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1.
Sci Rep ; 14(1): 5857, 2024 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-38467691

RESUMO

This study compared muscle strength and foot pressure among patients with metatarsalgia, patients with plantar fasciitis, and healthy controls. A total of 31 patients with foot pain (14 metatarsalgia and 17 plantar fasciitis) and 29 healthy controls participated in the study. The strengths of the plantar flexor and hip muscles were measured using isokinetic and handheld dynamometers, respectively. Foot pressure parameters, including the pressure-time integral (PTI) and foot arch index (AI), were assessed using pedobarography. Compared with the healthy control group, plantar flexor strength was significantly reduced in the affected feet of the metatarsalgia and plantar fasciitis groups (F = 0.083, all p < 0.001); however, hip strength was significantly decreased only in the affected feet of the metatarsalgia group (F = 20.900, p < 0.001). Plantar flexor (p < 0.001) and hip (p = 0.004) strength were significantly lower in the metatarsalgia group than in the plantar fasciitis group. The PTI was lower in the forefeet of the affected feet in the metatarsalgia (p < 0.001) and plantar fasciitis (p = 0.004) groups. Foot AI (p < 0.001) was significantly reduced only in the metatarsalgia group. These results suggest the need to consider the evaluation of muscle strength and foot pressure in both feet for the diagnosis and treatment of foot pain.


Assuntos
Fasciíte Plantar , Metatarsalgia , Humanos , , Metatarsalgia/terapia , Músculo Esquelético , Força Muscular
2.
Medicine (Baltimore) ; 103(3): e36912, 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38241574

RESUMO

Hallux valgus (HV) is often accompanied by metatarsalgia. This study compared the radiological and clinical outcomes of new triplanar chevron osteotomy (TCO) and chevron osteotomy (CO) in the treatment of HV, especially for patients with plantar callosities and metatarsalgia. In this retrospective analysis, 90 patients (45 patients per group) with mild to moderate HV and plantar callosities were treated with TCO and CO from July 2020 to January 2022. In both procedures, the apex was located in the center of the head of the first metatarsal bone, and the CO was oriented towards the fourth MTPJ at a 60° angle. Plantar-oblique chevron osteotomy was defined as chevron osteotomy and a 20° plantar tilt; TCO was defined as plantar-oblique chevron osteotomy-based metatarsal osteotomy with a 10° tilt towards the metatarsal head. Primary outcome measures included preoperative and postoperative hallux valgus angle, 1 to 2 intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), first metatarsal length (FML), and second metatarsal head height X-ray images; clinical measurements, including visual analogue scale and American Orthopaedic Foot & Ankle Society (AOFAS) scores; changes in callosity grade and area; and changes in the number of people with metatarsalgia. Secondary outcomes included complications, recurrence rates, and cosmetic appearance. The hallux valgus angle, IMA, and DMAA were significantly lower after surgery (P  < .001) in all patients. In the TCO group, the mean FML and second metatarsal head height increased significantly postoperatively (P < .001). The AOFAS and visual analogue scale scores improved postoperatively in both groups (P < .001). All patients experienced satisfactory pain relief and acceptable cosmesis. The plantar callosity areas were smaller postoperatively in both the TCO and CO groups, but the change in the area (Δarea) in the TCO group significantly differed from that in the CO group (P < .001). The number of postoperative patients with metatarsalgia and the plantar callosity grade were both significantly lower in the TCO group than in the CO group after osteotomy (P < .05). TCO prevents dorsal shift of the metatarsal head and preserves and even increases FML, thereby preventing future metatarsalgia in patients. Therefore, compared with CO, TCO has better orthopedic outcomes and is an effective method for treating mild to moderate HV and preventing transfer metatarsalgia.


