Current Concept Review: Metatarsalgia

Espinosa, Norman; Maceira, Ernesto; Myerson, Mark S.

doi:10.3113/fai.2008.0000x

Cited by 98 publications

(52 citation statements)

References 49 publications

(60 reference statements)

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“…However, the essential problem should not be the metatarsal length, and controversies on metatarsal length would still last if we continue focusing on the length itself, because the abnormal loading pattern secondary to inappropriate shortening might be the root cause indeed [9]. Other geometrical changes that may alter loading pattern during walking, such as elevation of the first metatarsal, supination of the forefoot, and subluxation of sesamoids, can also lead to transfer metatarsalgia.…”

Section: Introductionmentioning

confidence: 99%

Loading pattern of postoperative hallux valgus feet with and without transfer metatarsalgia: a case control study

et al. 2017

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BackgroundPostoperative transfer metatarsalgia is a common complication after hallux valgus surgeries. Shortening of the first metatarsal is traditionally thought to be the primary cause of it. However, we speculate the abnormal loading pattern during gait is the real reason. This study is to determine specific differences in the loading patterns between reconstructive hallux valgus (HV) feet with and without postoperative transfer metatarsalgia, so as to find risky loading characteristics of this complication.MethodsThirty feet with postoperative transfer metatarsalgia were recruited as pain group, while another 30 postoperative feet without pain as controls. All participants were asked to walk barefoot at self-selected speed through a plantar force measuring plate (Rs-Scan Inc.) for three times. Certain plantar load variables were recorded or calculated, and their differences between two groups were compared.ResultsFor pain group, the maximum plantar force and force time integral of the first metatarsal decrease significantly; the force time integral of the central rays (second plus third metatarsal) does not significantly differ with that in the controls, but their cumulative load percentage to the whole foot is higher. In pain group, the time point when central rays reached their peak force during the push-off is significantly later than that in controls. And the regional instant load percentage at this moment presented significantly higher for central rays, while significantly lower for the first metatarsal and the hallux compared to the controls.ConclusionsFor hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired. But for central rays, indicative difference is not reflected in either peak or cumulative load during the gait cycle, but in the instant load distribution when central rays reach their peak load. So we can conclude that whether the remaining regions can adequately share certain load during walking, especially around the time metatarsalgia often occurs, plays an unnegligible role. So surgeons should pay more attention to reconstruct a foot where load can be evenly distributed.

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Section: Introductionmentioning

confidence: 99%

Loading pattern of postoperative hallux valgus feet with and without transfer metatarsalgia: a case control study

et al. 2017

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“…Primary metatarsalgia is associated with biomechanical insufficiencies, and secondary metatarsalgia is associated with systemic conditions . Initially, metatarsalgia is managed with rest, stretching exercises, cushioning, plantar callosity shaving, and anti‐inflammatory medications, but data confirming their effectiveness is limited . If symptoms persist, surgery is employed to correct the alignment of the metatarsals and/or muscle/ligament balance.…”

mentioning

confidence: 99%

“…If symptoms persist, surgery is employed to correct the alignment of the metatarsals and/or muscle/ligament balance. Numerous surgical treatments are used, each with its benefits and complications . Surgical treatment redistributes pressure under the metatarsal heads by either dorsally displacing the head or by shortening the length of the metatarsal .…”

