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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seventy-five feet in 47 patients (46 women, 1 man) who had rheumatoid arthritis were observed for an average of 6 years (range, 4-11 years) after an operation on the forefoot that included a shortening oblique osteotomy of the metatarsal neck of the lateral toes. In addition, patients underwent either flexible hinge toe implant arthroplasty or Mitchell's osteotomy in the first metatarsophalangeal joint. Forty-two feet (56%) looked normal with no valgus or dorsal displacement of the toes. Recurrence of callosities occurred in 9 feet (12%) with moderate pain in 3 feet. Thirty-nine (83%) patients were satisfied with the outcome after surgery. Resection arthroplasty often is recommended for management of forefoot deformities. However, as shown in this series, the improvement in deformities, function, and cosmesis of metatarsophalangeal joint preservation may be better with an osteotomy of the metatarsal neck than with a resection arthroplasty. Because of the development of combined drug therapy, the benefits of synovectomy, osteotomy, and shortening in length should be reconsidered. The authors' studies suggest that the shortening oblique osteotomy should be considered 1 of the surgical reconstruction options for patients with rheumatoid arthritis who have forefoot deformities.
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PMID:Arthroplasty for rheumatoid forefoot deformities by a shortening oblique osteotomy. 917 Mar 74

Erythromelalgia is an acrocyanotic rheumatic disease presenting with erythema, and pain and a burning sensation in the hands and feet; it is rarely encountered during childhood. Hot or warm conditions may precipitate pain and erythema in the extremities and the symptoms may regress upon the application of cold water. The disease is usually secondary to other systemic diseases in adults. On the other hand, it is idiopathic in children. This article describes a case of erythromelalgia presenting with leukocytoclastic vasculitis and hypertension in a 7-year-old child who responded to therapy with prednisolone and phenoxybenzamine.
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PMID:Erythromelalgia associated with hypertension and leukocytoclastic vasculitis in a child. 953 98

Two procedures of hallux valgus correction in young patients were compared by long-term results: soft-tissue realignment (McBride) and Mitchell osteotomy. From 1970 to 1990, 33 hallux valgus deformities of 17 patients were corrected with one of these procedures at the Orthopaedic Department of the University of Mainz. Patients' age at operation ranged from 9 to 20 years and average follow-up was 16 years later. Reevaluation consisted of subjective criteria, such as pain, shoe-fitting, functional disability and cosmetics and objective parameters (hallux-valgus and intermetatarsal angle, osteoarthrotic changes and range of motion of the metatarsophalangeal joint). They were assessed by report, interview, radiograph and physical examination and determined the overall outcome. McBride procedure showed 59% good, 12% satisfying and 29% dissatisfying long-term results, whereas outcome after Mitchell osteotomy was graded as good in 69%, satisfying in 12% and dissatisfying in 19% of the cases. Critical analysis emerged, that each procedure has its own bounds of indication. Successful hallux valgus correction can be achieved by an individual approach consisting of careful study of the indications, well-performed surgery and appropriate postoperative care.
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PMID:Hallux valgus in young patients: comparison of soft-tissue realignment and metatarsal osteotomy. 955 Feb 76

Sixty-nine Mitchell osteotomies augmented with smooth-pin fixation and a trapezoidal step-off osteotomy to maintain ray length were performed on 46 adolescent patients with a painful hallux valgus deformity. Average follow-up time was 6 years. By using radiographic, clinical, and subjective patient data, we found an overall excellent or good result in 91% of cases. Nine feet were found to be cosmetically unsatisfactory, 11 required special shoewear, 10 had mild residual pain with high heels or strenuous running, and three had pain severe enough to restrict activities. Range of motion was normal in 56 feet, slightly decreased in 11 feet, and significantly reduced in two feet. We conclude that, given a success rate of 91%, this slightly modified Mitchell osteotomy is a satisfactory procedure for adolescent hallux valgus deformity with chronic bunion discomfort.
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PMID:Mitchell osteotomy for adolescent hallux valgus. 959 83

From 1988 to 1995, 96 patients (161 feet) underwent a modified Mitchell distal metatarsal osteotomy performed for mild-to-moderate hallux valgus. On AP x-rays of the standing foot, the average intermetatarsal angle was corrected from 15 degrees to 9 degrees, and the first metatarsophalangeal angles were corrected from an average of 41 degrees to 15 degrees. Criteria for evaluation of clinical results included relief of pain, appearance of foot, and shoe wear. After an average follow-up of 38 months, the overall satisfaction rate was 92.5%. Complications included 13 pin tract infections, two delayed unions, and two correction losses. The most common late sequela was transfer metatarsalgia of the lesser toes, which occurred in 20 feet (12.4%), leading to some dissatisfaction. The Mitchell osteotomy can be used on cases with less than 20 degrees of intermetatarsal angle, offering a stable construct with easy postoperative care.
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PMID:Modified Mitchell osteotomy for hallux valgus. 976 62

45 patients were included in a prospective study to evaluate the results of Mitchell's osteotomy of hallux valgus. 43 patients complained of pain preoperatively. 44 patients were reviewed after one year, and excellent results were achieved in alleviating pain for 35 of these patients. Four patients developed metatarsalgia after surgery. There was a mean improvement in the hallux valgus angle of eight degrees. The mean shortening of the first metatarsal was 6 mm (1-12 mm). This shortening showed no correlation with postoperative pain. Signs of osteoarthrotic changes in the metatarsophalangeal joint were found in one patient and early signs of osteonecrosis of the first metatarsal head in two. We conclude that in spite of some serious complications this method produces satisfactory results and can be recommended when pain over the medial prominence is the main indication.
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PMID:[Mitchell's osteotomy of hallux valgus]. 981 45

