A review is presented of 508 feet in 310 patients after telescoping osteotomy of the lesser metatarsals for metatarsalgia. The patients were predominantly female (80%), with a mean age of 55 years; the range of follow-up was 1 to 12 years. In 22% of the patients the metatarsalgia was associated with rheumatoid arthritis. Improvements in assessment and modifications in technique are reported and the management of complications is discussed. The results show that telescoping osteotomy for established cases of pressure metatarsalgia is a simple and reliable operation. Permanent relief of symptoms can be expected in over 80% of patients

Introduction and purpose: Many techniques for the treatment of metatarsalgia have been described. Weil’s osteotomy causes loss of movement of the metatarsophalangeal (MTP) joint. Some authors associate this deficiency with a hypertrophic soft tissue scar on the dorsal part of the MTP joint. The purpose of this study is to assess the results of distal osteotomy of the small metatarsals carried out by means of a mini-invasive (MIS) technique. Materials and methods: We retrospectively reviewed 43 feet, 111 osteotomies performed between 2002 and 2006. The mean age of the patients was 51.8 years. In 45.45% of cases there were associated hallux pathological conditions and in 57.5% there were alterations of the smaller toes. Patients underwent clinical and functional assessment. Radiologically it was possible to determine the metatarsal formula, the rate of consolidation and metatarsal shortening. Results: The follow-up period was 15 months. From the functional and cosmetic point of view 97% of the patients considered their results were excellent or good. Radiologically there was an average shortening of 2.88 mm; in 20% of cases there was a change to a more physiological metatarsal formula and union was achieved in all cases without significant delays. Complications seen: one case of cellulitis and 3 transfer metatarsalgias. Conclusions: MIS seems an appropriate surgical technique for the treatment of metatarsalgias of the smaller toes associated or not with forefoot surgery. Good clinical and cosmetic outcomes are seen in more than 95% of cases

Introduction Surgical treatment of metatarsalgia remains controversial, with many different techniques described. Recently the Weil osteotomy is gaining in popularity because of its relatively simple technique and excellent union rates, however, it is well known that the procedure does lead to stiffness in the metatarsophalangeal (MTP) joint with a reduction in plantarflexion. The aim of this study was to evaluate the outcome of the Weil osteotomy from a radiological and patient-based perspective. Method This was a retrospective review of 42 patients (110 Weil osteotomies), with mean follow up of 24.8 months (range 6–48). Clinical examination and X-ray assessment were performed at follow-up, along with completion of patient questionnaires, American Orthopaedic Foot and Ankle Society (AOFAS) Score and Lesser Metatarsal Scores (LMTS). Additional parameters including arc of motion of each metatarsal, metatarsal shortening, non-union, redislocation and requirement for further surgery were also recorded. Results Results showed that the average arc of motion for the second metatarsal was 61.1 degrees, the third metatarsal 59.6 degrees, and the fourth metatarsal 69.8 degrees. In all cases there was a significant reduction in plantarflexion at the MTP joint, with the average combined plantar flexion of less than 5 degrees. The average shortening was 7.2 mm, and there were no cases of redislocation or non-union. Analysis of the scoring systems showed that with AOFAS there were 88% excellent/ good results and with LMTS there were 83% excellent/ good results. No patients had residual metatarsalgia and plantar callosities disappeared in almost all patients, with 91% of patients reporting excellent/good satisfaction. Conclusion Formal scoring systems and patient satisfaction scores showed that dorsiflexion contractures post-operatively were not of concern to the patients. The study suggests that the Weil osteotomy remains a safe, reliable and predictable operation with excellent results, and may be of value in the treatment of resistant metatarsalgia

Aim:To assess the short-term results of a series of Weil metatarsal osteotomies. Material and Methods:31 Weil procedures (26 patients) performed to treat central metatarsalgias are analyzed. The series included oste-otomies from one to four metatarsals in all cases (55 osteotomies) with 24–48 follow-up. There were 16 meta-tarsophalangeal (MTP) dislocations. Results were assess according to AOFAS score. Results: Bone healing was obtained in all cases (4–8 weeks). There were no delayed unions or malunions in this series. The clinical results were very good in 10 feet, good in 14 feet, fair in 5 feet and poor in 2 feet. The mean preoperative AOFAS score was 33 and improved to 86 postoperatively (p< 0.001). Mobility of the MTP was reduced frequently (severe in 6 feet). Mild recurrent metatarsalgia was found in 2 feet, moderate in 4, and severe in 2. A complete dissa-pearance of the callus was found in 16 feet. The average metatarsal shortening was 5.6 mm. To date, recurrent dislocation of the MTP was found in 2 feet. Conclusions: Weil osteotomy allows us to obtain good results in median metatarsalgias and in cases with MTP dislocations, reducing the length of the central metatarsals. Mobility of the MTP is also frequently reduced

