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

Injuries of the forefoot are a challenge for orthopaedic surgeons. After healing of bone and soft tissue damage, posttraumatic metatarsalgia can persist. The paper presents a therapy algorithm with newly designed insoles, which consist of the common orthopaedic adaptations like a rocker bottom and a stiffening of the sole. The therapy is shown on two cases. With these orthotics adequate is possible and pain relief realistic.
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PMID:[Post-traumatic metatarsalgia. Early results of treatment with a new insole]. 1092 56

The aim of this prospective study was to evaluate if atrophy of the plantar fat pad in splay-foot deformities was a major cause of metatarsalgia. A sonographic method of measuring the thickness of the plantar fat pad under the second and third metatarsal heads was developed. The method was tested on 25 volunteers and the intraobserver reliability was calculated to be 97.1% for the second metatarsal and 96.7% for the third metatarsal. Sonographic measurement of the plantar fat pad was then performed on 100 symptomatic feet Pain frequency and pain intensity were determined by using a verbal rating scale (VRS) and a visual analog scale (VAS). The intermetatarsal angle 1/2 was measured and then compared to the thickness of the fat pad for each patient. A correlation between the increase of the intermetatarsal angle and the decrease of the fat pad thickness could not be demonstrated (r = 0.041). The frequency of metatarsalgia did not correlate with a decrease of the thickness of the plantar fat pad under the second metatarsal head (t statistic: 1.978; Durbin-Watson test: 1.999; p value = .0507) and the third metatarsal head (t statistic: 3.199; Durbin-Watson test: 1.962; p value = .0019). The pain intensity showed a similar lack of correlation with the thickness of the plantar fat pad under the second metatarsal head (t statistic: 1.828; Durbin-Watson test: 2.365; p value = .0706) and the third metatarsal head (t statistic: 1.846; Durbin-Watson test: 2.371; p value = .0678). This study shows that a splay-foot deformity is not associated with a decrease of the thickness of the plantar fat pad. Furthermore, alterations of the thickness of the plantar fat pad are not relevant to the intensity and frequency of metatarsalgia.
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PMID:Plantar fat pad atrophy: a cause of metatarsalgia? 1120 64

Twenty-one feet in fifteen patients underwent osteotomies of the calcaneus and one or more metatarsals for symptomatic cavovarus foot deformity. Seven (nine feet) were male, and eight (twelve feet) were female. The etiology included hereditary motor sensory neuropathy (HMSN) (fifteen feet), post-polio syndrome (two feet), sacral cord lipomeningocele (two feet), parietal lobe porencephalic cyst (one foot), and idiopathic peripheral neuropathy (one foot). Presenting complaints were metatarsalgia (fifteen feet), ankle instablility (five), and ulceration beneath the second metatarsal head (one foot). Eleven feet were assessed using the Maryland Foot Rating Score. Maryland Foot Rating Score (University of Maryland, Baltimore, MD) improved from 72.1 (avg.) preoperatively to 89.9 (avg.) post-operatively (follow-up 70.9 months avg.). Eight feet were assessed using the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot and Midfoot Scores. The AOFAS Ankle-Hindfoot Score improved from 46.3 (avg.) pre-operatively to 89.1 (avg.) post-operatively, and the AOFAS Midfoot Score improved from 40.9 (avg.) pre-operatively to 88.8 (avg.) post-operatively (follow-up 20.8 months avg.). The postoperative AOFAS Ankle-Hindfoot Score for all nineteen feet was 90.8 (avg.) and the post-operative AOFAS Midfoot Score for all nineteen feet was 90.2 (avg.). Two patients were lost to follow-up and were not included in the study. Ankle, hindfoot, and midfoot motion was maintained or improved in sixteen feet. Complications included delayed union in two and nonunion in three of 66 metatarsal osteotomies. While three patients required an AFO (ankle-foot orthosis) for ambulation preoperatively, all patients were brace free postoperatively. All patients expressed willingness to undergo the same procedure again if it were necessary. Weight-bearing radiographs were available for 17 feet. Radiographic analysis revealed a decrease in forefoot adduction (9.6 degrees avg.) and a reduction in both hindfoot (9.1 degrees avg.) and forefoot cavus (10.6 degrees) leading to an overall 13 percent reduction in the height of the longitudinal arch. Lateral sliding elevating calcaneal osteotomy combined with dorsolateral closing wedge osteotomies of one or more metatarsal bases in the severe symptomatic cavovarus foot can provide a pain-free, plantigrade foot with a lowered longitudinal arch and a stable ankle without sacrificing motion.
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PMID:Cavovarus foot treated with combined calcaneus and metatarsal osteotomies. 1120 19

