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

The chevron osteotomy for realignment of the first metatarsal head in metatarsus primus varus deformity has been utilized at the Mayo Clinic since 1976 on 26 feet (18 patients). Follow-up evaluation disclosed excellent relief of pain, good cosmetic correction, and overall patient satisfaction. Radiographic evaluation demonstrated reduction in the angle between the phalanx and the metatarsal bone of the great toe as well as narrowing of the forefoot with a decreased angle between the first and the second metatarsal bones. The stability of the osteotomy, the technical ease, and the absence of secondary difficulties such as transfer metatarsalgia make this procedure preferable when osteotomy of the distal portion of the first metatarsal bone is used for correction of moderate deformity.
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PMID:Chevron osteotomy for hallux valgus. 49 46

The case of a rare location of an epiderman cyst in the forefoor region is reported. Very intense pain on pressure or tension in the plantar region of the second and third metatarsals suggested a metatarsalgia and the existing diffuse swelling a synovitis. Surgical revision revealed an epidermoid cyst the size of a hazelnut which pressed the N. digitalis plantaris communis against the head of the third metartarsal.
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PMID:[Rare location of an epidermoid cyst in the forefoot region with nerve compression syndrome. Contribution to the differential diagnosis of Morton's metatarsalgia (author's transl)]. 81 45

A conservative approach to foot problems is especially useful in patients with diabetes, rheumatoid arthritis, diminished circulatory changes, and those who are too debilitated for surgical treatment. If one will start with either the medial heel wedge or the anterior heel correction, some response should be evident within 4 to 6 weeks. If the response after a trial period of approximately two to three months for a heel wedge or another two to three months for the anterior heel doesn't relieve pain, then perhaps some other problem might now become easier to localize, i.e. Morton's toe syndrome, hallux valgus, soft or hard corns, or hammertoe deformities. When the anterior heel is prescribed many foot problems other than metatarsalgia will stop being symptomatic and surgery treatment can be bypassed. A physician must know about the supply of shoes in the community and, if necessary, instigate a better inventory of available shoes. In addition, it is necessary to establish good rapport with the shoe repair man so that he will not intrude in your patient rapport or alter your directions. Patients also need advice about losing weight. Frequently a loss of 15 or 20 pounds will change a patient's complaint from one of extremely discomforting daily weight-bearing to a tolerance of a fair amount of walking and at least a reduction of the complaints to a more endurable and functional level. One can't expect the shoe correction to do everything for everyone. The anterior heel isn't the whole solution to the complicated problem but it helps to have patients begin to see results in more comfort in their shoe wear.
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PMID:The anterior heel for metatarsalgia in the adult foot. 85 20

A retrospective clinical and radiological review of 51 patients (mean age 66 years) was performed to assess the outcome of excision arthroplasty for hallux valgus in an elderly population and to compare the results of the Keller, which is still used frequently in many centers in the United Kingdom, and modified Mayo operations. Although significant correction of the deformity was obtained with both procedures, this was incomplete and the mean residual hallux valgus angle was greater than 20 degrees. Lateral metatarsalgia was present in over 40% of patients. Both procedures provided good pain relief, and considerable narrowing of the forefoot was obtained with the modified Mayo operation. Excision arthroplasty in the elderly should be reserved for the low demand patient with symptomatic degenerative changes in the first MP joint in the absence of lateral metatarsalgia.
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PMID:Excision arthroplasty for hallux valgus in the elderly: a comparison between the Keller and modified Mayo operations. 139 59

Pain, plantar to the metatarsophalangeal joints, is a common location for the presentation of pain in the forefoot. In the absence of fractures or specific inflammatory conditions common causes of pain in this area include: (1) nonspecific metatarsalgia, (2) plantar fat pad atrophy, and (3) interdigital (intermetatarsal) neuroma. The aggravation and possibly the etiology of these forms of forefoot pain may be related to acute or chronic extrinsic pressure to the forefoot. The role of nonweightbearing, compression of the metatarsal heads, weightbearing, and toe-stance (on the metatarsal heads) on the intermetatarsal pressure of the third interspace was measured in eleven asymptomatic volunteers. Intermetatarsal pressures were recorded using the Stryker Miniaturized Digital Fluid Pressure Monitor. Intermetatarsal pressures for nonweightbearing, nonweightbearing with medial-lateral compression of the metatarsal heads, weightbearing, and toe stance averaged 21 mm Hg, 22 mm Hg, 29 mm Hg, and 36 mm Hg, respectively. In comparison to nonweightbearing, significant increases in intermetatarsal pressures were measured with weightbearing (P = .0027) and toe stance (P = .0002). The change noted from weightbearing to toe-stance was also significant (P = .0005). These findings support the proposition that increases in forefoot plantar pressures convey greater pressures to the intermetatarsal space and metatarsal heads. Increased pressures to the intermetatarsal space may likewise lead to or exacerbate the symptoms of patients with fat pad atrophy, nonspecific metatarsalgia and Morton's neuroma.
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PMID:Quantitative determination of intermetatarsal pressure. 147 84