Assuntos
Calosidades , Doenças do Pé , Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Articulação Metatarsofalângica , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Fluormetolona , Metatarsalgia/cirurgia , Osteotomia/métodos , Ossos do Metatarso/cirurgia
3.
J Foot Ankle Surg ; 63(1): 85-91, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37714290

RESUMO

The main object of this prospective cohort study was to compare surgical treatment options for primary metatarsalgia and the severe instability of lesser metatarsophalangeal joints. The outcomes of triple Weil osteotomy combined with direct plantar plate repair and triple Weil osteotomy, performed with proximal interphalangeal joint arthrodesis, are analyzed and compared. One hundred thirteen patients (117 feet) were enrolled in the study. They were split into 2 groups. In the first group, undergoing Weil osteotomy, combined with the plantar plate repair, good results, including complete pain reduction, elimination of hyperkeratosis, and American Orthopedic Foot and Ankle Society Score improvement, were achieved in 84.7% of the cases. The second group, where the combination of Weil osteotomy and proximal interphalangeal joint K-wire arthrodesis was used, demonstrated good results in 52.4% of the cases. Weil osteotomy, combined with the plantar plate repair, achieves better results in comparison to osteotomy, performed with the interphalangeal joint arthrodesis.


Assuntos
Metatarsalgia , Articulação Metatarsofalângica , Placa Plantar , Humanos , Estudos Prospectivos , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Osteotomia/métodos
4.
Orthop Traumatol Surg Res ; 110(1S): 103782, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38048905

RESUMO

Lateral metatarsal osteotomy (LMO) aims to reposition the affected metatarsals in a chosen position. The approach may be open or percutaneous. There are several types of LMO, according to displacement: shortening, raising, translation or lengthening. Preoperative planning covers type and extent of displacement, osteotomy location and type (open or percutaneous), and number of metatarsals concerned. In the 1990s, older concepts of non-fixed osteotomies gave way to preoperative planning and calculated shortening, including the development of Weil shortening osteotomy. Diaphyseal lengthening or shortening osteotomy is mainly used for brachymetatarsia. The older concept of non-fixed lateral rays made a comeback with percutaneous first-ray surgery. Distal metatarsal minimally invasive osteotomy (DMMO) is the most effective, giving rise to variants such as distal oblique metatarsal minimally invasive osteotomy (DOMMO), to meet the requirements of greater displacement, especially in shortening and translation, and to be applicable in as wide a range of cases as possible. Presently, these percutaneous techniques have not demonstrated superiority over open surgery, and entail specific complications. Even so, they are now part of the armamentarium of forefoot surgery, as their minimal invasiveness corresponds to current trends in surgery, especially in the foot. Level of evidence: V.


Assuntos
Ossos do Metatarso , Metatarsalgia , Humanos , Ossos do Metatarso/cirurgia , Metatarsalgia/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , , Osteotomia/métodos
5.
Int Orthop ; 48(1): 103-109, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37582981

RESUMO

PURPOSE: Based on the tripod concept of load distribution, our study aimed to evaluate whether a slight extension of first metatarsal (M1) that may occur after the Lapidus procedure (LP) could alter the radiographic measurements of the hindfoot and influence clinical and functional outcomes. METHODS: Twenty-five patients (27 feet) were reviewed. Hindfoot radiographic analysis was based on seven measurements. Clinical and functional outcomes were evaluated with self-reported questionnaires. Transfer metatarsalgia was also assessed. Correlation analysis was performed according to variations of the studied variables. RESULTS: The average extension of the M1 was 4.26 degrees (p < 0.001). None of the hindfoot radiographic measurements changed significantly (p = 0.13, p = 0.50, p = 0.19, p = 0.70, p = 0.11, p = 0.36, p = 0.83). Patients improved on most questionnaires (p < 0.001). None presented transfer metatarsalgia. No correlation between M1 extension and clinical and functional outcomes was found. CONCLUSION: Possibly there is a tolerance of M1 extension in which it does not alter the radiographic measurements of the hindfoot, overload the lesser metatarsals, or compromise clinical and functional outcomes.


