The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment

Abstract

This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. The data analysis demonstrated that presently various types of osteotomies of metatarsal bones are the main surgical treatment options with the chance of complication ranging from 6 to 50%. Weil-osteotomy is known to be the most popular type of osteotomy for treatment of central metatarsalgia. The most common complication of Weil-osteotomy is floating toe, the one that doesn’t contact with the supporting surface. In case Weil-osteotomy and intraphalangeal arthrodesis with trans acticular fixation are both performed, the complication of floating toe increases up to 50%. When Weil osteotomy, plantar plate repair, extensor digitorum longum tendon lengthening and triple Weil-osteotomy are performed simultaneously, the complication rate is 15% approximately which is much lower. Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

Advances in the Causes and Treatment of Floating Toes after the Weil Osteotomy: A Scoping Review

“…These changes occur as a result of the metatarsal head being translated proximally, the metatarsals undergoing shortening and elevation, and the surrounding soft tissues being disrupted. 12 , 27 , 28 Nevertheless, inadequate attention was given to the treatment of ligaments and tendons during the surgical procedure, resulting in a lack of tension in these structures (Figure 4 ). This particularly affected the flexor tendon, impeding its ability to fulfill its usual function of exerting pulling force.…”

“…Previous research has indicated that following the Weil osteotomy procedure, there are alterations in the positioning of the ligaments and tendons (specifically, the flexor tendon and extensor tendon) in the foot. These changes occur as a result of the metatarsal head being translated proximally, the metatarsals undergoing shortening and elevation, and the surrounding soft tissues being disrupted 12,27,28 . Nevertheless, inadequate attention was given to the treatment of ligaments and tendons during the surgical procedure, resulting in a lack of tension in these structures (Figure 4).…”

The Conventional Weil Osteotomy Does Not Require Screw Fixation

“…The increasingly performed minimally invasive procedures were designed to reduce this problem. The evidence in the direct comparison of Weil osteotomy and DMMO is sparse and inadequate; furthermore, an unsatisfactory incidence of floating toes of sometimes 30% or more remains with both procedures [ 11 , 12 , 13 , 14 , 15 , 16 ].…”

Surgical treatment of hammertoes (literature review)

“…Необходимо оценить гибкость и величину данной деформации, а также стабильность плюснефалангового сустава. При осмотре необходимо также обратить внимание на сопутствующие деформации стопы и метатарзалгию [15], что помогает определить тактику дальнейшего лечения.…”