Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses . However, the role of direct trauma in the pathogenesis of fungal nail infections was only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated.Aim of the study: This is a multicenter single-author observational study over a period of 6 years performed at a specialized nail clinic in three countries. All patient photographs taken by the author during this period were screened for toenail alterations and all toe onychomycosis cases were checked whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture or polymerase chain reaction (PCR) were accepted.Results: Of 1653 cases, 185 were onychomycoses proven by mycologic culture, PCR or histopathology. Of these, 179 involved at least one big toenail, 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease and the onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), hallux erectus was observed in 43 patients, the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role for the localization of the fungal infection as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency and iatrogenic immunosuppression whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or to correct. Generally, when explaining the treatment of onychomycoses to the patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.

Introduction. A needle is inserted into a joint for arthrocentesis or injection of a therapeutic medication(s), commonly a corticosteroid. The aim of this paper is to discuss the first theme identified from a scoping review of corticosteroid injections for the pathology of the first metatarsophalangeal joint. Pathology. The two most common pathologies affecting the first metatarsophalangeal joint are osteoarthritis and bunions. An arthritic joint is regularly injected with a corticosteroid, but bunions are not. Other pathologies that may receive an injection include rheumatoid arthritis, gout, sesamoiditis and post-operative arthrofibrosis. Discussion. Most available evidence discusses corticosteroid injections for osteoarthritis, but there is a paucity of high-quality evidence, especially for corticosteroid use in other pathological conditions. Conclusion. Whilst the evidence base suggests that corticosteroid injections are safe short- and mid-term treatment options for a range of soft tissue and joint pathology, the specific indications, and short/long-term outcomes in the first metatarsophalangeal joint pathologies are not clear and warrant further study.

Abstract: Chemical burns are one of the most dangerous and aggressive types of burns as they can cause significant tissue damage, leading to pain, inflammation, necrosis, and scarring. We present a burn case report associated with the use of Acellular Dermal Matrix (MatriDerm® MedSkin Solution Dr. Suwelack AG, Billerbeck, Germany) for the reconstruction of a Hallux after the patient was mistakenly administered intramuscular Nitric Acid at another institution. The patient presented with a third degree burn that compromised the medial aspect of the hallux’s skin, the distal phalanx and nail bed. Early debridement was performed, and Negative Pressure Wound Therapy (NPWT VAC, 3M, US) was used to preserve and promote tissue viability. Eight days later, the patient was taken to the OR, and Acellular Dermal Matrix and split-thickness skin graft were used to reconstruct her right hallux’s defect. The patient achieved adequate clinical evolution and was discharged with complete reconstruction of the burned area. Acellular Dermal Matrix proved to be an important and viable option for reconstructive surgery after a chemical burn, and further studies are warranted to ensure its routine usage in this kind of lesions. Keywords: chemical burn, acellular matrix, hallux reconstruction, NPWT

Hallux valgus deformity (HVD) involves subluxation of the first metatarsophalangeal joint. While HVD is primarily considered a forefoot condition, midfoot instability may play a significant role in its development and severity. Therefore, this review had a particular focus on understanding midfoot instability based upon weightbearing imaging assessments of the TMT joint. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched five databases for studies on midfoot instability in HVD patients. Severity of HVD was defined by hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA). Data was extracted, and articles were graded using the Methodological Index for Non-Randomized Studies (MINORS). Of 547 initially retrieved articles, 23 met inclusion criteria. Patients with HVD showed higher HVA and DMAA on weight-bearing radiographs (WBRG) and weight-bearing computed tomography (WBCT) compared to healthy individuals. Midfoot instability was assessed through intermetatarsal angle (IMA) and tarsometatarsal angle (TMT angle). Patients with HVD exhibited greater IMA and TMT angles on both WBRG and WBCT. This review highlights the importance of weight-bearing imaging assessments for midfoot instability in HVD. IMA and TMT angles can differentiate between healthy individuals and HVD patients, emphasizing the significance of midfoot assessment in understanding HVD pathology.