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

Pain on the plantar aspect of the forefoot is a common malady whose specific cause is often difficult to diagnose. Using the Berkemann Laboratory version of the original mat of Harris and Beath, and a calibration curve, the patterns on a footprint can be translated into their actual pressure values withhin the range of 0.27 kg/cm2 to 4.80 kg/cm2. Using the procedure presented here, inexperienced subjects were able to estimate the pressure values of random prints of unknown pressure within a standard deviation of 0.28 kg/cm2 from their actual values. The mat is valuable for diagnosis of pressure metatarsalgia and other disorders of the foot. The specificity was 0.77, sensitivity was 0.57, with the sum being equal to 1.34. These results indicate that there is a relatively large population of normal people wit excessive localized pressure under their metatarsal heads who do not complain of pain. The apparently low sensitivty of the mat in this study does not seem to be a limitation, but is an indication of the haziness involved in the differential diagnosis of forefoot pain. Pressure metatarsalgia can be quantitated by analysis of the Harris footprint.
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PMID:The Harris and Beath footprinting mat: diagnostic validity and clinical use. 741 16

We reviewed the results of arthrodesis of the first metatarsophalangeal joint and excisional arthroplasty of the lesser metatarsophalangeal joints performed on patients who presented intractable metatarsalgia and forefoot deformities. The study included 18 feet (15 patients) in 12 women and 3 men. The follow-up averaged 5.2 years. A good to excellent result was achieved in 15 (83%) feet; pain, which had been moderate to severe before surgery, was reduced to none to mild, and function, which had been severely limited before surgery, was improved to virtually unlimited. The fusion rate of the first metatarsophalangeal joint was 94% (17 of 18 feet). Thirteen of the 15 patients (87%) stated they would have the procedure again. This repair has been demonstrated to be a useful salvage procedure in nonrheumatoid patients with severe metatarsalgia secondary to failed forefoot surgery.
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PMID:Surgical management for intractable metatarsalgia. 755 Sep 38

Congenital or acquired shortness of a metatarsal may cause pain in adjacent metatarsals. From 1983 to 1990, we performed nine metatarsal lengthenings in seven adolescent patients by metaphyseal osteotomy followed by gradual distraction of callus (callotasis). Two patients required bone grafts after the lengthening. We used a rigid, unilateral external fixator designed for use in the hand and foot. At follow-up, from three to ten years later, healing had been achieved in all with an average healing index of 50 days/cm, and metatarsalgia had been relieved by the restoration of correct metatarsal length.
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PMID:Metatarsal lengthening by callotasis during the growth phase. 761 6

Thirty-three feet in 29 patients with metatarsalgia were reviewed after Jones transfer to the lesser rays to evaluate the long-term results and the indications for these procedures. Transfer of the long extensor tendons to their respective metatarsal necks and fusion of the interphalangeal joints with shortening of the toe were performed. The procedures were performed in patients with symptoms of metatarsalgia, secondary to anterior pes cavus deformity (clawfeet, 16 patients), and in patients with mild or severe spreadfoot deformity with fall of the central metatarsals (12 patients). In all of our patients, the striking clinical sign was the long toes. Rating of the results was based on (1) the presence of pain or calluses and (2) residual deformity of the forefoot and toes. Symptoms of metatarsalgia were relieved in 25 feet, occasionally present in 6 feet, and unchanged in 2 patients. Complete correction of the deformity was achieved in 26 patients, 6 patients had slight residual deformities, and in the 1 poor result, overcorrection was present after the procedure. This operation is believed to be an excellent choice for patients with metatarsalgia due to (simple) pes cavus deformity and in patients with clawing and metatarsalgia secondary to excessively long toes.
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PMID:Jones transfer to the lesser rays in metatarsalgia: technique and long-term follow-up. 783 58

Eighty-six lesser toe basal hemiphalangectomies were performed in 52 patients. The surgical technique included an oblique dorsal incision, resection of 8 mm of bone, and an extensor tenotomy. Minimum follow-up was 2 years (range 2-6/1/2 years). Sixty percent of the patients had total relief of pain. Twenty-nine percent stated that they would not have the surgery again, and we categorized these patients as dissatisfied. An extensor tenotomy increased the satisfaction rate and was found to decrease the radiographic sagittal angulation of the toe. The preoperative diagnosis was significant to the outcome of the surgery. Patients with metatarsophalangeal joint synovitis and rheumatoid toe deformities had high rates of satisfaction; those with transverse deviation, metatarsalgia, and hammertoes with metatarsophalangeal joint subluxation/dislocation had lower rates of satisfaction. Seventy percent of the dissatisfied patients were dissatisfied because of persistent flexion deformity of the PIP joint or pain under the metatarsal head. We now add a PIP fusion if any flexion deformity, even a mild deformity, is present at the PIP joint and a plantar metatarsal condylectomy for metatarsalgia.
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PMID:Treatment of the atypical lesser toe deformity with basal hemiphalangectomy. 784 73