Morton’s Metatarsalgia is a painful condition and can often be debilitating. The value of surgical exicion has been doubted due to low success rate of surgical intervention. Objective: The purpose of this study is to examine the variation in the management steps of Morton’s Metatarsalgia. Methods: Several Surgeons from different European countries answered a questionnaire in regard to their routine management of a typical Morton’s Neuroma patient. Results: 25 surgeons (100%) stated they would routinely elicit intermetatarsal tenderness in comparison to 14(56%) and 10 (40%) surgeons who would routinely elicit Intermetatrsal tenderness and Mulder’s click respectively. The majority of them (84%) will routinely request plain foot radiograph, while 7 surgeons(28%) uses ultrasound routinely. Coservative management is initiated by 16 surgeons(64%). Local injection was first line of treatment among 13 surgeons (56%). Surgical treatment is favoured by 10 surgeons(40%), while only one surgeon (4 %) would use ultrasound guided injection routinely. The popular surgical approach is dorsal incision (75%). If surgical option was chosen then neurectomy is attempted by 17 (68%) surgeons. Conclusion: Considerable variation exists among continental surgeons in their initial management of a typical Morton’s Neuroma patient. This is probably due to lack of understanding of the true aetiology of the Morton’s “Neuroma”

Introduction Plantar foot pressure measurements using pressure distribution instruments is a standard tool for diagnostic and therapeutic interventions. Foot pressure studies have measured pressure distributions in patients with various conditions such as rheumatoid arthritis, diabetes and obesity . Pressure studies in metatarsalgia and Hallux rigidus, to our knowledge, has not been reported previously. Our aim was to measure plantar foot pressures in normal individuals and to compare them with variations in patients with metatarsalgia and Hallux rigidus. This data may enable us to identify areas of abnormal pressure distributions and thus plan foot-orthosis or surgical intervention. Materials and Methods This was a case control study. We measured the plantar foot pressures in different parts of the foot in normal subjects of various ages and then compared this with foot pressures of patients with metatarsalgia and hallux rigidus. For measurement and statistical analysis, the plantar contact of the foot was divided into six anatomical divisions. The foot pressures were measured under the hallux, head of first metatarsal, over heads of second, third and fourth metatarsals, the fifth metatarsal, midfoot and hindfoot. This was measured using the FSCAN insole pedobarograph system (Tekscan, Inc, Boston, MA). Results The foot pressures were measured in Kilopascals(Kpa). Independent T-tests was used to compare mean pressure distributions in the six anatomical divisions. Comparing normal with metatarsalgia, the mean pressures through the 5th metatarsal head 217(t=−2.32,p< 0.05) and midfoot 94(t=−3.17, p< 0.05), were significantly higher when compared to pressures in normal subjects. In patients with hallux rigidus, the mean pressures through the hallux 314 (t=−3.62, p< 0.01) and mid-foot 140 (t=-5.11, p< 0.01), were significantly higher, as compared to pressures in normal subjects. Discussion Metatarsalgia is a condition that presents with pain under the region of the 2nd to 4th metatarsal heads. Hence, the normal response of the body would be to avoid putting increased pressure through this region, thus causing increased pressures to be transmitted through other parts of the foot. The foot pressures through the hallux and midfoot were higher in patients with hallux rigidus (compared to normal). This results in pressure imbalances and thus may contribute to pain, deformity and abnormal gait. Our study, confirms this, the mean plantar foot pressures were higher under the 5th metatarsal head and the midsole as compared to normal subjects. This could be explained by the tendency to walk on the outer aspect of the sole to avoid the painful area. Thus, any foot orthosis or surgery should aim to redistribute these forces. Conclusion We have demonstrated increased pressures transmitted through the outer aspect of the sole of the foot, in patients suffering from metatarsalgia. The pressures through the Hallux and midfoot were higher in oatients with hallux rigidus. This information can be used further to plan any foot-orthosis or surgery to distribute pressures more evenly across the sole of the foot

