SEARCH · Search PubMed

Results for “Metatarsalgia”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed1996

[Weil's metatarsal osteotomy in the treatment of metatarsalgia].

The Weil distal shortening osteotomy of the lesser metatarsals has been used by the author since June 1992, particularly in the treatment of metatarsalgia. Its advantages are a direct approach to the metatarsophalangeal (MP) joint and the metatarsal head, providing not only correction of the deformity, but accurate control of the metatarsal shortening, primary healing and early functional recovery thanks to the strong fixation allowed by the twist-off screw. Its disadvantage is the limitation of MP articular range motion, which is temporary in most cases. The role of the Weil osteotomy in metatarsalgia is to bring the metatarsal head behind the callus and to provide an axial decompression resolving the hammer toe deformity or MP luxations that are increasing or resulting in metatarsalgia. In cases of metatarsalgia resulting from the first ray insufficiency, the Weil osteotomy is a fair, reliable and efficient procedure; it is also good in cases when the small metatarsal bones are too long. However, shortening the metatarsal bones has to be part of general forefoot therapeutic management. In isolated metatarsalgia, the indication may be slightly difficult, indicating a "slimming" resection. In contrast, both in important metatarsalgia, and generally in severe forefoot disorders, the Weil osteotomy, together with the scarf osteotomy, constitutes a real surgical improvement, opening a new means of articular conservative treatment of severe static disorders.

Bone Screws↗

PubMed2000

Morton neuroma and metatarsalgia.

Morton neuroma is most likely a mechanically-induced degenerative neuropathy that predilects the third common digital nerve in middle-aged women who frequently wear fashionable shoes that are not designed for the physiology of the foot. A compression test of the affected web space is quite specific for its diagnosis, and an ultrasonograph can tell its exact size. If conservative means fail to relieve the painful symptoms of a Morton neuroma, surgical removal can produce dramatic pain relief. Metatarsalgia means pain in the metatarsal head region, and exists in three general forms: metatarsalgia of the first metatarsal head region, metatarsalgia of the fourth lateral metatarsal head region, and generalized metatarsalgia. There are numerous causes of metatarsalgia; a selected and important group of causes is discussed in this article. When conservative means fail to relieve metatarsalgia, specific surgical operations are quite effective for relief of pain, and are briefly described in the text.

Female↗

PubMed1994

Jones transfer to the lesser rays in metatarsalgia: technique and long-term follow-up.

Thirty-three feet in 29 patients with metatarsalgia were reviewed after Jones transfer to the lesser rays to evaluate the long-term results and the indications for these procedures. Transfer of the long extensor tendons to their respective metatarsal necks and fusion of the interphalangeal joints with shortening of the toe were performed. The procedures were performed in patients with symptoms of metatarsalgia, secondary to anterior pes cavus deformity (clawfeet, 16 patients), and in patients with mild or severe spreadfoot deformity with fall of the central metatarsals (12 patients). In all of our patients, the striking clinical sign was the long toes. Rating of the results was based on (1) the presence of pain or calluses and (2) residual deformity of the forefoot and toes. Symptoms of metatarsalgia were relieved in 25 feet, occasionally present in 6 feet, and unchanged in 2 patients. Complete correction of the deformity was achieved in 26 patients, 6 patients had slight residual deformities, and in the 1 poor result, overcorrection was present after the procedure. This operation is believed to be an excellent choice for patients with metatarsalgia due to (simple) pes cavus deformity and in patients with clawing and metatarsalgia secondary to excessively long toes.

Adolescent↗

PubMed2002

[Distal shortening osteotomy of the metatarsals using the Weil technique: surgical treatment of metatarsalgia and dislocation of the metatarsophalangeal joint].

