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

Morton's foot syndrome is a hereditary syndrome characterized by a short first metatarsal bone, posterior displacement of the sesamoids, and hypertrophy of the second metatarsal, causing excessive weight to be borne by the second metatarsal head. This condition results in callus formation under the second metatarsal. Pain and tenderness are usually felt at the base of the first two metatarsal bones and at the head of the second. Pain (metatarsalgia) may be disabling. Conservative treatment consists of placing a flexible pad under the first metatarsal and toe to increase the range of motion and weight-bearing along the first metatarsophalangeal joint and the hallux. Surgical treatment consists of removing a small portion of bone from one or two joints to bring the toe down to the desired length. Lengthening short toes by placing a silicon implant into one of the joints is also possible.
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PMID:[Dudley Joy Morton's foot syndrome]. 1637 98

A distal metatarsal osteotomy with soft tissue correction is a frequently performed operation to correct mild to moderate hallux valgus deformity. This is a prospective study of 28 feet in 25 patients who underwent spike osteotomy of the first metatarsal with medial capsulorraphy for symptomatic hallux valgus. The osteotomy is a distal metatarsal osteotomy with a spike fashioned in the plantar and lateral quarter of the proximal fragment and impacted into the trough created in the center of the distal fragment, providing lateral and plantar shift of the distal fragment. The American Orthopaedic Foot and Ankle Society's rating scale was used for functional assessment, and a visual analog scale gauged pain. The average follow-up was 27 months. The rating scale score improved from a mean preoperative value of 39/100 to 84/100. Twenty-six feet had complete pain relief, whereas 2 feet had a lesser degree of persistent metatarsalgia. A review of preoperative and postoperative radiographs showed that the hallux valgus angle improved from a mean 36 degrees preoperatively to 18 degrees postoperatively. Likewise, the mean 1 to 2 intermetatarsal angle improved from 13 degrees to 7.3 degrees. There was no incidence of avascular necrosis. Fourteen patients (16 feet) rated the outcome as excellent, 10 (11 feet) as good, and 1 patient with asymptomatic mild hallux varus deformity rated the result as fair. These results demonstrate that the spike osteotomy is a suitable operation for treatment of mild to moderate hallux valgus.
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PMID:The spike osteotomy for hallux valgus: a clinical and radiological evaluation. 1714 76

Metatarsalgia of the central ray is a major surgical challenge. Without precise correction, transfer lesions may occur at an adjacent metatarsal or patients may have inadequate pain relief. Current surgical treatment strategies do not facilitate precise positioning in different planes, resulting in disappointing outcomes. To achieve better outcomes we used an oblique sliding osteotomy to facilitate precise correction. We hypothesized the procedure would reduce pain in patients with prominent second and/or third metatarsal heads, with few complications. We retrospectively reviewed 32 consecutive patients with 42 osteotomies of the lesser metatarsal bones. The mean and median ages at the time of surgery were 49 and 54 years, respectively, with a minimum followup of 26 months. Thirty-one patients (97%) had relief of plantar pain. The mean American Orthopaedic Foot and Ankle Society score was 82.4 points. We identified no transfer lesions. The median time to radiographic union was 10 weeks. Although time to bony union can be extended, the oblique sliding osteotomy facilitates intraoperative adjustment to provide the precise positioning critical to eliminating plantar pain.
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PMID:Resolution of metatarsalgia following oblique osteotomy. 1732 6

Plantar interdigital neuroma, also called Morton neuroma, neuralgia, or metatarsalgia, is a perineural fibrosis that induces severe intermittent pain and paresthesia, most frequently between the third and fourth metatarsal heads. This compression syndrome or entrapment neuropathy involves one branch of the common plantar digital nerves. Diagnosis is based essentially on clinical examination. Imaging techniques may be useful in the diagnosis of atypical cases and postoperative recurrences. In most case, conservative treatment (such as orthotic shoes or devices or injections) is successful. When they do not succeed, surgery (neurolysis, neurectomy) may be considered.
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PMID:[Thomas George Morton metatarsalgia]. 1731 86

We report the case of a healthy 36 year old man who suffered from foot pain lasting for weeks, without having a specific medical history relating to it. The clinical evaluation was interpreted as a transfer metatarsalgia caused by a splayfoot. The radiographs revealed no pathology except the splayfoot deformity. Due to persistent pain and swelling of the entire forefoot, after two weeks of conventional treatment, magnet resonance images (MRI) and a blood sample were taken. The laboratory investigation showed raised levels of white blood cell count and C-reactive protein. The MRI showed up oedema in the metatarsal heads II-IV, as well as soft tissue swelling of the forefoot without any signs of decomposition.Because of this atypical inflammation of the forefoot a laboratory investigation to check for rheumatology disease was done and revealed borrelia burgdorferi infection. On the basis of these findings, antibiotic treatment was started and maintained over three weeks. The symptoms disappeared after 2 weeks, and the patient was able to resume his sports activities.
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PMID:Oedema of the metatarsal heads II-IV and forefoot pain as an unusual manifestation of Lyme disease: a case report. 1762 Jan 25