Assuntos
Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Hallux Valgus/diagnóstico por imagem , Radiografia , Metatarsalgia/diagnóstico por imagem , Metatarsalgia/etiologia , Metatarsalgia/cirurgia
6.
Semin Musculoskelet Radiol ; 27(3): 337-350, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37230133

RESUMO

Lesser (or central) metatarsalgia is defined as pain in the forefoot under or around the lesser metatarsals and their respective metatarsophalangeal joints. Two common causes of central metatarsalgia are Morton's neuroma (MN) and plantar plate (PP) injury. Because both clinical and imaging features overlap, establishing the correct differential diagnosis may be challenging. Imaging has a pivotal role in the detection and characterization of metatarsalgia. Different radiologic modalities are available to assess the common causes of forefoot pain, so the strengths and weakness of these imaging tools should be kept in mind. It is crucial to be aware of the pitfalls that can be encountered in daily clinical practice when dealing with these disorders. This review describes two main causes of lesser metatarsalgia, MN and PP injury, and their differential diagnoses.


Assuntos
Metatarsalgia , Humanos , Diagnóstico Diferencial , Metatarsalgia/diagnóstico por imagem , Metatarsalgia/etiologia ,
7.
Foot Ankle Surg ; 29(3): 239-242, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36754688

RESUMO

BACKGROUND: Good clinical and radiological outcomes in mild-moderate hallux valgus (HV) can be achieved with Chevron osteotomy (CO) and modified-Mitchell osteotomy (MMO). The main goal of the present study was to compare the clinical and radiological outcomes after CO and MMO in HV. METHODS: The study included 45 patients, comprising 40 females with a mean follow-up of 87.5 ± 27.8 months. The outcome measurements of metatarsal length (MT1), HV angle (HVA), intermetatarsal angle (IMA), clinical outcomes, and metatarsalgia were evaluated pre- and postoperatively. RESULTS: No significant difference was determined between the MMO and CO groups in respect of metatarsalgia and AOFAS scores. The CO resulted in a significantly larger decrease in the MT1. The mean HVA and IMA correction was significantly greater after MMO than after CO. CONCLUSION: Since MMO may prevent MT1 shortening, which is a typical problem in the Mitchell osteotomy, MMO may be preferred over CO in patients with preoperative shortened first metatarsal.


Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Feminino , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Resultado do Tratamento , Osteotomia/métodos , Metatarsalgia/diagnóstico por imagem , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Estudos Retrospectivos
8.
Zhonghua Yi Xue Za Zhi ; 103(1): 25-31, 2023 Jan 07.
Artigo em Chinês | MEDLINE | ID: mdl-36594134

RESUMO

Objective: To investigate the correlation between the first tarsometatarsal joint (TMT1) sagittal mobility and hallux valgus (HV) combined with transfer metatarsalgia (TM). Methods: The weight-bearing CT (WBCT) imaging data of 111 HV patients (167 feet) who were treated at the Foot and Ankle Surgery Center, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2020 were retrospectively analyzed. The patients underwent PedCAT WBCT scans of both feet, and the hallux valgus angle (HVA), intermetatarsal angle (IMA), plantar distance (PD), medial cuneiform-first metatarsal angle (CMA) and metatarsal protrusion distance (MPD) were measured using CubeVue software. PD and CMA were signs of TMT1 instability. Visual analogue scale (VAS) and foot and ankle ability measures (FAAM) scores were obtained. The patients were divided into TM group and non-TM group according to the presence of metatarsalgia. The TM group and the non-TM group were compared in terms of HVA, IMA, PD, CMA, MPD, VAS and FAAM. Correlations between PD, CMA and HVA, IMA, VAS, FAAM were analyzed using Spearman correlation. Results: Total of 111 cases were included in this study, there were 35 males and 76 females with a mean age of (57.7±14.1) years. The average values of HVA (37.9°±8.6°), IMA (17.9°±2.6°), CMA (2.1°±0.3°) and PD [(1.8±0.4) mm] in TM group were all significantly higher than those in the non-TM group [HVA (32.5°±9.1°), IMA (15.1°±3.4°), CMA (1.7°±0.3°) and PD (1.6±0.2) mm] (All P<0.001). There was no significant difference in MPD between the two groups (P=0.580). The TM group demonstrated a higher VAS score when compared with the non-TM group (P<0.001). The FAAM score of the TM group (54.1±11.8) was significantly lower than that in the non-TM group (66.2±11.4) (P<0.001). The results of Spearman correlation analysis showed that there was no correlation between PD and HVA, IMA and VAS score. There was a negative correlation between PD, CMA and FAAM score, and the difference was statistically significant (rs=-0.637, -0.254, both P<0.001); CMA was positively correlated with HVA, IMA, and VAS score (rs=0.603, 0.971, 0.269, all P<0.001). Conclusions: WBCT is helpful for the diagnosis of TMT1 sagittal instability. The severity of TMT1 sagittal instability is positively correlated with hallux valgus and TM. The TMT1 instability may play an important role in the pathogenesis of hallux valgus.


