomic and Histological Features of the Extensor Digitorum Longus Tendon Insertion in the Proximal Nail Matrix of the Second Toe

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          Abstract

          Background: Anatomic and histological landmarks of the extensor digitorum longus (EDL) tendon insertion in the proximal nail matrix may be key aspects during surgery exposure in order to avoid permanent nail deformities. Objective: The main purpose was to determine the anatomic and histological features of the EDL’s insertion to the proximal nail matrix of the second toe. Methods: A sample of fifty second toes from fresh-frozen human cadavers was included in this study. Using X25-magnification, the proximal nail matrix limits and distal EDL tendon bony insertions were anatomically and histologically detailed. Results: The second toes’ EDLs were deeply located with respect to the nail matrix and extended superficially and dorsally to the distal phalanx in all human cadavers. The second toe distal nail matrix was not attached to the dorsal part of the distal phalanx base periosteum. Conclusions: The EDL is located plantar and directly underneath to the proximal nail matrix as well as dorsally to the bone. The proximal edge of the nail matrix and bed in human cadaver second toes are placed dorsally and overlap the distal EDL insertion. These anatomic and histological features should be used as reference landmarks during digital surgery and invasive procedures.

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          Quantification of regional matrix nail production.

          The relative nail producing capacity of different regions within the nail matrix has not been quantified. In order to do this, the number of nail plate cells in the dorsoventral axis of 12 human great toenails was counted at five sites in the longitudinal axis, and compared with direct measurements of nail plate thickness at the same sites. The mean number of nail cells in the nail plate reached a maximum at the lunula, with no further increase along the length of the nail bed. At the mid-point between the proximal tip of the germinal matrix and lunula, mean cell numbers achieved 81% of the value at the lunula. Mean nail thickness was only 90% of its maximum at the lunula, with a further significant increase (P = 0.02) between the lunula and end of the nail bed. These observations suggest that the proximal nail matrix is the main source of nail within the matrix. This is consistent with clinical experience where distal matrix surgery has a low potential for scarring in comparison with proximal matrix surgery. The additional finding of increased nail thickness, but not cell numbers, along the nail bed make it likely that cells within the nail plate change shape as they move distally.
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            Analysis of toe pressures under the foot while dynamic standing on one foot in healthy subjects.

            Dynamic balance is a crucial element in performing many activities of daily living. The one-leg stance test is a valuable test for balance impairment. The aim of the present study was to assess the relationships between body sway and toe pressure for dynamic balance test of one-leg standing on a perturbation platform. The subjects were 15 volunteers (six males and nine females, age = 21.1 +/- 1.8 years). The instrument used for evaluation of balance was the Balance System, whose software provides information on the subject's stance balance through calculation of two main variables: 1) body sway parameters (cm) and 2) peak pressure (percent of body weight/cm2) under the toes. The Balance System includes actuators which move the foot platform back and forth (+/- 40 mm perturbation at 0.25 Hz) at an average velocity of 20 mm/sec. The subjects were asked to balance on each leg for 20 seconds. The trials were repeated on the opposite foot after 5 minutes of rest. The dynamic postural control induced by low frequency perturbation in the anterior/posterior direction used the ankle strategy. Body sway was more significantly correlated with the peak anterior/posterior sway component than with lateral sway (p < 0.01). The peak pressure value of the great toe was significantly greater (p < 0.01) than the sum of the peak values of the other four toes for both sides. The study indicates the importance of the strength of the toes and somatosensory information from the sole and ankle during the dynamic one-foot standing balance as goals in rehabilitation for poor balance.
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              Anatomy and physiology of the perionychium: A review of the literature and anatomic study

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                Author and article information

                Journal
                Diagnostics (Basel)
                Diagnostics (Basel)
                diagnostics
                Diagnostics
                MDPI
                2075-4418
                07 March 2020
                March 2020
                : 10
                : 3
                : 147
                Affiliations
                [1 ]University Center of Plasencia, Faculty of Podiatry, Universidad de Extremadura, 10600 Badajoz, Spain; patibiom@ 123456unex.es
                [2 ]Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Alcorcon, Spain; marta.losa@ 123456urjc.es
                [3 ]School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid Spain davidrodriguezsanz@ 123456ucm.es (D.R.-S.)
                [4 ]Department of Human, Anatomy and Embryology, Faculty of Medicine, Madrid Complutense University, 28040 Madrid, Spain; jmurillo@ 123456med.ucm.es
                [5 ]Research, Health and Podiatry Group. Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol Spain; daniellopez@ 123456udc.es
                Author notes
                [* ]Correspondence: cescalvo@ 123456ucm.es ; Tel.: +34-913-941-532
                Author information
                https://orcid.org/0000-0003-3821-949X
                https://orcid.org/0000-0001-7588-2069
                https://orcid.org/0000-0003-1568-7602
                https://orcid.org/0000-0002-6569-1311
                https://orcid.org/0000-0002-9818-6290
                Article
                diagnostics-10-00147
                10.3390/diagnostics10030147
                7151017
                32156059
                9aea8d3f-7d3c-4dc1-8e35-38574dfb18fc
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 18 February 2020
                : 05 March 2020
                Categories
                Article

                anatomy and histology,foot,nails,nail matrix,toe joint,tendons,toe phalanges,nail deformity,anatomic landmarks

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