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PubMedDate not supplied

Asymmetric "V" osteotomy: a predictable surgical approach for chronic central metatarsalgia.

Chronic metatarsalgia is a condition found through the years to present many treatment difficulties. These difficulties began with a lack of understanding, not only concerning the etiologic nature of this condition, but failure to appreciate the surgical treatment ramifications inherent to alterations in the metatarsal parabola. These failures have subsequently led to lesions under the adjacent metatarsal heads, stress fractures, flail toes, and other postoperative pathology. This often leads to further surgical intervention or accommodative modifications. The authors offer an analysis of surgical approaches to this problem and present a more predictable surgical technique to enhance the metatarsal parabola, while decreasing either excessive plantarflexion of a particular metatarsal or set of metatarsals. To date the senior author (E.L.) has performed the asymmetric "V" osteotomy on 30 patients for a total of 40 metatarsals. After a 12- to 18-month postoperative period, there have been no significant complications, including recurrences, transfer lesions, excessive secondary bone callous, malunions, or adjacent metatarsalgia. Delayed union with secondary bone callous has developed in two instances. The authors introduce an innovative surgical approach to structural metatarsal abnormalities as a distinct advantage to other previously described osteotomies with greater predictability, better anatomic reduction, primary bone healing, and faster return to normal activities.

Chronic Disease↗
PubMedDate not supplied

Regnauld procedure in the surgical treatment of metatarsalgia: interpretation of follow-up X-ray imaging.

In lesser ray metatarsalgia (rays 2 through 5) due to an altered Lelievre's metatarsal formula (depending on the respective lengths of the metatarsals), the resection of metatarsal heads aims at restoring a correct metatarsal support. This being a destructive procedure, metatarsal head resection is best indicated in the treatment of severe forefoot deformities such as those resulting from rheumatoid arthritis. In all metatarsalgias that recognize biomechanical origin, the enclavement procedure, according to Regnauld's original report, should be preferred. The aim of this study is analysis of the radiographic evolution of the metatarsal epiphysis following the Regnauld procedure on the basis of anatomic and pathological events occurring during the attachment process. The procedure was performed on 31 feet and the patients were followed-up for 24 months postoperatively. The enclavement process evolved favorably in all cases. It consists of four anatomic/pathologic phases corresponding to typical radiographic features. While graft consolidation is achieved in 3 to 4 months postoperatively, complete recovery of the metatarsal bony architecture and functional adaptation requires 18 to 24 months.

Aged↗
PubMed2001

Lesser metatarsal osteotomies. A biomechanical approach to metatarsalgia.

As with most other orthopedic conditions, a firm understanding of the normal and pathologic biomechanics of the lesser metatarsals is essential when contemplating treatment of metatarsalgia. Despite its prevalence, metatarsalgia remains a technically demanding surgical challenge. Some of the difficulty with treatment of this problem arises because of some of the controversies discussed previously. Many lesser metatarsal osteotomies have been described, and their success depends on many factors. Alleviating the correct amount of pressure underneath the metatarsal head without adversely affecting the biomechanics of the region demands an exacting osteotomy that is stable and readily heals. Much of the research done to date has not proved which procedure can achieve these goals reproducibly for patients. It is hoped that future investigations will guide treatment choices and allow patients to obtain relief from this difficult problem with greater success.

Biomechanical Phenomena↗
PubMed2005

Optimum position of metatarsal pad in metatarsalgia for pressure relief.

OBJECTIVES: To determine the optimum position of a metatarsal (MT) pad to treat metatarsalgia. DESIGN: We used a sensing mat with 16 x 16 sensors, 4.4 x 4.4 mm each, to measure plantar pressure in ten metatarsalgia patients walking with an MT pad in various positions. Peak pressures of the MT head and MT pad were analyzed. RESULTS: Walking without MT pads, the peak pressure of the MT head was 678 +/- 227 and 687 +/- 228 kPa in one proximal and one distal row of three sensors. Placement of the MT pad resulting in peak pressure two sensors proximal to the peak pressure of the MT head did not significantly reduce peak pressure on the MT head. In contrast, placement of the MT pad resulting in peak pressure just proximal to the peak pressures of the MT head reduced the proximal and distal peak pressures on the MT head to 427 +/- 97 and 431 +/- 92 kPa (P < 0.05). CONCLUSIONS: Optimum pressure reduction on the MT head is attained when the peak pressure generated by the MT pad is just proximal to the MT head.

Humans↗
PubMedDate not supplied

Metatarsalgia caused by an increase in circulating platelets: a case report.

