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PubMed2005

Role of toe flexor tendoscopy in management of an unusual cause of metatarsalgia.

The purpose of this study is to describe an endoscopic approach to toe flexor tendons at the level of metatarsal head region. And this study is a kind of retrospective case series. Three patients with toe flexor tenosynovitis were evaluated after a follow-up of 2 years after toe flexor tendoscopy. One patient suffered from infective toe flexor tendosynovitis resulting from a penetrating injury and other two patients suffered from idiopathic focal toe flexor tenosynovitis. Pre-operative metatarsalgia subsided after toe flexor tendoscopy. No endoscopy-related complication was observed. Toe flexor tendoscopy can be an effective operative means in the management of focal toe flexor tenosynovitis.

Adult↗
PubMed2006

Resolution of metatarsalgia following oblique osteotomy.

Metatarsalgia of the central ray is a major surgical challenge. Without precise correction, transfer lesions may occur at an adjacent metatarsal or patients may have inadequate pain relief. Current surgical treatment strategies do not facilitate precise positioning in different planes, resulting in disappointing outcomes. To achieve better outcomes we used an oblique sliding osteotomy to facilitate precise correction. We hypothesized the procedure would reduce pain in patients with prominent second and/or third metatarsal heads, with few complications. We retrospectively reviewed 32 consecutive patients with 42 osteotomies of the lesser metatarsal bones. The mean and median ages at the time of surgery were 49 and 54 years, respectively, with a minimum followup of 26 months. Thirty-one patients (97%) had relief of plantar pain. The mean American Orthopaedic Foot and Ankle Society score was 82.4 points. We identified no transfer lesions. The median time to radiographic union was 10 weeks. Although time to bony union can be extended, the oblique sliding osteotomy facilitates intraoperative adjustment to provide the precise positioning critical to eliminating plantar pain.

Adult↗
PubMed2005

Morton's metatarsalgia: pathogenesis, aetiology and current management.

The aetiology and pathogenesis of Morton's Neuroma remain controversial. It is not true neuroma and therefore, it is better referred to as Morton's metatarsalgia. This article reviews the various thoughts regarding the pathogenesis of this condition. Chronic trauma, ischaemia, bursitis and entrapment neuropathy have been proposed as possible aetiologic factors. Careful history and clinical examination is essential to establish the diagnosis. However, if the clinical picture is doubtful, radiological investigation is recommended. Ultrasound, in the hand of an experienced radiologist, is the modality of choice. Conservative measures such as footwear modification and targeted injection of the hot spot are attempted before considering surgical intervention. Patients must be counselled preoperatively. The success of neurectomy rarely exceeds 83%. When surgery is considered, the dorsal approach is associated with less wound complications than the plantar approach. The neuroma is resected as proximally as possible in order to include plantar digital branches. For recurrent neuromas, a plantar approach is appropriate.

Analgesics↗
PubMed1981

Metatarsalgia due to insufficient support by the first ray.

Sixty-five feet with metatarsalgia due to inadequate support by the first ray are presented. A classification of different types of deficient anteromedial support is proposed in relation to the morphology of the first ray. When there is deficient anteromedial support and the first ray is normal, the ray is elevated and may or may not be associated with supination of the forefoot. When there is elevation of the first ray alone, operations are proposed which restore normal anteromedial support. The decision for choosing a particular type of operation is determined by an analysis of the cause of the elevation. There operations can be on the soft tissues, bone or both. When loss of anteromedial support is the consequence of complete supination of the forefoot, this has been corrected by a tarsal derotation osteotomy. Supination of the forefoot may be accompanied by elevation of the first ray. In there cases, the derotation osteotomy has been complemented by one of the operations described in the case of simple elevation of the first ray. The different indications of these surgical procedure are described as well as the results. In the case of deficient anteromedial support with an abnormal first ray, the treatment was conservative or surgical. The results of different operations performed to restore the normal loading under the forefoot are described.

Foot↗
PubMed1981

Surgical treatment of metatarsalgia.

Surgical treatment may be needed where conservative treatment fails in the management of metatarsalgia secondary to pes planus transversus sometimes associated with shortening of the first metatarsal. The author's technique of operation was employed in 85 feet of 45 patients with satisfactory results in 89.4%. The operation consists of a single or double V-shaped osteotomy of the middle metatarsal bones performed in the dorso-plantar plane of the proximal metaphysis. This allows realignment of the metatarsal heads and additional shortening of these bones if necessary. This type of osteotomy is simple and stable with rapid bony union.

