Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses.

PURPOSE: No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses. METHODS: Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes. RESULTS: Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters. CONCLUSION: Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.

Tips, quips and pearls: Ultrasound-guided distal metatarsal minimal invasive osteotomy (US-DMMO).

Metatarsalgia is a frequent cause of forefoot pain. Surgical treatment is based on the performance of osteotomies at the level of the minor radii to restore a normal distribution of pressure within the forefoot and improve the biomechanics during gait. In recent years, percutaneous surgery of the foot, and specifically distal metatarsal minimal invasive osteotomy, have proven to be a valid technique, providing satisfactory clinical results, similar to open osteotomy with less soft tissue aggression, but it requires intraoperative fluoroscopy to be performed. This article will present a modification to guide the procedure by ultrasound providing a new option that eliminates radiation and provides greater portability and accessibility.

FACTORS INFLUENCING RESULTS OF SURGICAL TREATMENT OF METATARSALGIA AND THEIR PROGNOSTIC VALUE.

Objective - to determine the prognostic value of factors that affect the long-term result of surgical treatment of metatarsalgia, to develop a system for predicting the results of surgical treatment of metatarsalgia. A prospective trial of long-term results of surgical treatment of 172 patients with metatarsalgia was conducted from 2000 to 2019. Two study groups were formed: the core study group comprising of 107 patients who underwent Weil-osteotomy, metatarsals proximal osteotomy. The control group consisted of 65 patients who underwent another surgical treatment (metatarsophalangeal resection arthroplasty, surgery of capsular-ligamentous and tendon apparatus of metatarsophalangeal joints, as well as the surgical therapy intended to remove only hammer 2-4 toes deformities). Clinical, instrumental and statistical (correlation-regression analysis) research methods were used. The factors that influenced the end result of treatment were identified. The statistically significant influence of age, sex, BMI < 25, "index minus" and hammer 2-4 toes on the prevalence of positive treatment results were determined. The estimation of the informative nature of the presented factors for the probability of achieving positive results of treatment, the calculation of the prognostic coefficients and their sum were determined. The system for predicting treatment results of metatarsalgia involves the possibility of obtaining a high, medium and low probability of a positive result when applying surgical treatment. The long-term result of surgical treatment of metatarsalgia under the heads of 2 - 4 metatarsals depends on age and factor "hammer 2-4 toes". A high prognostic evaluation of a successful treatment outcome should be expected with a total prognosis of + 6 to +16; a total estimate of prognostic coefficients from + 6 to +16 determines the average probability of positive treatment results; the sum of the prognostic coefficients from - 10 to - 2 determines the low probability of achieving positive treatment results.

Treatment of metatarsalgia based on claw toe deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint: Evaluation based on foot kinematics and plantar pressure distribution.

INTRODUCTION: This study investigated the effect of operative claw toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). METHODS: Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic claw toes were measured three months before and 12months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N=15). RESULTS: Claw toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. DISCUSSION: These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on claw toe deformity.

Shortening Proximal Chevron Metatarsal Osteotomy for Patients With a Hallux Valgus Deformity With Advanced Arthritis.

To correct hallux valgus deformities in patients with advanced arthritis of the first metatarsophalangeal joint, we designed a new reverse chevron-type shortening osteotomy technique that could be used to correct valgus deformities at the proximal metatarsal level, as well as shorten and lower the metatarsal, in a 1-time procedure. Sixteen feet in 16 patients with a minimum of 18 months follow-up who underwent a shortening proximal chevron metatarsal osteotomy for a hallux valgus deformity with advanced arthritic change between January 2014 and March 2016 were reviewed in this study. Double chevron osteotomies with 20° of plantar-ward obliquity at the proximal metatarsal level were made at 5-mm intervals for simultaneous valgus correction and metatarsal shortening. An additional Weil osteotomy of the second metatarsal was performed in all feet. Patients' mean age was 57.88 ± 6.55 years. The deformity was satisfactorily corrected by the operation. The first metatarsal was shortened by approximately 8.75 mm, and the relative length of the second metatarsal did not differ significantly postoperatively (p = .179). The relative second metatarsal height, as seen on forefoot axial radiographs, was maintained constantly, with no significant difference (p = .215). No painful plantar callosity or transfer metatarsalgia under the second metatarsal head was observed postoperatively. A shortening proximal chevron metatarsal osteotomy for hallux valgus deformities with advanced arthritic change showed a good result with respect to deformity correction and pain relief. Appropriate lowering and an additional Weil osteotomy effectively prevented postoperative pain and painful callosity under the second metatarsal head.

Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis.

INTRODUCTION: When conservative therapy for hallux rigidus fails, surgical options such as arthrodesis and interposition arthroplasty can be considered. Although arthrodesis of MTP joint is the gold standard treatment. However patients desiring MTP joint movement may opt for either interposition arthroplasty or implant arthroplasty to avoid the movement restrictions of arthrodesis. The purpose of this systematic review was to investigate clinical outcomes and complications following interposition arthroplasty for moderate to severe hallux rigidus, for patietns who would prefer to maintain range of motion in the MTP joint. METHODS: A systematic search on MEDLINE, EMBASE and Cochrane library database was performed during February 2018. Demographics, surgical techniques, clinical outcomes, radiological outcomes and complications were recorded from each included study. Pooled statistics performed for variables with homogenous data across the studies. A linear regression model used to compare the clinical outcomes between autogenous vs allogenous material interposition arthroplasty. RESULTS: Fifteen articles were included in the systematic review. Mean AOFAS scores improved from preoperative 41.35 to postoperative 83.17. Mean pain, function, and alignment score improved from preoperative values of 14.9, 24.9, and 10 to postoperative values of 33.3, 35.8, and 14.5. Mean dorsiflexion increased from 21.27° (5-30) to 42.03° (25-71). Mean ROM improved from 21.06° to 46.43°. Joint space increased from 0.8mm to 2.5mm. The most common postoperative complications included metatarsalgia (13.9%), loss of ground contact (9.7%), osteonecrosis (5.4%), great toe weakness (4.8%), hypoesthesia (4.2%), decreased push off power (4.2%), and callous formation (4.2%). CONCLUSION: Interposition arthroplasty is an effective treatment option with acceptable clinical outcomes in patients with moderate-severe hallux rigidus who prefer to maintain range of motion and accept the risk of future complications. LEVEL OF EVIDENCE: IV.

Hyaluronic Acid Filler Injections Under the Metatarsal Heads Provide a Significant and Long-Lasting Improvement in Metatarsalgia From Wearing High-Heeled Shoes.

BACKGROUND: Metatarsalgia is a common overuse injury that may be caused by wearing high-heeled shoes. OBJECTIVE: To evaluate the decrease in metatarsalgia using a hyaluronic acid dermal filler. METHODS: A 6-month, open study was conducted in 15 subjects with metatarsalgia because of regularly wearing high-heeled shoes. Hyaluronic acid (20 mg/mL) with lidocaine hydrochloride (3 mg/mL) was injected under the metatarsal heads at baseline. Pain (on a 0-10 scale) under the metatarsal heads when walking in high heels was recorded in a weekly subject diary. RESULTS: At 6 months after injections, 5 subjects (33.3%) reported no metatarsalgia pain. For subjects with pain, they were able to wear high heels for significantly longer than before the injections (7.2 hours at 6 months vs 3.4 hours at baseline). Significant improvements from baseline were observed at Month 6 for time to onset of pain (3.5 hours longer), time between onset of pain and intolerable pain (1.9 hours longer), and pain sensation (-2.2 grades at onset and -3.8 grades at shoe removal). No adverse events were reported. CONCLUSION: Injection of hyaluronic acid filler to the forefeet provided a significant effective, long-lasting, and well-tolerated improvement in metatarsalgia because of wearing high-heeled shoes.

Common Foot Problems: Over-the-Counter Treatments and Home Care.