A patient with a year-long history of metatarsalgia was found to have an elevated platelet count due to essential thrombocythemia, a benign myeloproliferative disease. Reduction of the platelet count with chemotherapy eliminated the foot pain. The authors recommended that a platelet count be part of the work-up of patients with metatarsalgia when the etiology of the foot pain is unclear.

Female↗
PubMed1989

Metatarsal osteotomy for primary metatarsalgia: radiographic and pedobarographic study.

The effect of surgical procedures for primary metatarsalgia on the load distribution and bony architecture of the forefoot is poorly understood. A prospective study was performed on 45 feet with this diagnosis treated by dorsal wedge osteotomy and compared with 29 symptom-free contralateral feet. Each foot was evaluated preoperatively and postoperatively with quantitative radiographic analysis, a pedobarographic study, and by physical examination. Following osteotomy there was a 4.5-mm increase in average height from ground and a 7.0 psi decrease in pressure. The symptom-free control group demonstrated no statistically significant changes. Residual pain occurred with an average height increase of less than 3.5 mm and an average pressure decrease of less than 1.5 psi. Transfer lesions developed in three of four patients with a height increase of greater than 4.5 mm. The symptoms of metatarsalgia are altered by changes in height of the metatarsal or the pressure beneath it. It is not possible to predict the surgical elevation of the metatarsal head required to precisely decrease the pressure beneath the metatarsal head, thereby eliminating symptoms.

Adult↗
PubMed1995

Surgical management for intractable metatarsalgia.

We reviewed the results of arthrodesis of the first metatarsophalangeal joint and excisional arthroplasty of the lesser metatarsophalangeal joints performed on patients who presented intractable metatarsalgia and forefoot deformities. The study included 18 feet (15 patients) in 12 women and 3 men. The follow-up averaged 5.2 years. A good to excellent result was achieved in 15 (83%) feet; pain, which had been moderate to severe before surgery, was reduced to none to mild, and function, which had been severely limited before surgery, was improved to virtually unlimited. The fusion rate of the first metatarsophalangeal joint was 94% (17 of 18 feet). Thirteen of the 15 patients (87%) stated they would have the procedure again. This repair has been demonstrated to be a useful salvage procedure in nonrheumatoid patients with severe metatarsalgia secondary to failed forefoot surgery.

Adult↗
PubMed1984

Morton's metatarsalgia. Clinical, electrophysiological and histological observations.

In an attempt to improve the accuracy of diagnosis, 16 patients suffering from Morton's metatarsalgia were investigated clinically and electrophysiologically. The histological findings were related to these observations. The precise aetiology of Morton's metatarsalgia remains obscure, but the findings are compatible with an entrapment syndrome. Nerve conduction studies have a place in the investigation of patients with atypical presentation of pain in the foot. Further refinement of the electrophysiological technique should be possible.

Action Potentials↗
PubMed1998

Primary metatarsalgia: the influence of a custom moulded insole and a rockerbar on plantar pressure.

The effects of a custom moulded insole and a rockerbar on peak pressure and force impulse as well as on pain scores in subjects with a history of metatarsalgia were studied. In addition the subjects' preference for the type of intervention was determined. Forty-two subjects with a history of primary metatarsalgia were selected. They were all provided with the same brand of extra depth shoes with a ready made insole. The effect of custom moulded insoles, a rockerbar and the interaction between the two interventions were studied by testing the four possible combinations: ready made insole without a rockerbar, ready made insole with a rockerbar, custom moulded insole without a rockerbar and custom moulded insole with rockerbar. At the most important region, the central distal forefoot, a rockerbar caused a decrease in force impulse of 15.1% and a decrease in peak pressure of 15.7%. The custom moulded insole produced a decrease of 10.1% in force impulse and of 18.2% in peak pressure. Pain scores were significantly lower for interventions with a custom moulded insole, while the rockerbar showed no influence on pain scores. Subjects with pain preferred a custom moulded insole more often than subjects without pain. Decrease of peak pressure or force impulse was not correlated to pain scores. The use of either a custom moulded insole or a rockerbar produced an important decrease of peak pressure and force impulse at the central distal forefoot and, therefore, either is suitable in any situation which a decrease of pressure is vital.

Adult↗
PubMed2000

Metatarsalgia and rheumatoid arthritis--a randomized, single blind, sequential trial comparing 2 types of foot orthoses and supportive shoes.