Adult↗
PubMed1983

Surgical treatment of metatarsalgia. Long-term evaluation of 105 cases.

The authors present a long-term evaluation of a special treatment of metatarsalgia. The results are based on clinical findings, footprints and radiographs. The postoperative results provide a satisfactory evaluation of our technique and understanding of the biomechanics in the foot.

Adult↗
PubMed1983

Metatarsal osteotomy for relief of metatarsalgia.

If surgery is indicated for metatarsalgia, osteotomy of the metatarsals should be considered. In the years 1967-1977 we have operated on 35 feet. The first 17 we performed a proximal V-shaped osteotomy, the next 18 we performed a distal oblique osteotomy. The results were excellent in 18 cases, good in 13 cases and poor in 4 cases. We recommend the oblique distal osteotomy because the operation is simple, recovery is rapid and symptoms are well relieved.

Adult↗
PubMed2000

[Post-traumatic metatarsalgia. Early results of treatment with a new insole].

Injuries of the forefoot are a challenge for orthopaedic surgeons. After healing of bone and soft tissue damage, posttraumatic metatarsalgia can persist. The paper presents a therapy algorithm with newly designed insoles, which consist of the common orthopaedic adaptations like a rocker bottom and a stiffening of the sole. The therapy is shown on two cases. With these orthotics adequate is possible and pain relief realistic.

Adult↗
PubMed1994

Histological comparison of the third interdigital nerve in patients with Morton's metatarsalgia and control patients.

This study compares the histology of the plantar-digital nerve supplying the third web space in asymptomatic patients with those who have clinically diagnosed Morton's metatarsalgia. Despite several studies concentrating on the histological changes in the interdigital nerve, the relevance of these changes is a matter of contention while the exact pathological process responsible for the symptoms has not been determined. The histological findings in control patients were identical to Morton's patients with the exception of demyelination, which was more common in the Morton's group. This suggests that the characteristic nodule and fibrotic changes seen in the interdigital nerves of patients with Morton's neuroma cannot account for the symptoms and that the changes seen in the neurovascular bundle are degenerative in origin and are found in asymptomatic patients.

Adult↗
PubMed1988

Treatment of metatarsalgia by sliding distal metatarsal osteotomy.

A consecutive series of 113 patients who had distal sliding metatarsal osteotomy performed between 1976 and 1983 at Winford Orthopaedic Hospital were reviewed. All patients originally had symptoms and signs of pressure metatarsalgia. A total of 124 feet in 94 patients were available for assessment. Review was performed using a symptomatic scoring system, clinical examination, AP and lateral standing radiographs, and walking foot pressure studies obtained from a Harris-Beath mat. The mean follow-up period was 3 years and 4 months (range nine to 102 months). Symptomatically, 58 feet (47%) were rated as good, 43 (34%) as fair, and 23 (19%) as poor. Eighteen feet (14%) had required revision procedures prior to the time of review because of persistent symptoms. Persistent tender prominence of one or more metatarsal heads associated with plantar callosities was seen in 49 feet (40%). Results were significantly worse in patients older than 65 years of age, when first and fifth metatarsal osteotomies were performed, and when plaster immobilization was used postoperatively.

Adult↗
PubMed1998

Use of ready-made insoles in the treatment of lesser metatarsalgia: a prospective randomized controlled trial.

Two insoles designed to treat primary lesser metatarsalgia were compared in terms of their effect on plantar pressures and the subjective symptom relief. A prospective single blind randomized trial of 8 weeks' treatment in 46 feet in 33 patients was performed. Subjective outcome measures were visual analogue pain scores and estimated compliance. Objective outcome measures were dynamic plantar pressures using the Musgrave Footprint System. In group 1 (Viscoped), 6 of 18 patients rated themselves much improved or somewhat improved, and in group 2 (Langer) the proportion was 12 of 15 (P = 0.02). Reported mean compliance was 16% higher in the Langer group. Plantar forefoot pressure was lowered by the insoles in all cases. The reduction was significantly greater (P < 0.001) in group 2, both in absolute pressure and as a percentage of initial pressure. Group 2 (Langer) was significantly better in terms of reduction of peak metatarsal pressure. All the subjective outcome measures were better for the group 2 (Langer).