Assuntos
Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Radiografia , Osteotomia/métodos , Ossos do Metatarso/cirurgia , Resultado do Tratamento
9.
Musculoskelet Surg ; 107(1): 123-126, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36637611

RESUMO

BACKGROUND: Plantar heloma is a keratotic disorder that can be described as a circumscribed area of thickening with a central core that may penetrate the dermis. Although often considered a minor complaint, longstanding lesions can be debilitating and severely impact on person's quality of life. We present the first retrospective case series at long-term follow-up about the use of plantar lipofilling as a treatment for metatarsalgia caused by plantar heloma. MATERIALS AND METHODS: Six patients affected by plantar heloma associated to external metatarsalgia underwent plantar lipofilling. The surgical session was performed as an outpatient procedure. Clinical evaluation was performed using the AOFAS lesser metatarsophalangeal-interphalangeal (MTP-IP) score. RESULTS: Mean AOFAS lesser MTP-IP score improved from a preoperative score of 66.6 ± 3.2 points (range 47-77 points) to a post-operative score of 92.8 ± 2.7 points (range 86-95 points); all patients were satisfied with the outcome at the final follow-up. Post-operative clinical examination at final follow-up showed an increase in thickness of the subcutaneous layer and a decrease of dermal layer thanks to the supporting and trophic action of fat cells. CONCLUSIONS: Plastic regenerative procedures applicated to a typical foot and ankle surgery field, such as metatarsal overloading, metatarsalgia and forefoot problems, should be encouraged to allow new treatment horizons.


Assuntos
Ossos do Metatarso , Metatarsalgia , Articulação Metatarsofalângica , Ortopedia , Cirurgia Plástica , Humanos , Estudos Retrospectivos , Qualidade de Vida , Osteotomia/métodos , Articulação Metatarsofalângica/cirurgia , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Metatarsalgia/diagnóstico , Ossos do Metatarso/cirurgia
11.
Zhongguo Gu Shang ; 35(12): 1121-6, 2022 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-36572425

RESUMO

OBJECTIVE: To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus. METHODS: Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed. RESULTS: Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups(P>0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups(P>0.05) before and after operation. There was no significant difference in RLFM between two groups(P>0.05), while had significant difference in RLFM between two groups at final follow-up (P<0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group (P<0.05). CONCLUSION: Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.


Assuntos
Joanete , Hallux Valgus , Hallux , Ossos do Metatarso , Metatarsalgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Hallux Valgus/cirurgia , Ossos do Metatarso/cirurgia , Estudos de Casos e Controles , Resultado do Tratamento , Osteotomia/métodos
12.
Artigo em Inglês | MEDLINE | ID: mdl-36074526