PURPOSE: Weil technique of the distal shortening osteotomy of metatarsal is a relatively new method of the surgical treatment of metatarsalgia and dislocation of metatarsophalangeal (MTP) joints. A retrospective study evaluates the first experience in Weil osteotomy at the authors' department. MATERIAL: Between May 1999 and the end of 2000 twelve patients (14 feet) were operated on in which the Weil technique of the osteotomy was performed on 28 metatarsals. Indication for the surgery was chronic metatarsalgia with dislocation of the MTP joint, with excessive length of one or more lesser metatarsals, with insufficiency of the first ray after the surgery of hallux valgus and metatarsalgia after the resection of the head of II metatarsal. All patients were women, average age of 57 years (range, 50-68 years) at the time of operation. The average follow-up is 9 months (range, 6-24 months). Dislocated prior to operation were 9 MTP joints, in 2 cases a deformity of 2nd digit of the digitus supraductus type was operated on. METHODS: The patients evaluated subjectively the functional and cosmetic outcomes of the surgery. Clinical evaluation related to recurrence or transfer of difficulties to the head of the neighbouring metatarsal, range of motion of the MTP joint, function and grip of the digit. Radiograph was used for the evaluation of the metatarsal index, post-operative shortening of II metatarsal, reduction of dislocation in the MTP joint and healing of osteotomy. RESULTS: Satisfied with the functionla and cosmetic results of the operation were 83% patients (10 of 12). Recurrence of metatarsalgia was not found in any patient, transfermetatarsalgia in one patient. Reduction of the range of motion in the MTP joint (plantar flexion) by more than 50% was recorded in 43% operated on metatarsals and in all metatarsals after the reduction of the dislocation. Acceptable function and strength of the digit evaluated by the ability to press by the digit a sheet of paper against the floor was preserved in most of the operated on metatarsals--86% (24 of 28). Average shortening of II metatarsal was 5.6 mm. All dislocated MTP joints were reduced postoperatively. Dislocation recurred in 2 cases. Avascular necrosis of the head of II metatarsal after the reduction of the dislocation was encountered in one case. DISCUSSION: The small number of recurrences and transfermetatarsalgia proves that Weil osteotomy allowing a controlled shortening of metatarsal with a fixation is a reliable method in the solution of metatarsalgia. The operation directly on the joint allows reduction of the dislocation of the MTP joint. Shortening of metatarsal facilitates reduction and reduces axial pressure in the MTP joint. Recurrence of dislocation is reported between 15% and 22%. After a more difficult reduction and danger of redislocation some authors recommend a temporary transfixation of the MTP joint by K-wire. The disadvantage of the operation is a frequent temporary limitation of the range of motion in the MTP joint which is caused by the opening of the articular capsule and its subsequent contraction. No author reports any problems with the healing of the osteotomy. The results in our group of patients are comparable with the results published by other authors. CONCLUSION: Weil osteotomy allows a planned controlled shortening of metatarsal with a stable fixation. Osteotomy heals well. Osteotomy is intraarticular which on one side provides the possibility to correct dislocation in the MTP joint, however, on the other hand it poses a risk of the limitation of the range of motion of this joint. The main contribution the authors see in the new possibility of surgical treatment of more severe matatarsalgia and deformities of the forefoot with the preservation of joints.

Aged↗

PubMed1999

Comparison of the results of the Weil and Helal osteotomies for the treatment of metatarsalgia secondary to dislocation of the lesser metatarsophalangeal joints.

We retrospectively reviewed the outcome of 30 patients who were treated surgically for metatarsalgia resulting from dislocation of one or more lesser metatarsophalangeal (MTP) joints. We used two treatments, including an osteotomy of the metatarsal head (Weil osteotomy, N = 15) or an osteotomy of the metatarsal shaft (Helal osteotomy, N = 15). Before surgery, all patients had been treated with various nonoperative modalities for a minimum of 6 months. Between 1991 and 1993, 15 consecutive patients underwent a Helal osteotomy (22 metatarsals), and 15 consecutive patients were subsequently treated between 1994 and 1995 with a Weil osteotomy (25 metatarsals). All patients were evaluated clinically and radiographically at a mean follow-up period of 22 months (range, 12-39 months), noting especially persistent subluxation or dislocation, recurrent metatarsalgia, and transfer lesions. Patients managed with a Weil osteotomy had significantly higher satisfaction (P = 0.049), lower incidence of recurrent metatarsalgia (0 vs. 27%, P = 0.107), and fewer transfer lesions (0 vs. 41%, P = < 0.001) than those managed with a Helal osteotomy. Furthermore, those managed with the Weil procedure had a higher percentage of radiographic reduction and maintenance of the MTP joint dislocation (21 of 25, 84%; vs. 8 of 22, 36%; P = 0.002) than those managed with the Helal procedure. In the Weil group, there was also no malunion or pseudoarthrosis; in the Helal group there were five malunions and three pseudoarthroses. Although the follow-up period for the Weil osteotomy (15 months) was shorter than that for the Helal osteotomy (26 months), the former group had higher American Orthopaedic Foot and Ankle Society forefoot scores, which were significantly different from the results attained with the Helal osteotomy. A telephone update was performed on the Weil osteotomy group at an average of 27 months postsurgery, and no patient had experienced changes since the clinical follow-up. We concluded that the Weil procedure is a satisfactory method for correcting metatarsalgia caused by dislocation of the MTP joint and that, because of the high complication rate, the Helal osteotomy is not an acceptable procedure for correcting this condition.