Purpose of the study: Hallux valgus is often associated with metatarsalgia due to insufficiency of the first ray. The purpose of this prospective study was to learn whether osteotomy of the first metatarsal can correct both conditions. Material and methods: This series included 35 women and 2 men, mean age 55 years. Metatarsalgia predominated in M2 in these patients with a round forefoot. Pain was a constant sign. Thirty-six patients wore special shoes for comfort with or without an orthesis. The mean preoperative metatarsal varus, measured radiographically was 16°. Scarf osteotomy used a horizontal cut at of the first metatarsal forming a 45° angle with the plantar aspect. Patients were reviewed at three years with a computed tomography of the forefoot. The Kita-oka score was determined. Results: Thirty-four feet were pain-free at last follow-up. The frontal scan of the forefoot showed the shaft of the first metatarsal had been lowered 2 mm on average. According to the Kitaoka score, outcome was good or very good for 31 feet, fair for 5 and poor for 5. There was a significant correlation between lowering of the first metatarsal and persistent metatarsalgia. Discussion: Barouk suggested the Scarf technique does not enable sufficient lowering of the first row to correct for around forefoot. The CT scan however showed the metatarsal was lowered 2 mm, which would appear to be sufficient to correct for the insufficient weight-bearing. The result of this series would appear to show that outcome is better then hallux valgus cure plus Weil oseotomy if there is no hallomegaly. Conclusion: This series shows the usefulness of lowering the first metatarsal for the treatment of hallux valgus with metatarsalgia without hallomegaly

1. A series of cases of Morton's metatarsalgia is reported in which twenty-seven selected patients have had thirty-five operations on the sole of the foot. 2. At operation, degeneration of the plantar digital artery to the cleft between the third and fourth toes has now been found to precede the fibrous thickening of the nerve described by Betts in 1940. Similar changes rarely occur in neighbouring clefts. 3. Local resection of the nerve almost always gives complete relief from pain, and the plantar scar gives rise to no trouble. 4. Histological findings show that the nerve lesion is ischaemic in nature. 5. Acute pain arising as a new event in cases of the deformity of "anterior flat foot" may prove to be due to this condition. 6. Morton's metatarsalgia is a distinct clinical and pathological entity which can best be described as a plantar digital neuritis

Objective: Our aim was the record variation in foot pressures through parts of the foot, in normal subjects and compare with foot pressure distribution in patients with conditions of the foot such as symptomatic hallux rigidus and metatarsalgia. Methodology: This was an observational study. We assessed the foot pressure distributions in 30 normal subjects, using the foot pressure pedobarograph system. The foot pressures were measured through the Hallux, 1st Metatarsal head, 2,3,4th metatarsal heads, 5 metatarsal head, midfoot and hindfoot. Foot pressure in patients with hallux rigidus and metatarsalgia were compared with the pressures in normal subjects, using statistical analysis. Results: The foot pressures were measured in Kilopascals(Kpa). Independent T test was used to compare pressures. In patients with hallux rigidus, the mean pressures through the hallux 314 (t= −3.62, p< 0.01) and midfoot 140 (t=−5.11, p< 0.01), were significantly higher, as compared to pressures in normal subjects. In patients with metatarsalgia, the mean pressures through the 5th metatarsal head 217 (t=−2.32, p< 0.05) and midfoot 94 (t=−3.17, p< 0.01), was significantly higher when compared to pressures in normal subjects. Conclusion: The foot pressures through the hallux and midfoot were higher in patients with hallux rigidus (compared to normal). Thus any foot orthosis or surgery should aim to relieve the pressure through these regions. Whereas, foot pressures through 5th metatarsal head and midfoot were higher in patients with metatarsalgia (compared to normal). This reflects the adaptation the foot develops to avoid the painful region and thus any orthosis or surgery should try to spread the foot pressures evenly across the foot

In this article, a definition of metatarsalgia is followed by an analysis of factors involved: biomechanical alterations, diseases of the forefoot and general diseases with an impact on the forefoot. This is followed by a brief recall of the historical background and a description of the pathological anatomy and determining anatomic and biomechanical factors. The frequency, symptoms and differential diagnosis are discussed together with the clinical, radiological, ultrasonographic and magnetic resonance imaging findings. Conservative and surgical treatments are proposed together with a detailed description of the procedures and the supramalleolar anesthesia used in our department