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confidence: 99%

Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure

et al. 2013

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Symptom relief of recalcitrant metatarsalgia can be achieved through surgical shortening of the affected metatarsal, thus decreasing plantar pressure. Theoretically an oblique metatarsal osteotomy can be oriented distal to proximal (DP) or proximal to distal (PD). We characterized the relationship between the amount of second metatarsal shortening, osteotomy plane, and plantar pressure. We hypothesized that the PD osteotomy is more effective in reducing metatarsal peak pressure and pressure time integral. We performed eight DP and eight PD second metatarsal osteotomies on eight pairs of cadaveric feet. A custom designed robotic gait simulator (RGS) generated dynamic in vitro simulations of gait. Second metatarsals were incrementally shortened, with three trials for each length. We calculated regression lines for peak pressure and pressure time integral vs. metatarsal shortening. Shortening the second metatarsal using either osteotomy significantly affected the metatarsal peak pressure and pressure time integral (first and third metatarsal increased, p < 0.01 and <0.05; second metatarsal decreased, p < 0.01). Changes in peak pressure (p ¼ 0.0019) and pressure time integral (p ¼ 0.0046) were more sensitive to second metatarsal shortening with the PD osteotomy than the DP osteotomy. The PD osteotomy plane reduces plantar pressure more effectively than the DP osteotomy plane. Keywords: second metatarsal; plantar pressure; metatarsalgia; lesser metatarsal osteotomies; gait simulation Metatarsalgia is defined as pain, often during weight bearing, of the plantar aspect of the foot under and related to the lesser metatarsal heads. Primary metatarsalgia is associated with biomechanical insufficiencies, and secondary metatarsalgia is associated with systemic conditions. 1 Initially, metatarsalgia is managed with rest, stretching exercises, cushioning, plantar callosity shaving, and anti-inflammatory medications, but data confirming their effectiveness is limited.2 If symptoms persist, surgery is employed to correct the alignment of the metatarsals and/or muscle/ligament balance. Numerous surgical treatments are used, each with its benefits and complications.2-6 Surgical treatment redistributes pressure under the metatarsal heads 7 by either dorsally displacing the head or by shortening the length of the metatarsal. 3 The amount of shortening is determined by the surgeon's experience considering the preoperative length of the metatarsals. 4,8 In this study, we compared the effects of two different osteotomy planes and the overall amount of second metatarsal shortening on plantar pressure. Insight into the relationship between osteotomy plane, metatarsal shortening, and plantar pressure contributes to a more effective treatment of metatarsalgia by providing the surgeon with greater knowledge of biomechanical principles that can be used to make intraoperative osteotomy decisions.The oblique distal to proximal (DP) sliding osteotomy and the oblique proximal to distal (PD) sliding osteotomy are designed to reduce sec...

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“…No suture dehiscence, nonunion, or malunion was observed. [40][41][42][43][44][45] The statistical assessment of the AOFAS Scale parameters and the extension angle of the lateral toes of the feet with weight bearing before and after the end of the surgical treatment associated with the use of the distal locking orthosis showed statistical significance. The use of the dorsal thermoplastic locking orthosis allowed the modulation and lengthening of the dense connective tissues of the oblique dorsal metatarsal osteotomy in the postoperative period and enabled the following:…”

Section: Discussionmentioning

confidence: 99%

“…There was recurrence of pain in 15% of the cases and transfer metatarsalgia in 7% of the cases, whereas suture dehiscence, nonunion, and malunion had a low prevalence rate of 3%. [40][41][42][43][44][45] Dense connective tissues-tendons, ligaments, articular capsule, and dermis-are mainly composed of collagen fibers, and these substances are continuously degraded and synthesized as a response to stress. In tissue healing, the arrangement of the fibers depends on the tension: that is, the collagen fibers present an alignment pattern according to the amount and direction of the traction forces exerted on the tissue.…”

Section: Research-article2014mentioning

confidence: 99%

Effectiveness of the Dorsal Thermoplastic Locking Orthosis to Prevent Floating Toes in Postoperative Follow-up of Weil Osteotomies

Godoy‐Santos

Fernandes

Luzo

et al. 2014

Foot & Ankle Specialist

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Current Concept Review: Metatarsalgia

Cited by 98 publications

References 49 publications

Loading pattern of postoperative hallux valgus feet with and without transfer metatarsalgia: a case control study

Loading pattern of postoperative hallux valgus feet with and without transfer metatarsalgia: a case control study

Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure

Effectiveness of the Dorsal Thermoplastic Locking Orthosis to Prevent Floating Toes in Postoperative Follow-up of Weil Osteotomies

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