Adult↗

PubMedDate not supplied

Metatarsalgia in hallux valgus deformity: a pedographic analysis.

The purpose of this study was to analyze the plantar loading patterns in patients with hallux valgus (HV) with and without symptoms of metatarsalgia in order to find predictive pressure variabilities which are likely to result in metatarsalgia. Two groups of subjects (100 feet) volunteered for this study. Both groups provided the diagnosis of HV deformity. Group A (50 feet) exhibited a metatarsalgia symptomatology, whereas group B was asymptomatic. Plantar loading patterns were assessed using the two-step method and data were collected by the use of a capacitive pressure measurement platform. For each patient, 10 acceptable trials were collected. For the analysis, the foot was divided into six plantar regions: heel, midfoot, medial forefoot, lateral forefoot, medial toe, and lateral toe. Maximal peak pressure (PP, N/cm2), pressure-time integral (P/T integral, N/cm2*s), and force-time integral (%) were calculated. In group A, loading patterns (PP, P/T integral) of the lateral forefoot were significantly higher than in group B. The mediolateral pressure transfer from the big toe to the lateral metatarsal region was significantly greater in group A compared to group B. Regarding the lateral forefoot, a pressure time integral < 10 N/cm2*s was indicative of asymptomatic HV feet, whereas in symptomatic HV feet, a pressure time integral >28 N/cm2*s was observed. These results were statistically significant at the p < .01 level.

Biomechanical Phenomena↗

PubMed1998

Ultrasound in the assessment of metatarsalgia: a surgical and histological correlation.

AIMS: To assess the reliability of ultrasound in the evaluation of metatarsalgia in a typical clinical setting. METHODS AND MATERIALS: The clinical records, ultrasound findings, surgical outcome and histology of patients with metatarsalgia referred for ultrasound evaluation were reviewed. All ultrasound examinations were performed by the same operator via a plantar approach using high resolution linear array probes. RESULTS: Thirty-seven patients were examined, age range 23 to 74, mean 49.6 years; thirty-one were female. Thirty-seven intermetatarsal masses were found in 32 patients. To date 26 patients have undergone surgery and 28 lesions (26 Morton's neuromas, one angiolipoma and one angioleiomyoma) have been excised. There were no false-positive ultrasound examinations. A solitary neuroma was missed. Sensitivity was 96% and positive predictive value 100%. CONCLUSION: Ultrasound is a valuable tool in the evaluation of metatarsalgia and has high sensitivity and positive predictive value for the detection of intermetatarsal masses. It provides exact localization prior to surgical resection and detects unsuspected additional lesions.

Adult↗

PubMedDate not supplied

Plantar fat pad atrophy: a cause of metatarsalgia?