In an attempt to improve the accuracy of diagnosis, 16 patients suffering from Morton's metatarsalgia were investigated clinically and electrophysiologically. The histological findings were related to these observations. The precise aetiology of Morton's metatarsalgia remains obscure, but the findings are compatible with an entrapment syndrome. Nerve conduction studies have a place in the investigation of patients with atypical presentation of pain in the foot. Further refinement of the electrophysiological technique should be possible

Aim: Our aim was to measure plantar foot pressures in normal individuals and to compare them with variations in patients with metatarsalgia. Methodology: We measured the plantar foot pressures in different parts of the foot in normal subjects of various ages and then compared this with foot pressures of patients with metatarsalgia. For measurement and statistical analysis, the plantar contact of the foot was divided into six anatomical divisions. The foot pressures were measured under the hallux, head of first metatarsal, over heads of second, third and fourth metatarsals, the fifth metatarsal, midfoot and hindfoot. This was measured using the FSCAN insole pedobarograph system (Tekscan, Inc, Boston, MA). The foot pressures were measured in Kilopascals(Kpa). Independent T-tests was used to compare mean pressure distributions in the six anatomical divisions. We found the mean pressures through the 5th metatarsal head – 217(t=−2.32,p< 0.05) and midfoot 94(t=−3.17, p< 0.05), were significantly higher when compared to pressures in normal subjects (table 1). Conclusion: We have demonstrated increased pressures transmitted through the outer aspect of the sole of the foot, in patients suffering from metatarsalgia. This can be used further to plan any foot- orthosis or surgery to distribute pressures more evenly across the sole of the foot

Purpose: Our aim was to measure plantar foot pressures in normal individuals and to compare them with variations in patients with metatarsalgia. Methods: This was a case control study. We measured the plantar foot pressures in different parts of the foot in normal subjects of various ages and then compared this with foot pressures of patients with metatarsalgia. For measurement and statistical analysis, the plantar contact of the foot was divided into six anatomical divisions. The foot pressures were measured under the hallux, head of first metatarsal, over heads of second, third and fourth metatarsals, the fifth metatarsal, midfoot and hindfoot. This was measured using the FSCAN insole pedobarograph system (Tekscan, Inc, Boston, MA. Results: The foot pressures were measured in Kilopascals(Kpa). Independent T-tests was used to compare mean pressure distributions in the six anatomical divisions. We found the mean pressures through the 5th metatarsal head – 217(t=−2.32,p< 0.05) and midfoot 94(t=−3.17, p< 0.05), were significantly higher when compared to pressures in normal subjects ( table 1). Conclusions: We have demonstrated increased pressures transmitted through the outer aspect of the sole of the foot, in patients suffering from metatarsalgia. This can be used further to plan any foot- orthosis or surgery to distribute pressures more evenly across the sole of the foot

Aims: The aim of this study is to determine the forefoot pressure distribution in normal subjects and in patients with metatarsalgia and to present an application of the electronic pedobarography in the design of orthoses. Methods: A control group of 358 normal subjects and a pathological group of 100 patients with metatarsalgia were studied with a wireless portable system for plantar pressure dynamic measurement. Each patient of the pathological group had their metatarsal head loads reequil-ibrated according to the loads obtained in the control group, by means of a set of orthopaedic sights located below the metatarsal heads which supported the lowest load, increasing its pressure support and lightening thus the overloaded metatarsal heads. The aim was to obtain a balance between the þve metatarsal heads similar to the control group. This balance was assessed with the electronic portable system. Results: The pathological group had a signiþcantly higher pressure under the third metatarsal head. The third metatarsal head pressure was significantly decreased, and the þrst, fourth and þfth metatarsal head pressures were signiþcantly increased by means of orthopaedics sights. Conclusions: The forefoot pressure distribution in patients with metatarsalgia differs from normal subjects. Redistribution of metatarsal head loads assessed by means of a electronic system can contribute to the design of orthoses to treat metatarsalgia

