The Frequency of Biphalangeal Toes in the Turkish Population: A Radiographic Study

Yıl 2024, , 187 - 193, 27.08.2024

Aziz Çataltepe , Melih Akan

https://doi.org/10.46332/aemj.1425018

Öz

Purpose: This study aimed to investigate the frequency of biphalangeal toes in the Turkish population.

Materials and Methods: Radiographs of 1096 cases (n=1286 feet) between September 2020 and August 2022 were analyzed. Our study had 386 left foot radiographs, 439 right foot radiographs, and 189 bilateral radiographs. Foot radiographs were assessed for biphalangealism of the second to the fifth toe. Data regarding sex, age, side, the number of phalanges of the fifth, fourth, third, and second toe, and the reason for performing radiographs were assessed. Groups were compared using Fisher’s exact test and the Chi-square test.

Results: The prevalence of biphalangealism in the fifth toe was found to be 35.70%, in the fourth toe 1.70%, in the third toe 0.50% and in the second toe 0.20%. The difference in the frequency of biphalangeal and triphalangeal toes regarding sex and the right/left foot was statistically insignificant (p=0.245, p=0.815 respectively). The asymmetrical distribution of the fifth biphalangeal toe was seen in 6.90%, and the asymmetrical distribution of the fourth biphalangeal toe was 0.50% in the 189 bilateral feet radiographs.

Conclusions: With this study, we found and demonstrated that the incidence of biphalangeal fifth toe is 35.70% and that this anatomical variant in the Turkish population is similar to other Turkish studies. The biphalangeal fifth toe must be kept in mind during the assessment of a case with foot pathologies and foot radiographs. Additionally, biphalangealism is not observed in the 4th and 3rd fingers on the same foot without the 5th finger being biphalangeal.

Anahtar Kelimeler

foot anatomy, two-phalanged toes toe symphalangism, pedal biphalangism, Turkish population

Türk Popülasyonunda Bifalangeal Ayak Parmakları Sıklığı: Radyografik Çalışma

Öz

Amaç: Bu çalışma, ayak parmaklarında bifalangeal varyantın Türk toplumundaki sıklığını araştırmayı amaçladı.

Araçlar ve Yöntem: Eylül 2020 ile Ağustos 2022 arasında 1096 vakanın (n=1286 ayak) radyografileri analiz edildi. Çalışmamızda 386 sol ayak grafisi, 439 sağ ayak grafisi ve 189 iki taraflı grafi mevcuttu. Ayak radyografileri ikinci ila beşinci parmaklarının bifalangealizmi açısından değerlendirildi. Cinsiyet, yaş, taraf, beşinci, dördüncü, üçüncü ve ikinci ayak parmaklarının falanks sayısı ve radyografi çekilme nedeni ile ilgili veriler değerlendirildi. Gruplar Fisher kesin testi ve Ki-kare testi kullanılarak karşılaştırıldı.

Bulgular: Bifalangealizmin beşinci ayak parmağında görülme sıklığı %35.70, dördüncü parmağında %1.70, üçüncü parmağında %0.50 ve ikinci parmağında ise %0.20 olarak tespit edildi. Cinsiyete ve sağ/sol ayağa göre bifalangeal ve trifalangeal parmaklarının sıklığı arasındaki fark istatistiksel olarak anlamlı değildi (sırasıyla p=0.245, p=0.815). 189 iki taraflı ayak grafisinde beşinci bifalangeal parmağın asimetrik dağılımı %6.90, dördüncü bifalangeal parmağın asimetrik dağılımı ise %0.50 olarak görüldü.

Sonuç: Bu çalışmayla, bifalangeal beşinci ayak parmağının görülme sıklığını %35.70 ve Türk toplumundaki bu anatomik varyantın diğer Türk çalışmaları ile benzer olduğunu bulduk ve gösterdik. Ayak patolojisi olan bir olgunun ayak röntgeni değerlendirilmesi sırasında iki falankslı beşinci ayak parmağı akılda tutulmalıdır. Ayrıca, aynı ayakta 5. parmak bifalangeal olmadan 4. 3. parmaklarda biphalengealizm görülmemektedir.

Anahtar Kelimeler

ayak anatomisi, ayak parmağı symphalangismi, iki falankslı ayak parmakları, pedal bifalangizmi, Türk nüfusu

Kaynakça

• 1. Snell RS. Clinical anatomy, 7th edition. Lippincott Williams and Wilkins. 2004.
• 2. Ucpunar H, Camurcu Y, Ozcan C, Buyuk AF, Tas SK, Cobden A. The incidence of biphalangeal fifth toe: Comparison of normal population and patients with foot deformity. J Orthop Surg (Hong Kong). 2019;27(1):2309499019825521.
• 3. Sandström B, Hedman G. Biphalangia of the lateral toes. A study on the incidence in a Swedish population together with some observations on digital sesamoid bones in the foot. Am J Phys Anthropol. 1971;34(1):37-41.
• 4. Case DT, Heilman J. Pedal symphalangism in modern American and Japanese skeletons. Homo. 2005;55(3):251-262.
• 5. Turan A, Kose O, Guler F, Ozyurek O. Fracture of biphalangeal fifth toe: A diagnostic pitfall in the emergency department. Journal of Emergency Medicine, Trauma and Acute Care. 2016:3:2-4.
• 6. Chan YLC, Dao WH, Yeung T, Chow ECS. Prevalence of toe symphalangism in Hong Kong Chinese population. J Orthop Trauma. 2019;26(1):56-60.
• 7. Thompson FM, Chang VK. The two-boned fifth toe: clinical implications. Foot Ankle Int. 1995;16(1):34-36.
• 8. Moulton LS, Prasad S, Lamb RG, Sirikonda SP. How many joints does the 5th toe have? A review of 606 patients of 655 foot radiographs. Foot Ankle Surg. 2012;18(4):263-265.
• 9. Dereymaeker G, van der Broek C. Biphalangeal fifth toe. Foot Ankle Int. 2006;27(11):948-951.
• 10. Ozyurek S, Kose O, Celiktas M. Prevalence of pedalsymphalangism in Turkish population. Italian J AnatomyEmbryology. 2017;122(2):110-120.
• 11. Candan B, Torun E, Dikici R. The Prevalence of Accessory Ossicles, Sesamoid Bones, and Biphalangism of the Foot and Ankle: A Radiographic Study. Foot Ankle Orthop. 2022;18;7(1):24730114211068792.
• 12. Davis DD, Kane SM. Fifth-Toe Deformities.USA: StatPearls Publishing. 2022:32491393.
• 13. Nakashima T, Hojo T, Suzuki K, Ijichi M. Symphalangism (two phalanges) in the digits of the Japanese foot. Ann Anat. 1995;177(3):275-278.
• 14. Ceynowa M, Rocławski M, Pankowski R, Mazurek T. The prevalence and ossification pattern of the biphalangeal and triphalangeal lateral toes. Surg Radiol Anat. 2018;40(9):1039-1045.
• 15. Talusan PG, Milewski MD, Reach JS Jr. Fifth toe deformities: overlapping and underlapping toe. Foot Ankle Spec. 2013;6(2):145-149.
• 16. Le Minor JM. Biphalangeal and triphalangeal toes in the evolution of the human foot. Acta Anat (Basel). 1995;154(3):236-241.
• 17. George M. Biphalangeal fifth toe: an increasingly common variant? J Anat. 2001;198(2):251.
• 18. Gallart J, González D, Valero J, Deus J, Serrano P, Lahoz M. Biphalangeal/triphalangeal fifth toe and impact in the pathology of the fifth ray. BMC Musculoskelet Disord. 2014;5(15):295.