The aim of this prospective study was to evaluate if atrophy of the plantar fat pad in splay-foot deformities was a major cause of metatarsalgia. A sonographic method of measuring the thickness of the plantar fat pad under the second and third metatarsal heads was developed. The method was tested on 25 volunteers and the intraobserver reliability was calculated to be 97.1% for the second metatarsal and 96.7% for the third metatarsal. Sonographic measurement of the plantar fat pad was then performed on 100 symptomatic feet Pain frequency and pain intensity were determined by using a verbal rating scale (VRS) and a visual analog scale (VAS). The intermetatarsal angle 1/2 was measured and then compared to the thickness of the fat pad for each patient. A correlation between the increase of the intermetatarsal angle and the decrease of the fat pad thickness could not be demonstrated (r = 0.041). The frequency of metatarsalgia did not correlate with a decrease of the thickness of the plantar fat pad under the second metatarsal head (t statistic: 1.978; Durbin-Watson test: 1.999; p value = .0507) and the third metatarsal head (t statistic: 3.199; Durbin-Watson test: 1.962; p value = .0019). The pain intensity showed a similar lack of correlation with the thickness of the plantar fat pad under the second metatarsal head (t statistic: 1.828; Durbin-Watson test: 2.365; p value = .0706) and the third metatarsal head (t statistic: 1.846; Durbin-Watson test: 2.371; p value = .0678). This study shows that a splay-foot deformity is not associated with a decrease of the thickness of the plantar fat pad. Furthermore, alterations of the thickness of the plantar fat pad are not relevant to the intensity and frequency of metatarsalgia.

Adipose Tissue↗

PubMedDate not supplied

[Short-term outcome of Weil osteotomy in treatment of metatarsalgia].

INTRODUCTION: The aim of this retrospective study was to analyse the short term results after the Weil-procedure for the treatment for metatarsalgia in 30 consecutive patients. METHODS: 30 patients (69 osteotomies) after the Weil-procedure with an average age of 60 years (range 25 to 78 years) were analysed by clinical and radiological evaluation. The average follow up was 15 months (range 12 to 26 months). Analysis was performed using the patients' records, weight-bearing radiographs and a standardized questionnaire. RESULTS: Subjective evaluation revealed 23 very satisfied and satisfied patients. Based on the Lesser-Metatarsal-Interphalangeal-Scale the objective results showed 77.1 points on average. The results were excellent in 17 cases, good in 4, fair in 3 and unsatisfactory in 6 cases respectively. Recurrent metatarsalgia was noted in 5 cases, whereas no transfermetatarsalgia was observed. The average shortening was 4.4 mm. Subluxation of the metatarsophalangeal joint was corrected in 18 out of 22 cases. A restricted plantar flexion of the metatarsophalangeal joint was noted in 14 cases. 2 patients showed loss of movement. CONCLUSION: Our short-term results reveal that the Weil-osteotomy is a sufficient treatment for metatarsalgia. This technique is able to reestablish the alignment of the metatarsals and to correct luxation and subluxation of the metatarsophalangeal joint. Restricted plantarflexion of the metatarsophalangeal joint is a drawback, which may be avoided by intensive physiotherapy.

Adult↗

PubMed2002

The surgical management of central metatarsalgia.

Seventeen patients (20 feet) underwent Weil osteotomies of the second and third metatarsals for the treatment of central metatarsalgia and were reviewed at an average of 18 months postoperatively. Fourteen patients were completely satisfied with the results of their surgery (85%), one patient was satisfied, one patient satisfied with reservations and one patient was dissatisfied. The American Orthopaedic Foot and Ankle Society clinical rating scale improved by an average of 44 points. One patient had complete recurrence of symptoms, eight out of the 40 toes involved in surgery were floating, four toes were stiff, there were three cases of infection, and transfer metatarsalgia affected the fourth metatarsal in one case. The Weil osteotomy is an effective and safe procedure for the treatment of central metatarsalgia.

Adult↗

PubMed1981

Metatarsalgia: a clinical review of diagnosis and management.

Metatarsalgia is the symptom of pain in the region of the metatarsophalangeal articulations. In a careful analysis of 98 patients who presented with complaints of forefoot pain, 23 distinct diagnoses were made as to the etiology of their pain. These diagnoses were grouped under primary metatarsalgia, secondary metatarsalgia, and pain under the forefoot. Specialized tests, such as stance phase cholesterol-crystal force plate analysis and intraarticular or digital nerve block, are helpful in determining the diagnosis and the likelihood of effective treatment.

Adult↗

PubMed1984

Telescoping osteotomy for pressure metatarsalgia.

A review is presented of 508 feet in 310 patients after telescoping osteotomy of the lesser metatarsals for metatarsalgia. The patients were predominantly female (80%), with a mean age of 55 years; the range of follow-up was 1 to 12 years. In 22% of the patients the metatarsalgia was associated with rheumatoid arthritis. Improvements in assessment and modifications in technique are reported and the management of complications is discussed. The results show that telescoping osteotomy for established cases of pressure metatarsalgia is a simple and reliable operation. Permanent relief of symptoms can be expected in over 80% of patients.

