Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus

Slullitel, Gastón; López, Valeria; Calvi, Juan Pablo; Seletti, Maximiliano; Bartolucci, Carla; Pinton, Gustavo

doi:10.1177/1071100715615323

Cited by 27 publications

(9 citation statements)

References 39 publications

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“…However, there is growing evidence that the deformity of the first ray is responsible for changing the weight-bearing dynamics of the foot, thereby causing lesser toe deformities and metatarsalgia. 8 Deformities of the first ray with subluxation of the sesamoids may eventually lead to arthritis, pain, and gait alterations. Many surgical procedures have been described for addressing juvenile hallux valgus, including proximal tarsal, proximal metatarsal, distal metatarsal, and double…”

Section: Discussionmentioning

confidence: 99%

“…An additional consideration for earlier treatment is the progression of the lesser toe deformities which can contribute significantly to pain and create long-term issues for patients, despite bunion correction. 8 It is possible to correct the deformity prior to skeletal maturity with growth plate modulation, growth plate sparing osteotomies, or with distal metatarsal osteotomies, as these do not involve a growth plate.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Adolescent Bunions: Treatment Options and Technical Pearls for the Distal Percutaneous Osteotomy

Nichols¹,

Ritacco

Gdalevitch³

2021

Journal of the Pediatric Orthopaedic Society of North America

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Juvenile hallux valgus is a complex condition that is associated with multiple forefoot abnormalities and can be accompanied by a flexible flat foot. Initial treatment remains conservative with large toe box shoes, pain control, stretching, taping, or spacers. When indicated, surgical treatment is controversial because of the greater than 100 described surgical procedures and a historically high prevalence of recurrence. However, more recent reviews of surgical techniques for juvenile bunions show less recurrence than previously reported. The percutaneous distal metatarsal osteotomy is one procedure that offers many advantages to correcting adolescent hallux valgus deformities including minimal scar, immediate weight bearing, and effectiveness at correcting the deformity in a reproducible manner. The purpose of this paper is to review the management of juvenile/adolescent bunions and share technical pearls for the successful treatment with a percutaneous distal metatarsal osteotomy. Juvenile bunions are complex deformities that are not “younger” versions of adult bunions because of an increased dysplastic metatarsal articular angle. Lesser toe deformities may accompany the obvious hallux valgus deformity. Historically high rates of recurrence for surgical treatment are decreasing with improved techniques such as percutaneous distal metatarsal osteotomy.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Adolescent Bunions: Treatment Options and Technical Pearls for the Distal Percutaneous Osteotomy

Nichols¹,

Ritacco

Gdalevitch³

2021

Journal of the Pediatric Orthopaedic Society of North America

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“…First ray insufficiency is caused by inability of the first ray to accept loads during weight bearing, leading to transfer pressure to the lesser MT [8]. First ray insufficiency occurs due to several conditions, such as hallux valgus, pes planus, and hypermobility of the first metatarsophalangeal (MTP) joint [10]. The long second MT shifts loads during weight bearing from the first to the second ray [9].…”

Section: Metatarsalgiamentioning

confidence: 99%

Forefoot disorders and conservative treatment

Park

Lee

2019

Yeungnam Univ J Med

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Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

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“…Other etiologic factors include plantar hyperkeratosis, subluxation of the metatarsophalangeal (MTP) joint, deformities of the first ray, transfer metatarsalgia, inflammatory or age-related atrophy of the plantar fat pad, rheumatoid arthritis, and traumatic (eg, weight-bearing sports), neurogenic (eg, Charcot-Marie-Tooth Disease, Morton neuroma), or tumorous diseases. 5,6,40,41,44,49 Approximately 10% of the population are affected by this condition. Women are affected more often than men.…”

Section: Introductionmentioning

confidence: 99%

“…18,50 Almost half of hallux valgus patients suffer from metatarsalgia. 40 Before a treatment regimen is advocated, proper physical examination and an accurate diagnosis of underlying or concomitant diseases are essential. Conservative therapy includes physiotherapy, removal of clavus, lifestyle modification, as well as the application of orthotics and proper footwear.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes

Neunteufel¹,

Krenn

Chraim³

et al. 2021

Foot Ankle Int.

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Background: The minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) is a percutaneous operative technique with the aim to relieve the symptoms of metatarsalgia. To our knowledge, no previous research has analyzed both pre- and postoperative pedobarographic data including the changes in plantar pressure. Methods: Thirty patients (31 feet) were operated on with a DMMO and included in a prospective study. Clinical, radiologic, and pedobarographic outcomes were evaluated in comparison with the preoperative parameters. The American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS), and a visual analog scale (VAS) for pain were used in order to assess clinical parameters. Radiographs were taken to compare metatarsal lengths. The pedobarographic analysis served to determine plantar peak pressure (PPP) beneath the metatarsophalangeal (MTP) joints. Results: All scores indicated a significant mean pre- to postoperative improvement (AOFAS = 31.9 points, FAOS = 16.3%, FFI = 24.3%, VAS pain = 4.1 points, VAS general limitation = 3.3 points) ( P < .05). PPP was substantially reduced in the relevant area (M6 [plantar area beneath the second and third MTP joint] had a mean pre to post PPP = 14.15 N/cm2) and concurrently higher in the lateral and medial MTP joint areas (M5 mean pre to post = +14.37, M7 pre to post = +7.11). Our mean metatarsal shortening was 6.6 mm. However, our findings do not demonstrate a significant correlation between metatarsal length relationships and the prevalence of metatarsalgia. Conclusion: Our results demonstrate a significant improvement in clinical scores and PPP. A statistically significant relation between metatarsal length and the prevalence of metatarsalgia was not found in this prospective case series Level of Evidence: Level IV, case series.

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Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus

Abstract: Level III, comparative series.

Cited by 27 publications

References 39 publications

Adolescent Bunions: Treatment Options and Technical Pearls for the Distal Percutaneous Osteotomy

Adolescent Bunions: Treatment Options and Technical Pearls for the Distal Percutaneous Osteotomy

Forefoot disorders and conservative treatment

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes

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