The current study elucidates the quality of long-term results after hallux valgus correction by Mitchell osteotomy in children and adolescents. Eight female and 1 male hallux valgus patient with a total of 16 bunion deformities underwent a Mitchell procedure in the period 1970 to 1985, and were reinvestigated in December 1994 (at an average of 16 years later). Their ages at operation ranged from 9 to 20 years (average 16 years). Patients' data were subdivided into subjective and objective criteria. Subjective parameters such as pain, shoe fitting, mobility and cosmesis were assessed by interview. Objective data were obtained from reports, radiographs and physical examination. Owing to the lack of established and recommended scores, we developed our own evaluation pattern. Overall outcome was judged as good in 69%, satisfying in 12% and dissatisfying in 19% by both patients and surgeon. In our experience, Mitchell osteotomy is an appropriate method for young hallux valgus patients, especially in forefeet with rigid malformation or moderately severe hallux valgus and metatarsus primus varus. Extensive metatarsal shortening should be excluded preoperatively in order to avoid postoperative metatarsalgia.
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PMID:Long-term results after Mitchell osteotomy in children and adolescents with hallux valgus. 982 70

Erythromelalgia (EM) is a chronic disorder characterized by intermittent burning pain, warmth and erythema of the extremities. Increasing the local temperature and dependency of the affected limb(s) precipitates the symptoms, whereas direct cooling and elevation of the limb(s) can provide partial relief. Our previous findings showed that patients with EM have enhanced cutaneous vascular tone at rest and during stimulation, which may be due to an increase in sympathetic neural activity. To test this, we measured skin vasoconstrictor responses to contralateral arm cold challenge (CC) and inspiratory gasp (IG) using laser Doppler flowmetry at the toe pulp and fingertip. These areas were chosen because of their dense sympathetic innervation. An index of the vasoconstrictor response (between 0 and 1) was calculated from the change in skin perfusion from baseline following CC and IG. In control subjects, vasoconstrictor responses to CC at the toe and fingertip were both 0. 70+/-0.02 (mean+/-S.E.M.), which were significantly greater (P<0. 001) than corresponding values in patients with EM (0.37+/-0.04 and 0.45+/-0.04 respectively). Similarly, vasoconstrictor responses to IG were significantly greater (P<0.001) at the toe and fingertip in control subjects (0.70+/-0.03 and 0.70+/-0.02 respectively) compared with values in EM patients (0.27+/-0.03 and 0.45+/-0.15 respectively). These data show that, in contrast with control subjects, patients with EM have diminished sympathetic vasoconstrictor responses to both CC and IG. Denervation supersensitivity may play a part by increasing vasoconstrictor responses to circulating catecholamines, leading to a reduction in skin blood flow. Therefore an interplay between neural and vasoactive agents may be involved in the pathophysiology of EM.
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PMID:Impaired skin vasomotor reflexes in patients with erythromelalgia. 1020 83

From a total of 153 patients (251 feet), 64 (41.8%) patients, who had had 105 modified Mitchell procedures, were clinically and radiographically examined with follow-up periods ranging from 15 to 24 years (mean, 21 years). Mean age at operation was 41 years (range, 12-64 years). The classic double osteotomies, which diverged slightly toward the plantar surface and the distal fragment, shifted laterally, and angled plantarward, were fixed with a smooth Kirschner wire. In this way, it was possible to achieve a reduction in the first intermetatarsal angle from an average of 22.5 degrees preoperatively to 7.7 degrees postoperatively, and the hallux valgus angle changed from an average of 33 degrees to 17 degrees, with an average shortening of the first metatarsal of 5.4 mm and an average lateral displacement of the first metatarsal head of 4.5 mm. In 67 feet (64%), the results were graded good to excellent; in 23 feet (22%), satisfied; and in 15 feet (14%), poor. The results were worse than the results obtained on the same patient population with a follow-up ranging from 2 to 11 years, with 97% good-to-excellent results reported. Pain over bunion caused by recurrence of the hallux valgus deformity was the main reason for this late deterioration of the results.
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PMID:Late results of modified Mitchell procedure for the treatment of hallux valgus. 1035 65

Erythromelalgia is not a commonly recognized or diagnosed condition that affects the lower extremities. The first reported case was in 1878, when Mitchell suggested the term "erythromelalgia." This condition is characterized by a burning sensation with erythema of the involved extremity. When the extremity is lowered, or heat is applied, the pain is intensified. The application of cold or elevation of the extremity will have the opposite effect of decreasing the pain. Erythromelalgia is classified as primary or idiopathic if there is no accompanying disease process. Secondary erythromelalgia is associated commonly with myeloproliferative syndrome-related thrombocythemia, and is mostly evident in adult onset of the condition. Treatment for adults with erythromelalgia includes a single daily dose of aspirin, but children who have no associated underlying disorder find little to no relief with acetylsalicylic acid.
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PMID:Erythromelalgia: diagnosis and classification. 1038 66


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