OBJECTIVE: To compare the effects of semi-rigid and soft orthoses worn in supportive shoes, and supportive shoes worn alone, on metatarsal phalangeal (MTP) joint pain. MTP joint synovitis, and lower extremity function in patients with rheumatoid arthritis. METHODS: Twenty-eight subjects referred to occupational therapy received in random order 3 interventions for 12 week trials, separated by 2 week washouts. A crossover design compared effectiveness of interventions. RESULTS: Twenty-four subjects completed the study. A reduction in mean pain scores from baseline to final visits showed that semi-rigid orthoses had a highly significant effect on pain. Soft orthoses did not show a significant effect on pain from baseline to final visit, nor did shoes worn alone. None of the interventions had a significant effect on synovitis or function. CONCLUSION: Semi-rigid orthoses worn in supportive shoes were an effective treatment for metatarsalgia. Supportive shoes worn alone or worn with soft orthoses did not provide pain relief for metatarsalgia.

Adult↗
PubMed2001

[Weil's cervicocapital osteotomy for median metatarsalgia. Report of 70 cases].

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases. The results were satisfactory in cavus feet and in cases where the osteotomy was combined with correction of a hallux valgus. Weil's osteotomy allows accurate adjustment of the shortening and early weight-bearing. This is indicated in cases with excessive length of the central metatarsals and also in cases with metatarsophalangeal dislocations.

Adult↗
PubMed1976

[Localisation and pathogenesis of Morton's metatarsalgia (author's transl)].

Todays concept of Morton's metatarsalgia is seen as a pseudoneuroma of the plantar digital nerve. Since clinic and pathogenesis tally, one should abandon the idea that Morton's metatarsalgia consists of interdigital pain (mainly in the 3rd space) and accept it as a pfeudoneuroma due mainly to pressure on the plantar digital nerve.

Female↗
PubMed1992

[Management of metatarsalgia using Helal's method for metatarsal osteotomy].

Authors report on the result of Helal's metatarsal osteotomies performed on 62 feet of 48 patients for metatarsalgia. In 85 per cent the result proved to be excellent, in 15 per cent there was no improvement. Analysing the causes of the postoperative complaints they call attention to the overload of the marginal arches and to the metatarsalgia developing on the non osteotomized neighbouring arch. These complaints appeared in 1/3 of their material and could be generally well influenced with conservative treatment.

Adolescent↗
PubMed1989

Metatarsalgia.

Metatarsalgia is a complex entity requiring specific diagnoses and appropriate management, which may include shoe modifications and inserts. Metatarsalgia, pain in the metatarsal head areas, has a variety of specific causes, including mechanical, neurogenic, vascular, and inflammatory conditions. Many problems may be treated successfully with shoe modifications and inserts. Surgical intervention may be appropriate in advanced and recalcitrant cases.

Humans↗
PubMedDate not supplied

Morton's metatarsalgia in rheumatoid arthritis.

Findings in a follow-up study of 66 operations Morton's metatarsalgia performed on 52 patients suffering from rheumatoid arthritis during the years 1954-1977 were in many respects different from those described as "classic" Morton's neuroma. The incidence was one to 520 in rheumatoid patients. The ratio of females to males was 9.4 to one. Histology revealed inflammatory or degenerative changes of the walls of synovial cavities often in connection with typical rheumatoid nudules. The changes of the nerves were non-specific alterations caused by chronic compression. Surgical removal of the tumor-like formations gave uniformly good results. Early metatarsophalangeal synovectomy for rheumatoid arthritis decreased in need of operations for Morton's metatarsalgia from 4.5 to 0.6 operations per year and can be recommended as a prophylactic procedure.

Adult↗
PubMed1996

Metatarsalgia.

Metatarsalgia, or pain in the metatarsal region of the foot, is a common orthopaedic problem, but is generally less well understood than pain in the toes, ankle or heel. The cause of metatarsal pain is often less apparent than in other regions of the foot, and in many cases plain X-rays are of no help. Morton's neuroma, a common cause of severe metatarsalgia, can usually only be diagnosed from the history and clinical examination. The key to diagnosis in the metatarsal region is to have a clear knowledge of the most likely conditions.

Diagnosis, Differential↗
PubMed1977

Morton's metatarsalgia.

In a series of 25 patients (predominantly women) with Morton's metatarsalgia, the most likely site for a neuroma is the third cleft of the left foot. If a swelling is present or if radiographic examination shows toe divergence then the diagnosis in unlikely to be a simple digital neuroma. A review of the literature suggests that there are other causes of pain in the forefoot. Usually the pain is diffuse by when it is localized, Morton's metatarsalgia is diagnosed. However, causes other than a digital neuroma, e.g. traumatic bursitis and rheumatoid arthritis, epithelial cyst, and foreign body should be borne in mind.

Adult↗