The authors feel that capsular interposition arthroplasty can give predictable pain relief in carefully selected individuals with severe (grade III) hallux rigidus. Attention to the relative lengths of the first and second metatarsals, minimal shortening of the proximal phalanx, and use of the dorsal capsule and EHB tendon as an interposition all contribute to good to excellent objective and subjective results. Approximately 30% of patients undergoing this procedure experience some degree of transfer metatarsalgia postoperatively and probably require orthoses for sports. The authors feel that this operation presents a reasonable alternative to many patients who are candidates for an arthrodesis of the first MTP joint for advanced degenerative disease.
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PMID:Hallux rigidus. Excisional arthroplasty. 1123 2

We retrospectively reviewed the results of a distal soft-tissue procedure and proximal crescentic osteotomy of the first metatarsal combined with a proximal shortening osteotomy of the second and/or third metatarsal. This was in patients who had hallux valgus with painful plantar callosities. The review covered seven years of procedures (1989-1996) in 12 patients (14 feet) averaging 53 years of age. Average follow-up was 52 months. All patients had pain at the first metatarsophalangeal joint and had metatarsalgia preoperatively. At follow-up, 11 feet had no pain at the first metatarsophalangeal joint, and three had some improvement of pain. Ten feet had no metatarsalgia, two had improvement of metatarsalgia, and two feet had transfer lesions postoperatively and required reoperation. The angle of hallux valgus averaged 40 degrees preoperatively and 13 degrees postoperatively. The intermetatarsal angle averaged 18 degrees preoperatively and 6 degrees postoperatively. Mean decreases in length of the second and third metatarsal after surgery were 5.4 mm and 4.8 mm, respectively. Our results suggested that this combined procedure for hallux valgus with painful plantar callosities may be successful, in carefully selected patients.
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PMID:Surgical treatment for hallux valgus with painful plantar callosities. 1131 Aug 61

INTRODUCTION:: Foot pressure measurements furnish information about distribution of pressures, forces, time and contact areas under the foot during standing and walking. Foot pressure measurement has been used in a number of rehabilitation and athletic applications in adults, however, little has been published regarding the clinical usefulness of this technology for children with disabilities. Children with juvenile rheumatoid arthritis (JRA) are reported to have various foot deformities and gait deviations and clinicians report that the children may have foot pain such as metatarsalgia. These may be treated with specially fitted shoes, shoe modifications or ankle foot orthoses. The purpose of this preliminary study was to describe the methodology used to quantify foot pressure distribution patterns and, further, to describe the patterns seen in individual children with JRA compared to aged matched typical children without JRA. METHODS:: Pressure, area and force were measured using the EMED-F system including a platform with 2048 capacitive pressure sensors and a computerized data collection and analysis system. Children were asked to walk comfortably and normally across the platform while time, pressure and area measurements were automatically taken. Other data collected were height and weight, observational gait analysis and lower extremity range of motion measurements. Data are reported for the entire foot, as well as particular areas of the foot that are of interest. For this study, eight discrete areas or masks were identified (medial and lateral heel, medial and lateral midfoot, first metatarsal, lateral four metatarsals, great toes and four lateral toes) for description. Information reported for each area and the total foot included force, peak pressure, total area, pressure time integral and force time integral. Data from three pairs of children were analysed and differences were described. RESULTS:: Several differences in the descriptive data were noted and will be highlighted. Children with JRA had striking asymmetries in several variables, higher peak pressures and in increased total foot pressure time integrals and force time integrals. This information is presented to improve our understanding of the patterns under the foot so that (1) appropriate treatment strategies for foot impairments may be better prescribed for children with JRA and (2) to assist in planning for treatment of gait abnormalities. This preliminary work will also form the basis for determining the clinically meaningful variables to consider in a larger study and statistical analysis.
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PMID:Foot pressure distribution: methodology and clinical application for children with ankle rheumatoid arthritis. 1141 20

