Search

Background: Hallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery., Methods: A retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients' preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered., Results: Median PCS significantly improved from 49 to 53 (p < 0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively., Conclusion: Three groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health., Level of Evidence: III., (Copyright © 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: Morton's neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to describe a technique of Morton's neuroma excision by a minimally invasive commissural approach and evaluate the long-term outcome and complications., Methods: A retrospective study of 108 patients with Morton's neuroma treated surgically with a commissural approach between September 1990 and December 2010 was performed. The surgical technique is described. Clinical outcomes and complications were evaluated. The average follow-up was 121 months. Eleven patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas were at the third space and 43.2% at the second space. Six patients presented 2 neuromas in the same foot, and 9 patients had bilateral neuroma., Results: The visual analog scale (VAS) average pain score was 5.4 points preoperatively and 0.2 points at the final follow-up. The author found a significant difference between the VAS scores preoperatively and postoperatively ( P < .01). Excellent and good satisfaction outcomes were achieved in 93.6%. The postoperative complication incidence was 3%., Conclusion: The author believes a minimally invasive commissural approach has advantages over a dorsal or plantar incision. It is a simple and reproducible technique, with satisfactory outcomes, low complication rates, and a quick return to usual activities., Level of Evidence: Level IV, retrospective case series.

Although many treatment modalities are available for Morton's neuroma, the injection of the neuroma with alcohol has gained popularity. However, recently, some investigators have observed a progressive deterioration in pain scores for patients initially pain free after the treatment. The purpose of the present retrospective comparative study was to determine whether mechanical metatarsalgia is related to symptom recurrence. We included 104 consecutive cases of ultrasound-guided alcohol injection for Morton's neuroma in 92 patients. Of these 104 cases, 51 were in group A (49%; Morton's neuroma) and 53 in group B (51%; Morton's neuroma associated with mechanical metatarsalgia). We evaluated each patient using a visual analog scale and American Orthopaedic Foot and Ankle Society forefoot scale, and Johnson satisfaction scale, with a mean follow-up period of 24 (range 12 to 39) months. Concomitant functional and mechanical disorders have been identified and treated with orthopedic inserts. The present study compared the clinical results and recurrence of symptoms in patients with isolated Morton's disease or Morton's disease associated with mechanical metatarsalgia. Of the 104 cases, the patients for 93 cases (89%) were completely satisfied or satisfied with minor reservations. No major complications developed. Symptoms recurred in 6 patients (6%), in whom neuroma was associated with mechanical disorders (p = .0269). Ultrasound-guided alcohol injection of Morton's neuroma is a relatively safe and well-tolerated treatment. Symptom recurrence is often associated with mechanical metatarsalgia. The treatment of the concomitant anatomical and functional disorders that target the genesis of the neuroma has an important role in the prevention of recurrence of this pathology., (Copyright © 2018 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Two concepts have been proposed to explain the etiology of metatarsalgia in hallux valgus patients: First, as the magnitude of hallux valgus increases, there is a mechanical overload of the lesser metatarsals. Second, increased relative lesser metatarsal length is a factor in the development of metatarsalgia. However, there is no current evidence that these structural factors lead to primary metatarsalgia. The purpose of the study was to evaluate the factors associated with metatarsalgia in hallux valgus patients., Methods: A cross-sectional study of 121 consecutive adult patients with non-arthritic hallux valgus was carried out. Binary logistic regression was performed to identify the effect of the clinical and demographic factors on the occurrence of metatarsalgia. One hundred twenty-one patients (184 feet) with hallux valgus were analyzed. The median weight was 65 kg (interquartile range 58-72)., Results: Metatarsalgia was present in 84 (45.6%) feet. The binary logistic regression showed that lesser toe deformity (OR 2.6, 95% CI 0.2-0.5), gastrocnemius shortening (OR 5.8, 95% CI 2.8-12.3), metatarsal index (OR 0.3, 95% CI 0.2-0.5), and weight (OR 2.5, 95% CI 1.2-5.3) were significantly associated., Conclusion: Metatarsalgia occurs in almost half of hallux valgus patients. It has a multifactorial etiology. Our findings contradict the common theory that both the magnitude of hallux valgus deformity and an increased length of the lesser metatarsals, by themselves, lead to primary metatarsalgia. Metatarsalgia was associated with Achilles shortening, excessive weight, and associated lesser toe deformity. These factors should be addressed in order to treat this disorder adequately., Level of Evidence: Level III, comparative series., (© The Author(s) 2015.)