RESUMO

BACKGROUND: Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation in participants with RA experiencing forefoot pain. METHOD: A prospective, quasi-experimental, pretest-posttest trial was performed at a rheumatology outpatient clinic. Participants were supplied with a simple insole comprising a valgus pad and a plantar metatarsal pad and covered with a cushioning material. The Foot Function Index (FFI) was self-administered before and 3 months after insole use. RESULTS: Reductions in forefoot pain (from 56.78 to 42.97) and total (from 41.64 to 33.54) FFI scores were noted. Statistical significance for this reduction was achieved following the t test (P = .002 and P = .0085, respectively). However, although reductions in mean disability and activity limitation scores were recorded (from 50 to 44.85 and from 18 to 14.57, respectively), these did not reach significance (P = .151 and P = .092, respectively) Conclusions: Simple insoles have been shown to be effective in reducing total and forefoot pain FFI scores in patients with RA experiencing metatarsalgia. This treatment offers advantages because these devices can be fabricated simply and cheaply, thus initiating the patient on an effective orthosis therapy immediately in the clinic without having to wait for prolonged periods until custom orthotic devices can be supplied.


Assuntos
Artrite Reumatoide , Órtoses do Pé , Metatarsalgia , Artrite Reumatoide/complicações , Artrite Reumatoide/terapia , Humanos , Metatarsalgia/etiologia , Metatarsalgia/terapia , Aparelhos Ortopédicos , Estudos Prospectivos , Sapatos
13.
Trials ; 23(1): 690, 2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-35986383

RESUMO

BACKGROUND: Weil osteotomies are performed to surgically treat metatarsalgia, by shortening the metatarsal via either a single distal oblique cut with translation of the metatarsal head (flat-cut) or through the removal of a slice of bone (wedge-cut). The wedge-cut technique purportedly has functional and mechanical advantages over the flat-cut procedure; however, in vivo data and quality of evidence are currently lacking. This study aims to investigate whether wedge-cut Weil osteotomy compared to traditional flat-cut Weil is associated with increased pain relief and fewer complications up to 12 months postoperatively. METHODS: Patient, surgical and clinical data will be collected for 80 consecutive consenting patients electing to undergo surgical treatment of propulsive metatarsalgia in a randomised control trial, embedded within a clinical registry. The primary outcome is patient-reported pain as assessed by the Foot and Ankle Outcome Score (FAOS) - Pain subscale, and the secondary outcome is the incidence of procedure-specific complications at up to 12 months postoperatively. The groups will be randomised using a central computer-based simple randomisation system, with a 1:1 allocation without blocking and allocation concealment. A mixed-effects analysis of covariance will be used to assess the primary outcome, with confounders factored into the model. A binary logistic regression will be used to assess the secondary outcome in a multivariable model containing the same confounders. DISCUSSION: To the best of the authors' knowledge, the trial will be the first to examine the clinical efficacy of the wedge-cut Weil osteotomy compared to the flat-cut technique with a prospective, randomised control design. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620001251910. Registered on 23 November 2020.


Assuntos
Doenças do Pé , Metatarsalgia , Austrália , Humanos , Incidência , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
JBJS Case Connect ; 12(3)2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35977038

RESUMO

CASE: Three cases of atypical metatarsalgia are presented, all diagnosed with foot synovial sarcomas (SSs) at different stages of evolution, after a year of medical consultations. One case was treated with marginal excision without requiring bone excision; the second patient required amputation of the first ray; and the third patient, with advanced disease, required amputation through Chopart's joint. CONCLUSION: Metatarsalgia is a recurrent reason for consultation in orthopaedics. Even so, patients with persistent symptoms should be studied further in depth. Computed tomography or magnetic resonance imaging can detect tumor pathology, such as SS, of insidious development.