Foot↗
PubMed1999

Morton's metatarsalgia: sonographic findings and correlated histopathology.

The results of 79 high resolution ultrasound examinations of the forefoot that were performed for suspected Morton's metatarsalgia were retrospectively assessed. Scans were only obtained if the pain was poorly localized or if there were atypical features that made the clinical diagnosis uncertain. Ultrasound detected 92 hypoechoic intermetatarsal web space masses in 63 patients. Surgery was performed on 23 web spaces in 22 patients where the response to nonsurgical management had been poor. The surgical specimens were retrieved and reviewed by a pathologist in 21 cases. The histopathology in 20 of 21 operated cases was that of Morton's neuroma; however, prominent mucoid degeneration was also found to involve the adjacent loose fibroadipose tissues in 19 of 20 neuroma specimens. Ultrasound was sensitive in the detection of web space abnormality (sensitivity, 0.95), but could not clearly separate Morton's neuroma from associated mass-like mucoid degeneration in the adjacent loose connective tissues. The implications of these observations for both diagnosis and treatment are discussed.

Adolescent↗
PubMed1984

Sensory conduction velocity of plantar digital nerves in Morton's metatarsalgia.

The orthodromic sensory conduction velocity of the plantar interdigital nerves were measured with needle electrodes in 28 healthy subjects. The stimulating needle electrodes were placed close to the shaft of the proximal phalanx of the toe, and the recording needle electrode was placed behind the medial malleolus. We examined six subjects with clinical symptoms of entrapment of the common plantar digital nerve (Morton's metatarsalgia). Five of the subjects later had surgery. The conduction velocities of the affected interdigital nerves were abnormally slow. The method is technically simple, but more painful than conventional conduction studies.

Adult↗
PubMed1980

The intermetatarsophalangeal bursa--its significance in Morton's metatarsalgia.

The intermetatarsophalangeal bursa was investigated by dissection, radiography and injection. In the web spaces between the second and third and the third and fourth digits the bursa lies superior to the transverse metatarsal ligament but projects distally to it, closely applied to the neurovascular bundle. Tissue from the web spaces of patients with classical Morton's metatarsalgia often shows lymphocytic infiltration, with additional fibrinoid necrosis of the bursal wall. It is suggested that inflammatory changes in this bursa could account for the pathological and histological findings in this condition. The bursa in the most lateral web space does not extend beyond the ligament and is not in contact with the neurovascular bundle, which may explain the rarity of symptoms in this space.

Bursa, Synovial↗
PubMed1995

Use of an in-shoe pressure measurement system in the management of patients with neuropathic ulcers or metatarsalgia.

Many injuries to the foot appear to be caused by repeated, excessive plantar pressures. In-shoe pressure systems are capable of measuring pressures at the interface between the shoe or orthotic and the plantar foot during a given functional activity. The purpose of this article is to describe the use of an in-shoe pressure system as a tool to aid physical therapists in the management of patients with foot problems as a result of excessive plantar pressures. Case histories are provided that describe the application of an in-shoe pressure device in the management of one patient with a neuropathic ulcer and one patient with metatarsalgia. A discussion of the primary clinical and equipment considerations of using this type of device is included.

Aged↗
PubMed1996

Helal metatarsal osteotomy for the treatment of metatarsalgia: a critical analysis of results.

We reviewed the results of treatment of 114 feet in 96 patients with pressure metatarsalgia treated with a metatarsal osteotomy performed according to the technique of Helal. Clinical examination was performed according to a standardized evaluation questionnaire using the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale. The results were correlated with number of metatarsal osteotomies, the length of the follow up, the age of the patient, and type of additional procedures performed. Sixty-one percent of the patients rated the operation as excellent or good. Patient age and number of osteotomies did not influence the results; however, the length of time following surgery and associated Keller-Brandes resection arthroplasty influenced the outcome negatively. There was a high incidence of increased transfer of weight to adjacent metatarsals. We concluded that the Helal type metatarsal osteotomy is unlikely to predictably achieve symptom relief over a long period.

Adult↗
PubMed1975

Metatarsal osteotomy for metatarsalgia.

An oblique osteotomy in the distal half of the metatarsal shaft is described for the treatment of metatarsalgia due to prolapse of one or more of the middle three metatarsal heads. Thirty-eight patients who have had this operation have been followed up for a period of from two to five years. The operation is simple, recovery is rapid and symptoms have been well relieved.

Adolescent↗