Objective: To study changes in the radiographic appearance during weight-bearing and non-weigh-bearing in hallux valgus, and to analyse the correlation between the elasticity of plantar soft tissue of hallux valgus and the pain under the metatarsal head., Methods: From May 2012 to October 2012, 240 feet of 120 patients with hallux valgus were enrolled in the study. The degrees of the pian under the metatarsal head of all the patients were observed. AP and lateral X-ray films of feet were taken on the condition of weight-bearing and non-weight-bearing. So the hallux valgus angle (HVA), the inter-metatarsal angle between the first and second metatarsals (IM1-2), the inter-metatarsal angle between the first and fifth metatarsals (IM1-5), top angle of the medial longitudinal arch (TAOTMLA),and anterior angle of the medial longitudinal arch (AAOTMLA) were measured on the X-ray films. The differences of HVA, IM1-2, IM1-5, TAOTMLA and AAOTMLA between two groups were compared, and the correlation between the changes of IM1-2, IM 1-5, TAOTMLA, AAOTMLA and the degree of the pain under the metatarsal head were analysed., Results: One hundred and forty-eight feet had the pain under the metatarsal head. The IM1-2, IM1-5 and TAOTMLA increased on weight-bearing position compared with those on non-weight-bearing position, but the HVA and AAOTMLA decreased on weight-bearing position compared with those on non-weight-bearing position. There was a moderate relationship between the changes of IM 1-2,IM1-5 and the degree of the hallux valgus deformity, as well as the relationship between the different of IM1-5 and the degree of the pian under the metatarsal head., Conclusion: The degree of the collapse of the arch of foot with hallux valgus becomes serious with its deformity increasing. The pain under the metatarsal head of hallux valgus increases with the increased changes of IM 1-2,IM 1-5 and TAOTMLA. Analysis of the X-ray observation indexes of hallux valgus on weight-bearing position and non-weight-bearing position has important significance in evaluating the degree of the collapse of the arch of foot with hallux valgus,preventing and curing the the pain under the metatarsal head.

Introduction: Metatarsalgia is the main symptom of a group of frequent ailments characterised by pain in the balls of the feet. Clinical knowledge and the availability of efficient complementary examinations are useful tools for the neurologist., Aim: To describe the range of processes related with metatarsalgia and a basic diagnostic schema that allows the aetiology to be differentiated., Development: We perform an elementary review of the neurological anatomy of the foot and outline the different neuropathies affecting the region, as well as the extra neurological processes that could call for a differential diagnosis., Conclusions: Familiarity with the pathologies responsible for metatarsalgias, whether they are neurological or not, is an enriching element for the diagnosis and management of these patients, as well as for greater efficiency in the referral among the medical professionals involved.

We present a retrospective study of 25 feet operated for an overriding second toe deformity, whether or not associated with hallux valgus deformity and metatarsalgia. The surgical technique of a medial sliding and decompressive Weil osteotomy is described. All patients, operated between January 2002 and December 2007 for this condition in our institution, were reviewed clinically and radiologically. The mean AOFAS score improved with 47.6 points from 45.9 to 93.5. The theoretical advantages of such a translation Weil osteotomy are discussed trying to clarify the previously described pathologic anatomy of this condition., (Copyright © 2009 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: Metatarsalgia with plantar hyperkeratosis can be a difficult problem to treat. Many different techniques have been reported with the Weil osteotomy very popular currently. Despite good results complications include metatarsophalangeal stiffness, hyperextension of the toe, prehensile deficit and a reduction in strength. We evaluated our results with a distal diaphyseal osteotomy., Materials and Methods: From 1999 to 2005, we performed 66 distal midshaft subtraction osteotomies in 62 patients suffering from metatarsal overload without metatarsophalangeal subluxation. Fixation was obtained with an absorbable pin. Some patients underwent simultaneous corrective surgery for hallux valgus, hallux rigidus or lesser toe deformities. There was an average of 18 months followup., Results: The mean preoperative Maryland score was 52; the mean postoperative score was 86. Seventy-two percent of the patients were very satisfied and 28% felt their condition improved with only occasional pain (VAS 2 to 4). The only complications reported was a loss of correction due to breakage of the pins in three patients (two sustained trauma and the third began walking prematurely without a postoperative shoe)., Conclusion: The good clinical results obtained and the low incidence of complications have encouraged us to use this technique to treat symptomatic metatarsal overload. Surgical accuracy, adherence to the postoperative regimen and, where necessary, adequate correction of the first ray were important factors for success.

This review focuses on many of the foot and ankle injuries commonly seen among dancers. These unique athletes place extreme demands on their musculoskeletal system and thereby face a variety of acute and overuse injuries. Conservative treatment is successful in the majority of cases, but these patients often continue to dance while healing--commonly prolonging and at times complicating treatment. When surgery is being contemplated, the dancer's performance level and expectations about returning to dance after surgery should be thoroughly explored. Foot and ankle surgeries that routinely yield good to excellent results in the general population can prematurely end a dancer's otherwise promising career. The physician must consider all these factors when designing an appropriate treatment plan for a dancer.