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Search Results for : Metatarsalgia
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Management of the second and third metatarsal in moderate and severe hallux valgus.
Author(s): Wang, X; Jiang, JY; Ma, X; Huang, JZ; Gu, XJ
Journal: Orthopedics 2010 Feb 26; Vol. 32, Issue 12; Page(s) 892-6
[Medline ID - 19968220]

Hallux valgus is a common disorder of the forefoot that results from medial deviation of the first metatarsal and lateral deviation and/or rotation of the great. The management of hallux valgus is usually focused on the malalignment of the first ray, however, some patients report that pain at the plantar aspect of second and/or third metatarsal head(s) is more severe than the first metatarsophalangeal joint. In order to alleviate the metatarsalgia, we developed an oblique sliding osteotomy to manage the second metatarsal. This article reports the results of 17 feet that were treated with oblique sliding osteotomy. Average patient age was 55.3 years. The transverse arch of all patients had sagged, and all patients had painful calluses below the lesser metatarsals. Functional outcome was evaluated with the hallux valgus angle, intermetatarsal angle, proximal articular and distal articular set angles, and American Orthopaedic Foot and Ankle Society scoring system. The mean hallux valgus angle was 37.6 degrees preoperatively and 13.2 degrees postoperatively (mean correction, 24.4 degrees) and the mean intermetatarsal angle was 14.6 degrees preoperatively and 6.8 degrees postoperatively (mean correction, 8.8 degrees). American Orthopaedic Foot and Ankle Society scores improved from an average of 58 preoperatively to 87 postoperatively. Based on appearance and function, the outcomes of 16 feet were satisfactory. Pain of the forefoot was ameliorated and Mielke scores of 14 feet were either very good or good (82.3%) and satisfactory for 2 feet. Final follow-up was an average of 16 months and all patients were ambulating normally. We thus conclude that this surgical technique is effective in patients with moderate or severe hallux valgus.

Lengthening of the shortened first metatarsal after Wilson's osteotomy for hallux valgus.
Author(s): Singh, D; Dudkiewicz, I
Journal: J Bone Joint Surg Br 2010 Jan 26; Vol. 91, Issue 12; Page(s) 1583-6
[Medline ID - 19949121]

Metatarsalgia is a recognised complication following iatrogenic shortening of the first metatarsal in the management of hallux valgus. The traditional surgical treatment is by shortening osteotomies of the lesser metatarsals. We describe the results of lengthening of iatrogenic first brachymetatarsia in 16 females. A Scarf-type osteotomy was used in the first four cases and a step-cut of equal thicknesses along the axis of the first metatarsal was performed in the others. The mean follow-up was 21 months (19 to 26). Relief of metatarsalgia was obtained in the six patients in whom 10 mm of lengthening had been achieved, compared to only 50% relief in those where less than 8 mm of lengthening had been gained. One-stage step-cut lengthening osteotomy of the first metatarsal may be preferable to shortening osteotomies of the lesser metatarsals in the treatment of metatarsalgia following surgical shortening of the first metatarsal.

Relationship between plantar pressure and soft tissue strain under metatarsal heads with different heel heights.
Author(s): Ko, PH; Hsiao, TY; Kang, JH; Wang, TG; Shau, YW; Wang, CL
Journal: Foot Ankle Int 2009 Dec 23; Vol. 30, Issue 11; Page(s) 1111-6
[Medline ID - 19912724]

BACKGROUND: Metatarsalgia due to increased plantar pressure under the metatarsal head (MTH) is often seen with wearing high-heeled shoes. However, the concomitant soft tissue strain has not been well discussed. The objective of our study was to explore the standing plantar pressure and corresponding soft tissue strain under the metatarsal heads (MTHs) with different heel heights. MATERIALS AND METHODS: Twenty-one healthy subjects (10 male and 11 female) participated. The plantar pressure and soft-tissue thicknesses were measured simultaneously with a load cell and a 10-MHz linear-array ultrasound (US) transducer respectively. The changes in plantar pressure and soft tissue strain under the MTHs were analyzed for different heel heights. RESULTS: As hypothesized, plantar metatarsal pressure significantly increased and shifted to the first and second MTHs with increasing heel height from 2 cm to 4 cm (p < 0.05). However, the change in soft tissue strain under the medial forefoot became insignificant when the heel height was greater than 2 cm (p = 0.473 and 0.517). CONCLUSIONS: Increased heel height resulted in increasing medial forefoot loading pressure; however, the soft tissue exhibited stationary compressibility when the heel height was greater than 2 cm. CLINICAL RELEVANCE: Our finding provides an understanding of the biomechanical changes with wearing high-heeled shoes and suggests possible strategies to reducing discomfort and risk of injury, such as limiting heel height to no greater than 2 cm and using medial padding under MTHs.

