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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several techniques have been suggested for correction of clawtoe deformities in the lateral toes, ranging from multiple arthrodesis of the interphalangeal joints to phalanx resections, partial or total amputation of the impaired toes. An evaluation of the flexor-extensor transfer procedure is the basis of this study. Between 1977 and 1983, 39 feet were operated on in 31 patients, presenting a wide variation in etiology, degree of deformity, and symptoms. Average age at the time of surgery was 57.5 (16 to 80). All of the patients were available for recall and were able to return for an interview and examination. Average length of follow-up was 38 months (range, 10-80 months). The report includes a general discussion of the deformities, description of the operative technique, and the results obtained in our series. Assessment emphasized a subjective report including patient satisfaction, cosmetic result, relief of pain, and objective examination to evaluate the presence of recurrent callosities, range of movement at the metatarsophalangeal joint, and degree of residual passive mobility of the toes. Reduction of metatarsalgia and callosities with improved shape of the toes was achieved in most cases. Our experience indicates that the treatment can be recommended for use in the elderly, too, in appropriate cases. Radical procedures are rarely accepted for cosmetic as well as for functional reasons.
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PMID:Correction of clawtoes by the Girdlestone-Taylor flexor-extensor transfer procedure. 650 Apr 12

Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.
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PMID:Chevron osteotomy for the treatment of hallux valgus. 669 98

A patient with a year-long history of metatarsalgia was found to have an elevated platelet count due to essential thrombocythemia, a benign myeloproliferative disease. Reduction of the platelet count with chemotherapy eliminated the foot pain. The authors recommended that a platelet count be part of the work-up of patients with metatarsalgia when the etiology of the foot pain is unclear.
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PMID:Metatarsalgia caused by an increase in circulating platelets: a case report. 671 65

A distal oblique osteotomy on the first metatarsal, with lateral displacement of the metatarsophalangeal joint and internal fixation with a compression screw, was performed. No splint or plaster was used. The operation is relatively simple and effective. Pain and discomfort during a short healing period are minimal. Forty-nine feet were operated on in 42 patients by eight surgeons. The patients were advised to bear full weight after six weeks. Return to unlimited work was possible after six weeks. The complications were superficial infection in one case and screws entering the metatarsophalangeal joint in two cases. One patient complained of metatarsalgia after the operation, but all other patients were satisfied after follow-up periods ranging from three months to six years.
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PMID:A new operation for hallux valgus. 683 85

Supracondylar osteotomy is an alternative to other procedures for realignment of the rheumatoid hindfoot. Of 64 hindfoot operations performed since 1964, 12 were supracondylar osteotomies. The specific indication for this procedure was an ankylosed rheumatoid foot with equinovarus deformity and limited range of tarsal motion. Conventional triple arthrodesis in such circumstances creates a rigid foot, further compromising an already damaged ankle. Of the nine feet available for evaluation one to ten years after operation, seven were relieved of pain and two had anterior metatarsalgia from recurrence of equinus deformity. Correction of varus deformity was maintained in all. Ankle motion diminished from a mean of 17 degrees before operation to 7 degrees when reviewed. Five of the eight ankles had bony fusion. Mean rotatory tarsal motion was improved in two and diminished in seven; mean rotation remained constant, at approximately 13 degrees. Whereas ankle joint motion fared badly under the combined onslaught of disease and osteotomy, the preservation of tarsal motion, correction of deformity, and relief of pain make supramalleolar osteotomy a worthwhile alternative procedure under the specific circumstances cited.
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PMID:Supramalleolar osteotomy in the management of the rheumatoid hindfoot. 686 10

In a retrospective survey of 65 patients who had rheumatoid arthritis, the late results of excision arthroplasty of the forefoot were investigated and compared with nonoperative management. Subjective assessment of foot shape and severity of pain as well as objective changes in gait and deformity were considered. Surgery relieved pain initially, but the recurrence rate of metatarsalgia was high. In those who wore surgical shoes, lack of cosmesis was the most important factor in determining poor compliance. The operation was recommended at random, and there was little difference in the outcomes of nonoperative and surgical treatments. A long-term randomized prospective trial is required to establish the criteria for selection of a management regime.
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PMID:Management of the deformed rheumatoid forefoot. A comparison of conservative and surgical methods. 708 58

The results of surgical procedures to correct hallux valgus have thus far been unpredictable. Hitherto the problem has been approached on the horizontal plane (i.e., from the dorsoplantar point of view), but the author has devised a new apparatus for measuring and recording the weight-bearing frontal alignment (WFA). Abnormal positions of the metatarsal heads, observed from the front, may cause pain in the forefoot, and hallux valgus may contribute to the problem. Analysis of the WFA before a surgical operation enables the surgeon to select the proper procedure for each foot and simultaneously to correct the defects in the horizontal and frontal planes. WFA analysis also enables the surgeon to avoid grave errors in choosing a surgical procedure. After hallux rigidus surgery, the forefoot tends to be more pronated than before and although painless, is predisposed to metatarsalgia. if the WFA is known, this can be avoided.
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PMID:Hallux disorder and metatarsal alignment. 724 48

Metatarsalgia is the symptom of pain in the region of the metatarsophalangeal articulations. In a careful analysis of 98 patients who presented with complaints of forefoot pain, 23 distinct diagnoses were made as to the etiology of their pain. These diagnoses were grouped under primary metatarsalgia, secondary metatarsalgia, and pain under the forefoot. Specialized tests, such as stance phase cholesterol-crystal force plate analysis and intraarticular or digital nerve block, are helpful in determining the diagnosis and the likelihood of effective treatment.
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PMID:Metatarsalgia: a clinical review of diagnosis and management. 726 52

The use of footprints in evaluating surgical results is most significant to the physician. This clinical investigation consisted of patients whose surgical correction of severe hallux valgus included the use of the Swanson-total great toe hinged prosthesis. The resulting failure of weightbearing by the great toe pulp postoperatively were found to be associated with excessive weightbearing by the lesser metatarsal heads, evidenced by discrete keratomas, a relative lesser metatarsalgia, and footprinting analysis. In conclusion, we believe that there is a definite relationship between the lack of weightbearing under the first ray and the instability of the first metatarsophalangeal musculoligamentous structures. This was found to be influenced by metatarsal protusion and first metatarsophalangeal joint range of motion. The possibility also exists that the intrinsic property of silicone played a role in failure of great toe weight-bearing. It is our belief that the Swanson-total is truly and mainly a joint spacer that relieves pain associated with first metatarsophalangeal joint arthrosis. The possibility exists that when using the Swanson-total with a short first metatarsal protrusion it may be necessary to perform shortening osteotomies on the appropriate lesser metatarsals. This redesigning of the metatarsal parabola could restore a normal forefoot weight-bearing pattern and minimize postoperative complications. Further research on this matter is in the planning stages.
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PMID:A clinical evaluation of the total first metatarsophalangeal joint prosthesis: the use of footprints in assessing foot contact. 727 50

Metatarsalgia is a symptom, not a diagnosis. A careful study of ninety-eight patients who had complaints of pain in the fore part of the foot revealed twenty-three distinct diagnoses. These diagnoses were grouped as primary metatarsalgia, secondary metatarsalgia, and pain under the fore part of the foot. This division assisted in determining the form of nonoperative or operative treatment. The use of a pressure-sensitive cholesterol-crystal force-plate analysis or intra-articular or digital nerve blocks was helpful both in accurately pinpointing abnormal pressures and in determining whether operative treatment had been effective. Unexpected problems occurring after metatarsal surgery may be preventable in the future.
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PMID:Metatarsalgia: diagnosis and treatment. 739 Oct 95


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