The almost universal surgical approach for the treatment of Morton's metatarsalgia is to resect the neuroma through a dorsal incision. Considering that the mechanism for the metatarsalgia is chronic repetitive compression of the common plantar digital nerve between the metatarsal heads, this report explores the use of neurolysis in five patients with 11 involved nerves. In surgery, the intermetatarsal ligament is divided, intrinsic fibrosis is released, and the epineurium is opened. The mean follow-up period is 33 months. Complete pain relief was achieved in four of the five patients, with the fifth patient, 13 years after a crush injury to the foot, achieving good pain relief. All five patients resumed their usual jobs and athletic activities. One patient wears sneakers instead of regular shoes. The patient with the crush injury wears custom-made shoes.
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PMID:Treatment of Morton's neuroma as a nerve compression. The role for neurolysis. 146 May 80

Pain in the foot and ankle is most frequently secondary to static and degenerative changes, eg, corns, hammer toes, bunions, anterior metatarsalgia, and heel pain. A second common group consists of rheumatologic disorders that encompass immune and hereditary factors. This group includes rheumatoid arthritis, the often underdiagnosed seronegative spondyloarthropathies, and, less commonly, crystalline deposit disorders and diffuse connective tissue diseases. Both the physician and the public need a heightened awareness of the existence and presence of these disorders, which may be devastating, eg, psoriatic arthritis and tenosynovitis. To these groups, we now must add Lyme disease and acquired immunodeficiency syndrome. The advances in testing, including immunologic and nuclear imaging (eg, magnetic resonance imaging), have permitted more rapid and specific diagnosis with earlier treatment.
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PMID:Foot and ankle pain resulting from rheumatic conditions. 158 Nov 52

Pathologic conditions of the metatarsophalangeal joints comprise the majority of painful conditions of the forefoot. Clinical manifestations commonly include hallux valgus (bunion), bunionette ("tailor's bunion"), and metatarsalgia. Conservative treatment remains the hallmark of initial management of these disorders. Conservative measures emphasize the adequate accommodation of the forefoot within the toe box of the shoe and the even distribution of plantar pressures by various metatarsal pads or bars and soft insoles. Numerous and sometimes controversial surgical procedures have been developed when conservative measures fail to achieve significant pain relief. In general, these procedures can be grouped as 1) soft tissue realignment procedures, 2) bony realignment procedures, 3) combined bony and soft tissue realignment procedures (ie, osteotomy), 4) bony and joint resection, 5) arthrodesis techniques, and 6) Silastic joint replacement techniques.
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PMID:Surgical management of foot disorders: bunions and bunionettes. 204 57

Metatarsal osteotomy according to Helal is a successful method of treating metatarsalgia. Using this method, 72% of our patients, followed up between 1974 and 1986, (114 patients with a total of 336 osteotomies) were relieved of pain, the result depending on the patients' age. On reviewing the unsuccessful results using pedobarographic measuring, the major part of failures was due to an unequal distribution of weight on the forefoot. Two main types of faulty weight-bearing were stated: 1. Excessive weight-bearing on non-osteotomized adjacent metatarsals (domino-effect). In concern of the overall-result no difference could be found between cases with routine osteotomy II-IV and ones with single or double osteotomy. 2. Excessive weight-bearing on the complete fore-foot as a consequence of missing support by contracted metatarsophalangeal joints. When planning an operation, the length of all metatarsals in relation to each other, as well as the mobility of the toes should therefore be taken into consideration.
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PMID:[Helal's metatarsal osteotomy. Indication and technic with reference to shape and function of the foot]. 259 47

A double-threaded compression screw (Herbert) was used as internal fixation of metatarsal neck osteotomy and nonunion repair in 16 patients (18 feet). Fifteen patients had associated symptomatic conditions of the foot. Twelve patients had one or more previous surgical procedures on the involved foot. Fourteen patients (15 feet) underwent 20 primary or revision lesser metatarsal osteotomies. Four of these patients had undergone previous lesser metatarsal osteotomies and had developed recurrent pain beneath six metatarsals and transfer metatarsalgia in one case. The remaining two patients (three feet), with six nonunions from previous metatarsal osteotomies, had repair with screw fixation and bone grafting. Follow-up for the series averaged 14 months.
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PMID:Metatarsal osteotomy using a double-threaded compression screw: an adjunct to revision forefoot surgery. 261 24


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