Introduction: Our aim is to analyse the results for the treatment of metatarsalgia comparing, in a retrospective way, Opened surgery (standard Weil osteotomy, group O) and Percutaneous surgery (osteotomies of the metatarsal neck with no internal fixation, group P). Material and method: We review 30 cases in each group according to demographic data, surgery procedure, complications, time to healing and metatarsal curve. An interview with every patient was performed in order to obtain the AOFAS scale results, time to wear comfort shoes, return to daily activities, analgesia needed, visual analogic scale and global satisfaction. Results: Group O: 29 women, 1 man. Mean age of 61 years. Mean number of metatarsal osteotomies per patient 2,21. 27 cases associated to hallux valgus surgery. Group P: 25 women, 5 men. Mean age of 51,5 years. Mean number of metatarsal osteotomies per patient 2,56. 23 cases associated to hallux valgus surgery. Groups O/P: time to bone healing 4,21/17,5 weeks; AOFAS scale 80,56/88,32 points; VAS 3,0/2,04 points; metatarsal curve in milimeters −0,75/−4,67/−6,67/−12,2 vs +0,72/−5.72/−5,52/−11,52; time to wear comfort shoes 18/11 weeks; return to daily activities 12,4/10,5 weeks; analgesia needed for 9/5 weeks. Global satisfaction was: group O 44% excellent, 24% good, 20% fair and 12% bad; group P 54% excellent, 25% good, 7% fair and 14% bad. Complications: 44.8% in group O (mainly minor problems of wound) and 23,3% in group P (mainly non-unions). Conclusions: We would like to remark the differences with statistical significance: mean age is lower in group P, time to bone healing is longer in group P but time to wear comfort shoes is shorter in these patients. There are no statistical differences for metatarsal curve. According to AOFAS scale there are no differences except for the alineation items (better in group O). No differences neither for global satisfaction of the patients nor for visual analogic scale. Complications are predictable for each technique: skin problems in group O and union problems in group P. We conclude that both procedures are acceptable in the treatment of metatarsalgia with similar objective and subjective results

An oblique osteotomy in the distal half of the metatarsal shaft is described for the treatment of metatarsalgia due to prolapse of one or more of the middle three metatarsal heads. Thirty-eight patients who have had this operation have been followed up for a period of from two to five years. The operation is simple, recovery is rapid and symptoms have been well relieved

1. Arthrodesis of the first metatarso-phalangeal joint combined with excision of those lesser metatarsal heads with fixed subluxation and painful callosities is an excellent treatment for painful hallux valgus with metatarsalgia. 2. A series of thirty feet in twenty-five patients is reported in which this combined operation was done

Introduction:. The surgical treatment of intractable metatarsalgia has been traditionally been an intra-articular Weil's type of metatarsal osteotomy. In such cases, we adopted the option of performing a minimally invasive distal metaphyseal metatarsal ostetomy (DMMO) to decompress the affected ray. The meta-tarsophalangeal joint was not jeopardised. We present our outcomes of Minimally Invasive Surgery for metatarsalgia performed at our teaching hospital. Material and methods:. This is a multi-surgeon consecutive series of all the thirty patients who underwent DMMO. The sex ratio was M: F- 13:17. Average age of patients was 60 yrs. More than one metatarsal osteotomy was done in all cases. The aim was to try and decompress the affected rays but at the same time, restore the metatarsal parabola. It was performed under image-intensifier guidance, using burrs inserted via stab incisions. Patients were encouraged to walk on operated foot straight after the operation; the rationale being that the metatarsal length sets automatically upon weight bearing on the foot. Outcome was measured with Manchester-Oxford Foot Questionnaire's (MOXFQ's) and visual analogue pain score (VAS). Minimum follow up was for six months. Results:. The average MOXFQ score was 26. Average improvement in the visual analogue pain score was 3.5. VAS deteriorated in three patients' whose pain got worse after surgery. Among these three, two had a further procedure on their toes. All of the patients experience prolonged forefoot swelling for at least 3 months. Discussion:. The most common complication after intra-articular ostetomy of the metatarsal head is stiffness of the metatarsophalangeal joint. We believe that using minimally invasive surgery with an extra-articular osteotomy, reduces the soft tissue injury to the joint, and therefore the amount of post-operative stiffness. In our cohort of patients, DMMO is associated with good patient satisfaction and low complication rates in the vast majority of cases

1. A clinical test of diagnostic significance in Morton's metatarsalgia is described. 2. Findings at operation in twelve cases are recorded. 3. The causation of the digital neuroma is discussed