This study evaluates the outcome of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint (MTPJ) combined with multiple Weil's metatarsal osteotomies (WMO) to the lesser rays. A retrospective study on 17 consecutive patients (26 feet) was performed with subjective, clinical, and radiological analysis. At an average follow-up of 26.2 months, patients rated the result in 88% of cases as excellent or good with 76% improvement in pain, 74% improvement in function, and 70% improvement in footwear. This corresponded with a high mean modified AOFAS score of 72/100 (34 to 90). First MTPJ arthrodesis union rate was 92%. Fourteen percent of lesser toes were aligned preoperatively compared to 86% at latest review. There was a 12% rate of recurrent metatarsalgia and or callosities. This combined procedure provides stabilization of the first ray, offloading the lesser metatarsals and preventing early recurrence of deformity. Preserving the lesser metatarsal head further widens the surgical options if revisional surgery is necessary in the future. ACFAS Level of Clinical Evidence: 4.
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PMID:Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil's metatarsal osteotomies of the lesser rays. 1831 14

Various disorders cause pain in the forefoot. Factors contributing to the development of metatarsalgia include: biomechanical alignment, foot biomechanics, anatomical structure of the foot and leg, physical activity, and pathological disease states. The foot functions to balance and support forward locomotion by acting as a mobile adaptor to the ground and as a rigid lever during propulsion at the early and late phases of stance. Forefoot pathomechanics results from an overload of the anterior support or from an irregular distribution of the metatarsal weightbearing load. Orthotic therapy may be provided with insoles made from flexible, semiflexible, or rigid materials. The orthotic should be individualized in each patient's case. The purpose of treatment is to increase weightbearing tolerance by balancing the metatarsal load, assisting proper foot biomechanics, and cushioning or protecting the metatarsal heads. J Orthop Sports Phys Ther 1985;6(6):324-333.
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PMID:Management of metatarsalgia with foot orthotics. 1880 97

Malunion of a first metatarsal osteotomy or fracture can result in dorsal angulation of the distal fragment and shortening of the metatarsal, among other deformities. Dorsal malunion can be caused by improper orientation of the osteotomy, poor intraoperative fixation, or loss of fixation post-operatively due to premature weight bearing or catastrophic failure. There is little in the literature on the rate and incidence of malunion following first metatarsal fractures treated either operatively or nonoperatively. However, treatment options would be similar as for malunion following an osteotomy. The treatment of malunions depends on how symptomatic the patient is, including pain, difficulty with ambulation, and whether they complain of transfer metatarsalgia.
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PMID:First metatarsal malunion. 1923 94

Brachymetatarsia of the first metatarsal is an uncommon condition, but one that is amenable to treatment by lengthening via distraction osteogenesis, a process that employs 2 groups of pins of an appropriate external fixator inserted in the metatarsal to apply gradual distraction across an intervening osteotomy. We present the case of a female, aged 13 years, who presented with congenital bilateral first brachymetatarsia and left foot pain due to transfer metatarsalgia. The short and plantarflexed first ray could not accommodate both groups of fixator pins, even with the fixator set at its shortest length. An alternative strategy was devised that reduced the degree of plantarflexion using a tarsometatarsal arthrodesis, which effected subsequent lengthening through the healing fusion site. Lengthening commenced after 10 days and continued over a period of 52 days, at a rate of 0.5 mm to 1.0 mm per day. Consolidation occurred at 20 weeks with a final increase in length of 25 mm. The patient returned to vigorous sporting activity 1 year after removal of the fixator. To our knowledge, this is the first account of a metatarsal-lengthening arthrodesis at the tarsometatarsal level.
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PMID:Lengthening of the first metatarsal through an arthrodesis site for treatment of brachymetatarsia: a case report. 1923 67

Morton's neuroma is a common cause of metatarsalgia caused by intermetarsal digital nerve thickening. This study reviews the pathology, presentation, symptoms and signs, and patient satisfaction with surgical treatment. Seventy-eight patients (82 feet) were treated for Morton's metatarsalgia by excision of the interdigital nerve. The patients were followed-up for a mean of 4.6 years (range 0.8-8.1 years) and scored using the Foot Functional Index and the American Orthopedic Foot Ankle Society scoring system. In 74 patients the Foot Functional Index was more than 85 (maximum score 100). Seventy-one patients scored more than 90 on the American Orthopedic Foot Ankle Society scoring system with two patients scoring 100 (maximum score). Postoperatively, 82% reported excellent or good results, 10% had a fair result with restriction of activities or pain and 8% had no improvement at all after surgery while 71% had restrictions with footwear.
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PMID:The outcome of Morton's neurectomy in the treatment of metatarsalgia. 1948 37


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