Adult↗

PubMed2001

Sonography in the study of metatarsalgia.

OBJECTIVE: To identify sonographically the changes of the forefoot in patients with metatarsalgia. METHODS: Sonography of the foot was performed in 112 patients with metatarsalgia and in 50 healthy controls. Metatarsophalangeal (MTP) joints, intermetatarsal web spaces, flexor and extensor tendons, and plantar aponeurosis were examined. RESULTS: Sonography showed intermetatarsophalangeal bursitis in 20.5% of cases, Morton's neuroma in 15.2%, and effusion of MTP joints in 11.7%. CONCLUSION: Sonography gives useful information about the possible alteration responsible for metatarsalgia.

Adult↗

PubMed1982

Morton's metatarsalgia due to intermetatarsophalangeal bursitis as an early manifestation of rheumatoid arthritis.

Of 50 patients in whom Morton's metatarsalgia was diagnosed during an 18-year period, 12 (24%) had rheumatoid arthritis at the time of presentation. After conservative management had failed, 20 patients had subtotal excision of the intermetatarsophalangeal bursa and associated digital nerve; in two patients, only the nerve was excised. During the follow-up period ranging from two months to 15 years, an additional eight patients developed sero-positive rheumatoid arthritis. Thus, a total of 20 patients (40%) presenting with Morton's metatarsalgia had rheumatoid disease at initial presentation or later developed this disease. Histological changes in the intermetatarsophalangeal bursa consistent with rheumatoid arthritis were found in ten patients. Of these, two were known already to have rheumatoid arthritis, three subsequently developed rheumatoid arthritis, and five do not yet have other evidence of the disease. The evidence suggests that Morton's metatarsalgia is associated with rheumatoid arthritis and is the basic etiology in a significant number of patients.

Adult↗

PubMed1980

Metatarsalgia: diagnosis and treatment.

Metatarsalgia is a symptom, not a diagnosis. A careful study of ninety-eight patients who had complaints of pain in the fore part of the foot revealed twenty-three distinct diagnoses. These diagnoses were grouped as primary metatarsalgia, secondary metatarsalgia, and pain under the fore part of the foot. This division assisted in determining the form of nonoperative or operative treatment. The use of a pressure-sensitive cholesterol-crystal force-plate analysis or intra-articular or digital nerve blocks was helpful both in accurately pinpointing abnormal pressures and in determining whether operative treatment had been effective. Unexpected problems occurring after metatarsal surgery may be preventable in the future.

Child↗

PubMed1996

["Chevron" basal osteotomy of the middle metatarsal bones for static metatarsalgia. Apropos of 69 cases].

PURPOSE OF THE STUDY: Round or flat forefoot metatarsalgia are frequent and surgical techniques are various. The authors relate a series with chevron basi-metatarsal osteotomy. MATERIAL: 69 operated metatarsalgia were reviewed at a mean follow up of 5 years. METHODS: The surgical approach was dorsal, aligned on metatarsal diaphysis. The basi metatarsal "chevron shape" osteotomy was performed using an oscillatory saw, on 1, 2 or 3 metatarsi inducing lowering and shortening. This osteotomy wasn't fixed. Weight bearing was allowed at the third post-operative day. RESULTS: In 68 per cent of cases, the global result was good or very good, but it persisted 32 per cent of post-operative pain either climatic or continuous, including 29 per cent metatarsalgia. The plantar corns only disappeared one out of twice, but the shoe wearing was improved in 82.6 per cent of cases. DISCUSSION: This study showed that the results improved when 3 median metatarsal osteotomy were performed simultaneously. The forefoot morphology didn't influenced the final result. In fact, this technique includes a good result one out of twice in hollow feet. It seems that three metatarsal osteotomies induce a metatarsal elevation and shortening, once out of twice. CONCLUSION: The advantage of this technique are : a dorsal medio plantar surgical approach, an osteotomy realized in cancellous bone and no need for fixation allowing a more accurate adjustment of the metatarsal height.

Adult↗

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↗