Most foot disorders do not require podiatry referral or complex interventions. After the clinical diagnosis is made, these conditions can typically be managed with over-the-counter (OTC) and home remedies, with guidance from the primary care physician. Stretching and strengthening exercises, along with the use of heel cups, resolve most plantar fasciitis cases and are at least as effective as nonsteroidal anti-inflammatory drugs or steroid injections. Hallux rigidus is best managed with a hard-soled shoe or rigid insert that relieves pain by restricting motion across the metatarsophalangeal joint. Hallux valgus responds to use of wide toe box shoes, and surgery is not clearly beneficial beyond one year. Plantar warts can be treated effectively at home with OTC salicylic acid and cryotherapy topical agents, which have equal effectiveness to liquid nitrogen. In patients with corns and calluses, OTC topical salicylic acid has short-term benefits, and pads and inserts that more evenly redistribute contact forces have long-term benefits. Inserts are commonly recommended to redistribute forefoot pressure and relieve pain. Several OTC preparations are available for the treatment of tinea pedis, with topical allylamines being the most effective. Although OTC topical treatments have been widely used for onychomycosis, they have poor long-term cure rates compared with prescription oral medications.

Morton's interdigital neuroma of the foot: A literature review.

Morton's neuroma is one of the most common causes of metatarsalgia. Despite this, it remains little studied, as the diagnosis is clinical with no reliable instrumental diagnostics, and each study may deal with incorrect diagnosis or inappropriate treatment, which are difficult to verify. The present literature review crosses all key points, from diagnosis to surgical and nonoperative treatment, and recurrences. Nonoperative treatment is successful in a limited percentage of cases, but it can be adequate in those who want to delay or avoid surgery. Dorsal or plantar approaches were described for surgical treatment, both with strengths and weaknesses that will be scanned. Failures are related to wrong diagnosis, wrong interspace, failure to divide the transverse metatarsal ligament, too distal resection of common plantar digital nerve, an association of tarsal tunnel syndrome and incomplete removal. A deep knowledge of the causes and presentation of failures is needed to surgically face recurrences.

Percutaneous distal osteotomy of lesser metatarsals (DMMO) for treatment of metatarsalgia with metatarsophalangeal instability.

BACKGROUND: Clinical and radiological results of percutaneous distal metatarsal minimally invasive osteotomy (DMMO) of the lesser rays for surgical treatment of primary metatarsalgia due to plantar overpressure with metatarsophalangeal instability are described. The aim of this prospective study was to assess the efficacy, feasibility and safety of this minimally invasive surgical (MIS) technique, verifying the possibility to lower the complication rate related to surgical exposures, to reduce operating times with comparable functional and cosmetic results to those reported with traditional open procedures. METHODS: Hundred and six consecutive percutaneous distal osteotomies without fixation (DMMO) of the second, third or fourth metatarsal bones were performed in 57 patients (70ft) with a mean age at the surgery of 60.2 years (30-81) for treatment of metatarsalgia with metatarsophalangeal instability. Patients were clinically assessed with the AOFAS and Coughlin's Scores, the latter classifying the results in relation to the patient's subjective satisfaction. RESULTS: The mean follow-up was of 45.0±13.3months (24-68). All patients reported the disappearance or reduction of the pain that they had experienced prior to the operation around the metatarsal heads. The mean overall AOFAS score improved from 42.7±13.4 points (9-77) to 92.8±8.6 points (44-100) at the time of final follow-up. Patient subjective satisfaction according to Coughlin's classification was excellent in 62ft (88.6%), good in 7ft (10.0%), fair in 0ft and poor in one foot (1.4%). CONCLUSIONS: We consider the percutaneous distal lesser metatarsal osteotomy without fixation (DMMO) a reliable surgical option in metatarsalgia due to metatarsophalangeal instability in early stages as in grade I and II according to Coughlin classification.

[The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment].

This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. The data analysis demonstrated that presently various types of osteotomies of metatarsal bones are the main surgical treatment options with the chance of complication ranging from 6 to 50%. Weil-osteotomy is known to be the most popular type of osteotomy for treatment of central metatarsalgia. The most common complication of Weil-osteotomy is floating toe, the one that doesn't contact with the supporting surface. In case Weil-osteotomy and intraphalangeal arthrodesis with trans acticular fixation are both performed, the complication of floating toe increases up to 50%. When Weil osteotomy, plantar plate repair, extensor digitorum longum tendon lengthening and triple Weil-osteotomy are performed simultaneously, the complication rate is 15% approximately which is much lower. Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

To what extent is foot pain related to biomechanical changes and ultrasound-detected abnormalities in rheumatoid arthritis?

