Association of Metatarsalgia After Hallux Valgus Correction With Relative First Metatarsal Length

Nakagawa, Satoru; Fukushi, Jun Ichi; Nakagawa, Takeshi; Mizu-uchi, Hideki; Iwamoto, Yukihide

doi:10.1177/1071100716634792

Cited by 38 publications

(43 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, when these conservative measures fail and the metatarsalgia becomes recalcitrant, it requires surgical treatment with or without procedures on the first ray [14, 15]. The primary goal of surgery is to relieve pain and restore an ideal forefoot morphology with a normal distribution of pressure in the forefoot [16–18].…”

Section: Introductionmentioning

confidence: 99%

Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

Biz

Corradin

Kanah

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

Background The purpose of this prospective study was first to evaluate the safety and effectiveness of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) in treating central metatarsalgia, identifying possible contraindications. The second objective was to verify the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Methods A consecutive series of patients with metatarsalgia was consecutively enrolled and treated by DMMO. According to Maestro criteria, preoperative planning was carried out by both clinical and radiological assessment. Patient demographic data, AOFAS scores, 17-FFI, MOXFQ, SF-36, VAS, and complications were recorded. Maestro parameters, relative morphotypes, and bone callus formation were assessed. Statistical analysis was carried out (p < 0.05). Results Ninety-three patients (93 feet) with a mean age of 62.4 (31-87) years were evaluated. At mean follow-up of 58.7 (36-96) months, all of the clinical scores improved significantly (p < 0.0001). Most of the osteotomies (76.3%) had healed by 3-month follow-up, while ideal harmonious morphotype was restored only in a few feet (3.2%). Clinical and radiological outcomes were not different based on principal demographic parameters. Long-term complications were recorded in 12 cases (12.9%). Conclusion DMMO is a safe and effective method for the treatment of metatarsalgia. Although Maestro criteria were useful to calculate the metatarsal bones to be shortened and a significant clinical improvement of all scores was achieved, the ideal harmonious morphotype was restored only in a few feet. Hence, our data show that Maestro criteria did not have a predictive value in clinical outcomes of DMMO.

show abstract

Section: Introductionmentioning

confidence: 99%

Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

Biz

Corradin

Kanah

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…The DMAA is the angle between the first metatarsal axis and the distal articular surface of the first metatarsal [26]. The length of the first metatarsal was measured using the method of Munuera et al [27] and Nakagawa et al [28] as the distance between the distal ends of the head and base of the metatarsal.…”

Section: Methodsmentioning

confidence: 99%

Introduction the revolving scarf osteotomy for treating severe hallux valgus with an increased distal metatarsal articular angle: a retrospective cohort study

Wang

et al. 2019

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundHallux valgus(HV) with an increased distal metatarsal articular angle (DMAA) is one of the most common foot deformities among adults. Double metatarsal osteotomy (DMO) is effective in treating severe HV deformity with an increased DMAA. However, this technique presents the risk of avascular necrosis (AVN) of the metatarsal head and transfer metatarsalgia due to shortening of the first metatarsal. The aim of this study was to introduce a surgical procedure defined as revolving scarf osteotomy (RSO) and compare the clinical and radiological results of RSO and DMO performed for treating severe HV with an increased DMAA.MethodsFirst metatarsal osteotomies and Akin osteotomy were performed in 56 patients (62 ft) with severe HV with an increased DMAA in Honghui Hospital from January 2015 to December 2017. RSO was performed in 32 ft and DMO was performed in 30 ft. The Akin osteotomy was performed in both groups. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, the hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, and first metatarsal length (FML) and the rates of complications were compared preoperatively and postoperatively in the two groups.ResultsThe mean AOFAS score, VAS score, HVA, IMA, and DMAA showed significant improvements in both groups after surgery, but with no significant differences between the two groups. The postoperative FML was significantly larger in the RSO group than in the DMO group (p < 0.001). One of the 30 ft (3.3%) in the DMO group exhibited transfer metatarsalgia at 12 months postoperatively, while another foot (3.3%) in same group had avascular necrosis of the metatarsal head. One of the 30 ft (3.1%) in the RSO group had hallux varus.ConclusionsNo differences in the clinical and radiographic results were observed between the two groups with severe HV and an increased DMAA. However, RSO does not cause shortening of the metatarsal and AVN of the metatarsal head. A long-term, randomized, controlled prospective study with a larger sample would provide higher-level evidence for confirming the clinical efficacy and safety of RSO.

show abstract

“…For a long time, shortening of the first ray has been considered to be the main cause of pain due to transfer metatarsalgia [2]. Thus, most surgeons [3–5] tend not to shorten the first metatarsal, regardless of the procedures they choose.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, in vivo human studies are nearly impossible to get rid of the confounding factors mentioned above. When evaluating the effects of length changes on clinical outcomes, none of those studies focused on the intrinsic biomechanics changes caused by shortening of the first metatarsal [3–5, 7]. Therefore, different studies tend to draw different conclusions, and we believe that this controversy may endure if studies merely focus on changes in length.…”

Section: Introductionmentioning

confidence: 99%

Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study

Geng

Shi

Chen

et al. 2019

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundsThere has long been a consensus that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. However, appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. This study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed.MethodsA finite element model of the human foot simulating the push-off phase of the gait was established. Progressive shortening of the first metatarsal from 2 to 8 mm at an increment of 2 mm were sequentially applied to the model, and the corresponding changes in forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was calculated. The effect of depressing the first metatarsal head was also investigated.ResultsWith increasing shortening level of the first metatarsal, the plantar pressure of the first ray decreased, while that of the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky; but it could still be manipulated to normal if the distal end of the first metatarsal displaced to the plantar side by 3 mm.ConclusionsDuring the first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.

show abstract

Association of Metatarsalgia After Hallux Valgus Correction With Relative First Metatarsal Length

Abstract: Level IV, retrospective case series.

Cited by 38 publications

References 28 publications

Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

Introduction the revolving scarf osteotomy for treating severe hallux valgus with an increased distal metatarsal articular angle: a retrospective cohort study

Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study

Contact Info

Product

Resources

About