Mitchell's osteotomy in the management of hallux valgus: An Indian perspective.
Author(s): Baba, AN; Bhat, JA; Paljor, S; Mir, NA; Majid, S
Journal: Indian J Orthop 2009 Sep 16; Vol. 43, Issue 1; Page(s) 76-81
[Medline ID - 4600689]

BACKGROUND: Hallux valgus is a common condition that affects the forefoot. A large number of procedures are described for managing this condition. Mitchell's osteotomy and its modifications are being widely used for treating hallux valgus. However, most of the studies describe the results from the developed world. We present results of the classic Mitchell's osteotomy in hallux valgus in Indian subcontinent. MATERIALS AND METHODS: Forty eight adult patients (including 12 bilateral ones) in the age range of 18-60 years with hallux valgus were managed with the classic Mitchell's osteotomy. Pain over the bunion was the reason for surgery in 53 of 60 feet and cosmesis in the remaining 7 feet. Patients with hallux valgus angle more than 20 degrees and not responding to a trial of conservative treatment were included. Patients having metatarsophalangeal (MTP) joint osteoarthritis (Grade II and higher), hallux rigidus, rheumatoid arth ritis, and with subluxation of MTP joint were excluded from the study. Further, patients with first metatarsal more than 3 mm shorter than second metatarsal were also excluded. RESULTS: The average follow-up period is 3 yrs (range 18months - 6yrs). About 55 feet (83%) were painless after surgery. Forty-two (70%) patients were happy with the cosmetic results of the surgery. Metatarsalgia was the reason for dissatisfaction with the procedure in five patients. The average correction of hallux valgus and the intermetatarsal angles achieved was 19.7 degrees and 6.9 degrees , respectively. Using the Broughton and Winson scoring system, 37 (61.7%) feet had excellent results, 18 (30%) had good, and five (8.3%) feet had a poor results. CONCLUSION: The classic Mitchell's procedure is a simple procedure and gives good cosmetic and radiological results.

Prediction of plantar shear stress distribution by artificial intelligence methods.
Author(s): Yavuz, M; Ocak, H; Hetherington, VJ; Davis, BL
Journal: J Biomech Eng 2009 Dec 16; Vol. 131, Issue 9; Page(s) 091007
[Medline ID - 19725696]

Shear forces under the human foot are thought to be responsible for various foot pathologies such as diabetic plantar ulcers and athletic blisters. Frictional shear forces might also play a role in the metatarsalgia observed among hallux valgus (HaV) and rheumatoid arthritis (RA) patients. Due to the absence of commercial devices capable of measuring shear stress distribution, a number of linear models were developed. All of these have met with limited success. This study used nonlinear methods, specifically neural network and fuzzy logic schemes, to predict the distribution of plantar shear forces based on vertical loading parameters. In total, 73 subjects were recruited; 17 had diabetic neuropathy, 14 had HaV, 9 had RA, 11 had frequent foot blisters, and 22 were healthy. A feed-forward neural network (NN) and adaptive neurofuzzy inference system (NFIS) were built. These systems were then applied to a custom-built platform, which collected plantar pressure and shear stress data as subjects walked over the device. The inputs to both models were peak pressure, peak pressure-time integral, and time to peak pressure, and the output was peak resultant shear. Root-mean-square error (RMSE) values were calculated to test the models' accuracy. RMSE/actual shear ratio varied between 0.27 and 0.40 for NN predictions. Similarly, NFIS estimations resulted in a 0.28-0.37 ratio for local peak values in all subject groups. On the other hand, error percentages for global peak shear values were found to be in the range 11.4-44.1. These results indicate that there is no direct relationship between pressure and shear magnitudes. Future research should aim to decrease error levels by introducing shear stress dependent variables into the models.

Disorders of the lesser toes.
Author(s): Smith, BW; Coughlin, MJ
Journal: Sports Med Arthrosc 2009 Aug 15; Vol. 17, Issue 3; Page(s) 167-74
[Medline ID - 19680113]

Lesser toe disorders are an often under-appreciated source of pain and disability in athletes. Patients may have significant symptoms from corns, hammertoe and mallet toe deformities, and metatarsalgia resulting from neuromas and metatarsophalangeal joint instability. Although patients may present with vague symptoms, a careful history and physical examination will point a clinician to an accurate diagnosis. Treatment of these lesser toe disorders is straightforward and leads to predictably good results.