Metatarsalgia is a common presenting symptom with an established list of differential diagnoses. The authors present a classification system and surgical treatment algorithm for chronic metatarsophalangeal pain due to metatarsophalangeal joint capsule tear. A series of 58 metatarsophalangeal joints with partial tear diagnosed by arthrogram and treated by surgical repair are reviewed. The authors propose a classification system based on preoperative arthrography and a surgical repair procedure for each type of three distinct patterns. A study was developed and funded to perform postoperative arthrograms on 15 patients who had undergone surgical repair using the procedures presented. The purpose of the study was to validate the utility of the arthrogram in the diagnosis and clarification of the nature of the capsular tear. The authors were also able to demonstrate that the arthrographic findings became normal postoperatively, and that surgical repair of a seemingly innocuous capsule tear relieves pain. Fifty-six patients in the series reported relief of their preoperative symptoms. Postoperative arthrograms in 15 patients demonstrated a normal pattern in 73%, 20% had decreased extravasation, and 7% were unchanged.
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PMID:Metatarsophalangeal joint capsule tears: an analysis by arthrography, a new classification system and surgical management. 1199 36

We performed a retrospective study in 188 patients (254 feet) with rheumatoid arthritis and compared the late results of Keller's procedure with those of Hueter-Mayo's technique after 7.9 years. More than 60% of the Keller group and 30% of the Hueter-Mayo group were suffering from persistent metatarsalgia due to increased forefoot pressure as well as experiencing pain around the great toe. Plantar callosities, recurrent hallux valgus deformity, lack of plantar flexion and weakened push-off were more frequent after Keller's procedure.
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PMID:The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis. 1179 67

Between 1985 and 1995, 30 modified Mitchell osteotomies were performed in 18 children with hallux valgus, 12 bilateral and 6 unilateral. The mean age at surgery was 15 (10-18) years. The surgical modification consisted of diverging trapezoidal cuts, plantar displacement of the head, release of the lateral collateral ligament and the adductor insertion and Kirschner wire fixation of the osteotomy. At an average follow-up of 8 (5-14) years there were no nonunions, avascular necroses or recurrences. All the patients were satisfied with the cosmetic results, could use regular shoes and had no physical restrictions. Only 2 complained of occasional pain, thought to be secondary to transfer metatarsalgia. The presence of an open physis at the time of surgery did not affect the results.
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PMID:Hallux valgus in children: a 5-14-year follow-up study of 30 feet treated with a modified Mitchell osteotomy. 1207 19

The purpose of this study was to consider the causes of patient dissatisfaction following foot surgery and review whether poor outcomes are more commonly associated with particular techniques. Two hundred forty-four patients who had previously undergone foot surgery were referred to a podiatric surgery service because of continued pain, disability, footwear-fitting problems, and cosmetic concerns. The majority of cases had previously undergone first ray surgery to correct hallux valgus. The most common reason for referral was transfer metatarsalgia followed by recurrence of hallux valgus and lesser digit deformity. Thirty-two patients were treated with conservative measures, including orthoses and cortisone injections. Eight patients (25%) were completely satisfied with conservative treatment, 20 patients (63%) were satisfied with reservations, and four patients (12.5%) were dissatisfied. One hundred seventy-six patients underwent revision surgery. High patient satisfaction was achieved with surgical revision with 123 patients (69%) completely satisfied at an average 5.6-month follow-up, 43 patients (24%) were satisfied with reservations, while 10 patients (6%) were dissatisfied. Complications occurred in 23 patients (13%) with nine cases developing a superficial postoperative infection. In reviewing this series of patients, it is apparent that poor surgical outcomes and the need for revision surgery could in many cases be prevented with selection of surgical techniques that avoid joint destruction, excessive shortening of single metatarsals, and digital amputation.
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PMID:Revision of failed foot surgery: a critical analysis. 1240 Jul 14


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