OBJECTIVES: To investigate the presence of biomechanical abnormalities and ultrasound (US)-detected inflammation and damage in low disease or remission status rheumatoid arthritis (RA) patients with foot complaints. METHODS: We recruited 136 subjects with foot complaints. Sixty-two were biologic disease-modifying antirheumatic drug-treated RA patients presenting Disease Activity Score-determined remission or low disease activity while the remaining 74 were gender matched controls without rheumatic or musculoskeletal disorders. Both groups underwent a comprehensive podiatric, biomechanical and B-mode and Doppler US assessment of the feet. RESULTS: Most RA patients and controls were female (77.4% and 83.8%, respectively). There was no statistical difference in the proportion of obese subjects in either group (p=0.792). Inappropriate shoes were used by 50.0% of RA patients and 33.8% of controls (p=0.080). Talalgia, particularly heel pain, was more frequent in the control group, with associated talalgia and metatarsalgia being more prevalent in the RA group (p<0.05). The RA patient group was also more likely to present greater foot deformity, more limited joint movement and biomechanical abnormalities than the controls (p<0.05). US inflammatory and structural changes were significantly more frequent in RA patients than in controls (p<0.05). US structural involvement was significantly associated with limited joint mobility and pathologic biomechanical tests only in RA patients (p<0.05). CONCLUSIONS: RA foot complaints seemed to be linked to US-detected RA involvement and biomechanical abnormalities. Podiatric and US assessments can be useful to help the clinician to optimise the management of RA patients in remission/low disease activity with foot complaints.

A comparison of two podiatric protocols for metatarsalgia in patients with rheumatoid arthritis and osteoarthritis.

OBJECTIVES: In rheumatoid arthritis (RA) and osteoarthritis (OA) forefoot involvement causes disability and metatarsalgia. Our objective was to evaluate, in RA and OA patients, the efficacy of two protocols combining insoles in polypropylene terephtalate (PPT) and custom silicone orthoses for toes on disability and metatarsalgia. METHODS: Twenty-four women (13 with OA, 11 with RA) with metatarsalgia were treated with two protocols: group A (protocol A) wore PPT insoles (T1) for 30 days and for another 30 days silicone orthosis for toes were added (T2). Group B (protocol B) wore PPT insoles and silicone orthosis (T1) for 30 days and in the following 30 days only insoles (T2). At T0, T1 and T2, pain, disability and function (Foot Function Index - FFI), pressure (KPA) and plantar contact areas (cm2) (baropodometer), and gait spatial-temporal parameters (GAITRite®) were assessed. RESULTS: At T0 versus T2, both protocols reduced FFI-pain, -disability and -functional limitation (p<0.05), with better results of protocol A than protocol B (p<0.05) for FFI-pain and -disability. Both protocols reduced baropodometer foot plantar pressures (p<0.001), with better results for protocol A for right foot pressures (p<0.05) and increased foot contact areas (p<0.05), with no difference between them (p=NS). Gait parameters were not significantly changed by both protocols (p=NS). CONCLUSIONS: In patients with RA and OA with metatarsalgia, the synergic action of silicone toe orthosis and PPT insoles improves FFI, reduces foot plantar pressures and increases foot plantar contact areas. Protocol A, using firstly insoles and then adding silicone toe orthoses, is the more efficacious.

Metatarsal pain and plantar hyperkeratosis in the forefeet of female professional flamenco dancers.

OBJECTIVES: The objectives of this study were to determine the frequency of metatarsal pain and of hyperkeratosis on the plantar forefoot in female professional flamenco dancers, and to determine whether there is a relationship between the two disorders. METHOD: Forty-four female professional flamenco dancers, with a minimum activity of 25 hrs/wk, participated in this cross-sectional study. The presence or absence of metatarsal pain while dancing was recorded, and plantar pressures were measured on a pressure platform, both barefoot and shod with the usual dance shoe. The heel height of the dance shoe was also measured. RESULTS: Of the dancers, 80.7% experienced metatarsal pain while dancing, and 84.1% presented with plantar hyperkeratosis. Plantar hyperkeratosis coincided with the presence of metatarsal pain in 67.04% of the feet studied. The maximum load point in the feet when the dancers were barefoot was located 59.5% in the rearfoot and 40.5% in the forefoot; when dancers wore their specific flamenco dancing shoes, it was located 52.4% in the rearfoot and 47.6% in the forefoot. CONCLUSIONS: Metatarsal pain and plantar hyperkeratosis in the forefoot are common foot disorders in female flamenco dancing. The incidence of the maximum load point being located in the forefoot, and the difference between the results of the tests while shod or barefoot, are both too low to support the idea that the raised heels of flamenco shoes are a major contributing factor for these injuries. Therefore, these disorders may be caused by chronic repetitive trauma suffered during the practice of footwork dancing.