Assuntos
Metatarsalgia , Sarcoma Sinovial , Articulações Tarsianas , Amputação Cirúrgica/métodos , Pé/patologia , Humanos , Metatarsalgia/diagnóstico por imagem , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Sarcoma Sinovial/complicações , Sarcoma Sinovial/diagnóstico por imagem , Sarcoma Sinovial/cirurgia
15.
Foot Ankle Surg ; 28(8): 1433-1439, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35995690

RESUMO

BACKGROUND: The role of concomitant Weil osteotomy to address second toe metatarsalgia during hallux valgus correction is unclear. We aimed to critically analyse outcomes of an additional Weil osteotomy versus isolated Scarf osteotomy.in the management of hallux valgus and second metatarsalgia. METHODS: Patients with second toe metatarsalgia who underwent first metatarsal Scarf osteotomy for hallux valgus were enrolled retrospectively. Demographics, radiographic measurements and functional outcomes were assessed at baseline, 6-months and 2-years postoperatively. Between-group significance was established with Fisher exact test, Chi-square or Mann-Whitney U test. Within-group changes from baseline were assessed with paired t-test and Wilcoxon signed-rank test. RESULTS: 48 feet (34 isolated Scarf, 14 concomitant Weil osteotomy) were included. Both cohorts demonstrated significant improvements across all measures of functional outcome. However, patients with additional Weil osteotomy reported poorer short-term outcomes. CONCLUSION: Superiority of additional Weil osteotomy versus isolated Scarf osteotomy in addressing second toe metatarsalgia or improving functional outcomes was not demonstrated.


Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Humanos , Estudos Retrospectivos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Hallux Valgus/etiologia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Metatarsalgia/diagnóstico por imagem , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Osteotomia/efeitos adversos , Joanete/etiologia , Resultado do Tratamento
16.
Foot Ankle Clin ; 27(2): 253-269, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35680287

RESUMO

Hallux rigidus can be treated with a variety of surgical procedures, including joint preserving techniques, arthrodesis, and arthroplasty. The most commonly reported complications for joint preserving techniques consist of progression of arthritis, continued pain, and transfer metatarsalgia. Although good outcomes have been reported for arthrodesis overall, careful attention must be paid to technique and positioning of the toe to avoid nonunion or malunion. Arthroplasty preserves motion but in the case of failure can present the additional challenge of bone loss. In these scenarios, the authors recommend distraction bone block arthrodesis with structural autograft.


Assuntos
Hallux Rigidus , Metatarsalgia , Articulação Metatarsofalângica , Artrodese/efeitos adversos , Artrodese/métodos , Artroplastia/métodos , Hallux Rigidus/cirurgia , Humanos , Metatarsalgia/cirurgia , Articulação Metatarsofalângica/cirurgia
17.
BMC Musculoskelet Disord ; 23(1): 475, 2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35590295

RESUMO

BACKGROUND: Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness. The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study. METHODS: Maximal pressure (Kpa) and pressure-time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad. RESULTS: Mean second metatarsal head maximal pressure and mean pressure-time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure-time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure-time integral reduction. CONCLUSIONS: The Fixtoe Device® reduces median maximal pressure and median pressure-time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.


Assuntos
Ossos do Metatarso , Metatarsalgia , Estudos Transversais , , Humanos , Pressão
18.
Einstein (Sao Paulo) ; 20: eAO6543, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476080

RESUMO

OBJECTIVE: The magnetic resonance imaging diagnostic criteria for a complete tear of metatarsophalangeal plantar plate are well-established. However, more subtle abnormalities can also occur and be a source of pain. The objective of this study is to determine the prevalence of degenerative plantar plate injuries in patients with metatarsalgia who underwent forefoot magnetic resonance imaging and describe the main abnormalities found. The hypothesis is that mild capsular fibrosis will have high sensitivity but low specificity for plantar plate degenerative injuries. METHODS: A retrospective cross-sectional study was conducted with 85 patients (105 feet) with metatarsalgia who underwent forefoot magnetic resonance imaging using a specific protocol to study metatarsophalangeal plantar plate. The experiment observer classified second toe plantar plate as normal, complete rupture or degenerative lesion and described the main magnetic resonance imaging findings. RESULTS: A normal plantar plate was observed in 75 (71.4%) of the 105 feet assessed, in 25 (24%) feet there were degenerative plantar lesions, and in 5 (4.6%) feet there were complete ruptures. Degenerative injury of the plantar plate was best identified in coronal short axis intermediate-weighted images, with high sensitivity (92%). Pericapsular fibrosis below the intermetatarsal ligament was identified in 96% of cases, with high sensitivity (96%) for diagnosis of degenerative plantar plate injury. CONCLUSION: Degenerative lesions of the metatarsophalangeal plantar plate were more prevalent than complete ruptures and were best viewed in coronal short axis intermediate-weighted sequences. Pericapsular fibrosis below the intermetatarsal ligament was the indirect finding most strongly associated with degenerative plantar plate injury.