A retrospective analysis of the distal "L" osteotomy with bunionectomy (Reverdin-Laird procedure) for correction of hallux abducto valgus was performed. Sixty-nine cases meeting strict eligibility and exclusion criteria underwent evaluation an average of 33.51 months after the procedure. The evaluation included radiographs, physical examination, patient survey, and medical record review. The average decreases in radiographic angles were as follows: Hallux abductus: 19.97 degrees, relative intermetatarsal angle: 7.49 degrees, proximal articular set angle: 13.9 degrees. Twenty-seven cases demonstrated a negative proximal articular set angle. Only five of these cases resulted in clinical hallux varus. There was an average of 4.23 mm. of first metatarsal shortening with this procedure. Average postoperative range of motion of the first metatarsophalangeal joint was 72.05 degrees. The appearance of the forefoot was judged good or excellent in 91.3% of the surgeries. Hallux position was in rectus or mild abductus in 86.9% of cases. Complication rates included hallux varus, metatarsalgia, lesion subsecond metatarsophalangeal joint, pain at the surgical site, long-term stiffness, pin tract infection, and numbness. There were no cases of osteomyelitis or avascular necrosis. Survey results revealed a high level of patient satisfaction with this procedure (94.2%). Patient satisfaction was dependent on elimination of pain and ability to wear the desired shoe gear comfortably, not on hallux position.
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PMID:The first metatarsal bicorrectional head osteotomy (distal "L"/Reverdin-Laird procedure) for correction of hallux abducto valgus: a retrospective study. 813 Jul 84

Ninety-one (91) Mitchell osteotomies on 63 patients (60 females and 3 males) were reviewed. The average follow-up was 40 months (min. 12, max. 70). The average age at the time of the surgery was 51 years (min. 20, max. 74). The presence of a apinful bunion justified the surgery in a majority of cases (92%). The clinical evaluation was done by an independent observer. Weight bearing X-rays of the feet were made in each case. The results show a satisfactory improvement of the pain in 92% of the cases. The patients were satisfied with the appearance of their foot in 93% of the cases. The average active articular range of motion was 47 degrees (min. 20 degrees, max. 120 degrees). The Das De scale showed 75% of excellent and good results. Twelve per cent (12%) of the patients presented residual metatarsalgia. We observed minor complications in 10 cases (11%). We report no cases of avascular necrosis, pseudarthrosis or infection. Clinico-radiological correlations were made. We obtained an average correction of 13 degrees (min. -5 degrees, max. 28 degrees) of the hallux valgus and 3.5 degrees (min. -7 degrees, max. 7 degrees) of the intermetatarsal angle. We recommend the Mitchell osteotomy as long as the indication criterias and the surgical technique are respected.
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PMID:[Mitchell's osteotomy in the treatment of hallux valgus]. 814 58

In six ballet dancers with overuse syndromes of the foot a study on the effect of taping on stabilisation, proprioception and muscular activity was performed. By using synchronous surface electromyography and 3-dimensional motion analysis three standard ballet positions without and with applied tape were performed. Muscular activities of pronator muscles (peroneus longus) and supinator muscles (tibialis posterior) were recorded. EMG measurements showed significant differences between patients with stable or unstable ankles and painful or pain-free feet. Applying tape led to significant changes of muscle activities in height and antagonist reflex patterns. These changes were highest in dancers with unstable ankle joints and metatarsalgia.
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PMID:[Overuse syndrome in ballet: study of the effect of a tape bandage of the upper ankle joint with motion analysis]. 835 40

The authors report a series of 40 cases of metatarsalgia operated according to a modified Helal technique. The mid-diaphyseal osteotomy was situated obliquely inferoanteriorly at an angle of 45 degrees on the metatarsal diaphysis. Twenty cases of hallux valgus were operated during the same procedure Surgery allowed a reduction in pain and hyperkeratosis in 67.5% of patients. Comparison of the results obtained with those reported in the literature confirms that the osteotomy must be metaphyseal and that weight bearing must be early and effective.
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PMID:[Metatarsalgia and modified Helal's operation. Apropos of a series of 40 cases]. 835 13

Metatarsalgia, or pain in the metatarsal region of the foot, is a common orthopaedic problem, but is generally less well understood than pain in the toes, ankle or heel. The cause of metatarsal pain is often less apparent than in other regions of the foot, and in many cases plain X-rays are of no help. Morton's neuroma, a common cause of severe metatarsalgia, can usually only be diagnosed from the history and clinical examination. The key to diagnosis in the metatarsal region is to have a clear knowledge of the most likely conditions.
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PMID:Metatarsalgia. 895 16


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