Plantar Forefoot Pressure Changes After Second Metatarsal Neck Osteotomy

Khalafi, Afshin; Landsman, Adam; Lautenschlager, Eugene P.; Kelikian, Armen S.

doi:10.1177/107110070502600710

Cited by 26 publications

(14 citation statements)

References 23 publications

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“…Several studies measuring pressures associated with DP osteotomy showed a similar trend . In a clinical study, Vandeputte et al showed similar pressure reductions post‐op (88.3 kPa/5.9 mm shortening = 15.0 kPa/mm) to the slopes of the second metatarsal PP and second metatarsal shortening regressions in our study.…”

Section: Discussionsupporting

confidence: 87%

“…In a clinical study, Vandeputte et al showed similar pressure reductions post‐op (88.3 kPa/5.9 mm shortening = 15.0 kPa/mm) to the slopes of the second metatarsal PP and second metatarsal shortening regressions in our study. In a statically loaded cadaveric study, Khalafi et al reported a significant decrease in pressure under the operated second metatarsal of 36% (70.6–45.1 kPa) in neutral position and 65% (813–281.4 kPa) in 45° of plantar flexion and an increase in pressure under the first metatarsal in neutral position. Significant decreases in pressure also occurred under the third metatarsal, contrary to our study, possibly explained by axially loading the specimens and not simulating the entire gait cycle.…”

Section: Discussionmentioning

confidence: 99%

“…The actual amount of shortening was determined via linear calipers. The literature reports metatarsal shortening ranging from <4 up to 8 mm . The bracket was low profile and did not interfere with lesser toe extensor tendon excursion.…”

Section: Methodsmentioning

confidence: 94%

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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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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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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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“…Hence in this study all patients had more than 1 lesser metatarsal osteotomy. 2,16 In the case of isolated long second metatarsal and callosity, a Weil osteotomy with fixation is a favorable procedure as this enables perfect control of the planned proximal migration of the metatarsal head. 13,16,18,30 When using minimally invasive surgery in the forefoot, there is concern about iatrogenic neurovascular and tendon damage.…”

Section: Discussionmentioning

confidence: 99%

“…2,16 In the case of isolated long second metatarsal and callosity, a Weil osteotomy with fixation is a favorable procedure as this enables perfect control of the planned proximal migration of the metatarsal head. 13,16,18,30 When using minimally invasive surgery in the forefoot, there is concern about iatrogenic neurovascular and tendon damage. However with appropriate training and 3-dimensional anatomic awareness of the foot, the risk of neurovascular and tendon injury associated with minimally invasive techniques in the forefoot is minimal.…”

Section: Discussionmentioning

confidence: 99%