Assuntos
Metatarsalgia , Placa Plantar , Estudos Transversais , Fibrose , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Metatarsalgia/diagnóstico por imagem , Placa Plantar/diagnóstico por imagem , Placa Plantar/lesões , Estudos Retrospectivos , Ruptura
19.
J Foot Ankle Surg ; 61(5): 1114-1118, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35283034

RESUMO

Recognition of metatarsophalangeal joint plantar plate injuries has improved over time as the condition has become more widely understood and identified. With the diagnosis of a plantar plate injury as a subset of metatarsalgia becoming more common place, there are multiple surgical options that have been utilized to address the condition. Direct repair of the plantar plate has emerged as the treatment of choice for foot surgeons with a tendency to favor a direct dorsal approach for the repair. We performed a systematic review and meta-analysis using preferred reporting items for systematic reviews and meta-analysis guidelines, to determine the magnitude of change that can be expected in visual analog scale pain and American Orthopedic Foot and Ankle Society scores postoperatively. A total of 12 studies involving 537 plantar plate tears were included who underwent direct repair of the plantar plate through either a dorsal (10 articles) or plantar approach (2 articles). Summary estimates were calculated which revealed improvement in visual analog scale pain (pooled mean change of -5.01 [95%CI -5.36, -4.66] pre-to postoperative) and improvement in American Orthopedic Foot and Ankle Society scores (pooled postoperative mean improvement 40.44 [95%CI 37.90, 42.97]) of patients within the included studies. Random effects models were used for summary estimates. I2 statistic was used to assess for heterogeneity. We concluded there is a predictable level of improvement in pain and function in patients undergoing a direct dorsal approach plantar plate repair with follow-up out to 2 years.


Assuntos
Instabilidade Articular , Metatarsalgia , Articulação Metatarsofalângica , Placa Plantar , Humanos , Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/lesões , Articulação Metatarsofalângica/cirurgia , Osteotomia , Placa Plantar/lesões , Placa Plantar/cirurgia
20.
Foot Ankle Surg ; 28(4): 526-533, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35279396

RESUMO

BACKGROUND: Several surgical procedures have been described to treat hallux rigidus. Keller arthroplasty is a joint-sacrificing procedure proposed in 1904. Considering the current trends to mini-invasiveness and the debate about the technique's suitability, this review intends to state Keller arthroplasty results and the conditions where it could be still adopted in the treatment of hallux rigidus. METHODS: Selected articles were reviewed to extract: population data, surgical indications, different surgical techniques, clinical and radiological outcomes, and complications. RESULTS: Seventeen retrospective studies were selected, counting 508 patients. Mean age at surgery was 55 years. Patients were affected by moderate-severe hallux rigidus. Three modified Keller arthroplasty were identified. Good clinical and radiological outcomes were reported. Metatarsalgia was the most frequent complication (12%). CONCLUSION: Despite for many authors KA seems a viable surgical treatment for middle aged and elderly patients affected by moderate-severe hallux rigidus, the available literature provides little evidence on the real efficacy and safety of the technique. A non-negligible percentage of complications may occur, and therefore is essential to set correct indications through an accurate patients' selection.


Assuntos
Hallux Rigidus , Metatarsalgia , Articulação Metatarsofalângica , Idoso , Artroplastia/métodos , Seguimentos , Hallux Rigidus/complicações , Hallux Rigidus/diagnóstico por imagem , Hallux Rigidus/cirurgia , Humanos , Metatarsalgia/cirurgia , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
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