Lesser Metatarsophalangeal Instability: Diagnosis and Conservative Management of a Common Cause of Metatarsalgia

Abstract

Context: Lesser metatarsophalangeal (MTP) instability is a common condition that can become debilitating and require surgery. Evidence Acquisition: An extensive literature review was performed through MEDLINE and Google Scholar for publications relating to the etiology, diagnosis, and treatment of lesser MTP instability using the keywords metatarsophalangeal instability, athlete, forefoot pain, and metatarsalgia from database inception to 2019. Study Design: Clinical review. Level of Evidence: Level 4. Results: Lesser MTP instability is a common condition, especially in the active and aging populations. It is frequently misdiagnosed, causing delays in treatment that allow for progressive pain and deformity, which prevents an active lifestyle. Fortunately, MTP instability can be diagnosed easily with the drawer test. Magnetic resonance imaging is helpful when still in doubt. Conservative treatment entails joint immobilization and gradual return to play with taping and offloading metatarsal pads. Conclusion: Lesser MTP instability is a common diagnosis. Its early detection and conservative treatment can help the patient regain their previous level of activity and avoid surgery.

Effectiveness of the Fixtoe Device® in plantar pressure reduction: a preliminary study

“…Conservative treatment aims to control biomechanical disorders causing metatarsal overload in order to reduce local plantar pressure and lead the patient to a subclinical condition, slowing down deformity progression [ 6 , 20 , 34 ]. Multiple conservative options have been described, such as nonsteroidal anti-inflammatory drug administration, physical therapy, plantar foot orthosis, cushioning metatarsal pads and footwear modifications [ 18 , 32 , 35 ].…”

Effectiveness of the Fixtoe Device® in Plantar Pressure Reduction: A Preliminary Study.

“…3,6,14,25 Conservative treatment aims to control biomechanical disorders causing metatarsal overload in order to reduce local plantar pressure and lead the patient to a subclinical condition, slowing down deformity progression. 6,20,34 Multiple conservative options have been described, such as nonsteroidal antiin ammatory drug administration, physical therapy, plantar orthosis, cushioning metatarsal pads and footwear modi cations. 18,32,35 The metatarsophalangeal stabilizing taping technique described by Yu et al has shown good results as a provisional treatment in propulsive metatarsalgia, reducing the phalanx dorsal luxation and synovitis, although, in order to be effective, it may have to be carried out for several months.…”

Prospective Cohort Validation Study of a Novel Foot Offloading Device

“…Although there are several off-the-shelf insoles, studies on these insoles lack objective clinical data. Comparable devices such as at the Darco PegAssist are meant to offload, but there is no current data outside of metatarsophalangeal instability, 1 or studies evaluating pain using the device itself without any additional treatment provided to all groups. 2 There has been a paucity of studies to date using validated patient-reported outcome measures (PROMs) in foot offloading literature.…”

“…Although there are several off-the-shelf insoles, studies on these insoles lack objective clinical data. Comparable devices such as at the Darco PegAssist are meant to offload, but there is no current data outside of metatarsophalangeal instability, 1 or studies evaluating pain using Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Summary: Pressure offloading is often considered a crucial factor affecting healing after a foot injury.…”