Minimally invasive distal metatarsal osteotomy for mild-to-moderate hallux valgus deformity.
Author(s): Lin, YC; Cheng, YM; Chang, JK; Chen, CH; Huang, PJ
Journal: Kaohsiung J Med Sci 2010 Feb 5; Vol. 25, Issue 8; Page(s) 431-7
[Medline ID - 19605337]

Minimally invasive surgery has recently been introduced for foot and ankle surgery, and hallux valgus surgery is no exception. The purpose of our study was to analyze the early results and to present our experience of minimally invasive distal metatarsal osteotomy in correcting mild-to-moderate hallux valgus deformities. Between September 2005 and December 2006, 31 consecutive patients (47 feet) with mild-to-moderate hallux valgus deformities underwent minimally invasive distal metatarsal osteotomies. The clinical and radiographic outcomes were assessed. The satisfaction rate was 90.32%. The mean total American Orthopedic Foot and Ankle Society hallux-metatarsophalangeal-interphalangeal scale was 92.7 points. Complications included two (4.26%) episodes of stiffness, six (12.77%) episodes of pin tract infection, and one (2.13%) deep infection. There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. On weight-bearing anteroposterior foot radiographs, the mean hallux valgus angle and first intermetatarsal angle corrections were 11.8 degrees and 6.3 degrees, respectively, which is a statistically significant difference (p < 0.001) between the preoperative and postoperative status. Here, minimally invasive distal metatarsal osteotomy was associated with good satisfaction, functional improvement and low complication rates. This technique offers an effective, safe and simple way to treat hallux valgus with a first intermetatarsal angle less than 15 degrees.

Total sesamoidectomy for painful hallux rigidus: a medium-term outcome study.
Author(s): Tagoe, M; Brown, HA; Rees, SM
Journal: Foot Ankle Int 2009 Oct 9; Vol. 30, Issue 7; Page(s) 640-6
[Medline ID - 19589310]

BACKGROUND: The nature of the sesamoid complex in the development of hallux rigidus or limitus (HL) has been poorly characterized and the role of the sesamoids in the surgical management of this condition has not been explored. Previous surgical approaches in younger active patients unsuited to destructive procedures have been limited. MATERIALS AND METHODS: Thirty-three patients (36 procedures) were reviewed between 2 and 4 years following total sesamoidectomy for the management of hallux rigidus/limitus. The American Orthopedic Foot & Ankle Society hallux (AOFAS) clinical rating system was used to compare pre and postoperative scores. The range and quality of motion and transfer metatarsalgia were noted. The three most important patient problems and the degree to which these had been addressed by the surgery and the time to maximal improvement were noted. RESULTS: No significant functional impairment or malalignment were found. There were no instances of pain on metatarsal compression, or of transfer metatarsalgia with or without callus formation. A highly statistically significant improvement in AOFAS scores was found (p < 0.001). CONCLUSION: High levels of clinical improvement and patient satisfaction were found following total sesamoidectomy. No deleterious consequences of sesamoid removal were observed. For symptomatic patients where a joint replacement/fusion is not indicated, total sesamoidectomy was beneficial as an interim procedure, for joints with a moderate (grades 2 to 3) degree of ar throsis.

An adaptation of Weil's osteotomy of the lesser metatarsal neck.
Author(s): Bennett, AJ; McLeod, I
Journal: J Foot Ankle Surg 2009 Oct 3; Vol. 48, Issue 4; Page(s) 516-7
[Medline ID - 19577733]

Weil's osteotomy is a useful technique for the treatment of central metatarsalgia and lesser metatarsophalangeal joint dislocation. In this report, we describe a technical maneuver that involves predrilling and tapping holes that can be used to guide translocation of the capital fragment of the metatarsal. This configures the final hole that will be used for single screw placement to secure the osteotomy in the position of correction. This technical tip is useful in regard to establishing the intraoperative orientation of the osteotomy and screw placement, and enables the use of a single, generic screw for stabilization of the realigned metatarsal.

The outcome of Morton's neurectomy in the treatment of metatarsalgia.
Author(s): Pace, A; Scammell, B; Dhar, S
Journal: Int Orthop 2010 Jun 11; Vol. 34, Issue 4; Page(s) 511-5
[Medline ID - 19484237]

Morton's neuroma is a common cause of metatarsalgia caused by intermetarsal digital nerve thickening. This study reviews the pathology, presentation, symptoms and signs, and patient satisfaction with surgical treatment. Seventy-eight patients (82 feet) were treated for Morton's metatarsalgia by excision of the interdigital nerve. The patients were followed-up for a mean of 4.6 years (range 0.8-8.1 years) and scored using the Foot Functional Index and the American Orthopedic Foot Ankle Society scoring system. In 74 patients the Foot Functional Index was more than 85 (maximum score 100). Seventy-one patients scored more than 90 on the American Orthopedic Foot Ankle Society scoring system with two patients scoring 100 (maximum score). Postoperatively, 82% reported excellent or good results, 10% had a fair result with restriction of activities or pain and 8% had no improvement at all after surgery while 71% had restrictions with footwear.
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