Arthroscopic excision of a symptomatic os trigonum in a lateral decubitus position.

BACKGROUND: The purpose of this study was to introduce our technique of arthroscopic excision of the os trigonum in the lateral decubitus position through anterolateral, centrolateral, and posterolateral portals and also to investigate the safety and clinical results of this technique. METHODS: Between May 2007 and May 2011, 23 ankles of 23 consecutive patients underwent subtalar arthroscopic removal of the os trigonum in a lateral decubitus position. Twenty patients were male and 3 were female. All patients injured their ankles during sports activities. Mean duration of postoperative follow-up was 18 months, and no patients were lost to follow-up. Clinical evaluations were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analog scale (VAS) for pain. The time to return to work and sports activities was assessed. RESULTS: Average AOFAS ankle-hindfoot score increased from 71.3 (range, 59-85) preoperatively to 94.7 (range, 90-100) postoperatively, and VAS for pain decreased from 6.7 (range, 3-10) to 1.5 (range, 0-3). Average plantarflexion of the ankle increased from 28.8 degrees (range, 15-40) preoperatively to 42.5 degrees (range, 25-50) postoperatively. Mean time to resumption of sports activities was 6.7 weeks (range, 5-12). There were no major complications in any patient. CONCLUSION: Arthroscopic excision of a symptomatic os trigonum using anterolateral, centrolateral, and posterolateral portals in the lateral decubitus position was a safe and effective technique. LEVEL OF EVIDENCE: Level IV, retrospective case series.

[Metatarsalgia: diagnosis and treatment]. / Métatarsalgies: diagnostic et prise en charge.

Metatarsalgias refer to pain localized in the forefoot and under the metatarsal heads. It is one of the main reasons for specialist consultation. Consequences of a wide array of different diseases, they require a biomechanical and systematic approach to fully understand their cause and presentation in a variety of clinical presentations. Treatment, either conservative or surgical, is based on an accurate knowledge of their etiology and meets specific criteria of classification.

Orthopaedic and plastic surgery collaboration in resolution of plantar heloma and metatarsalgia using lipofilling: a retrospective evaluation.

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.

Morton's neuroma: A clinical versus radiological diagnosis.

BACKGROUND: The aim of our study was to compare the clinical versus radiological diagnosis of patients suffering from a Morton's neuroma. METHODS: Clinical assessments and pre-operative radiological imaging of patients who had excision of a Morton's neuromas were retrospectively compared. RESULTS: 43 neuromas were excised from 36 patients over 68 months. The commonest clinical symptoms were tenderness on direct palpation (100%), pain on weight bearing (91%) which was relieved by rest (81%). The most sensitive clinical sign was a Mulder's click. Clinical assessment had a sensitivity of 98% (42/43). Ultrasonography had a sensitivity of 90% (28/31) and magnetic resonance imaging had a sensitivity of 88% (14/16). CONCLUSION: There is no absolute requirement for imaging patients who clinically have a Morton's neuroma. The two main indications for imaging are (a) an unclear clinical assessment and (b) cases when more than one web space is affected. Ultrasonography should be the investigation of choice.

Keller's arthroplasty in adults with hallux valgus and hallux rigidus.

BACKGROUND: The role of Keller's resection arthroplasty in the management of adult hallux valgus with hallux rigidus is debatable. There are no studies addressing this particular problem. METHODS: This study is a retrospective review of 32 patients (49 feet), conducted by an independent assessor. Subjective and objective criteria were used to assess the results of surgery. There were 30 women and 2 men with an average age at surgery of 62.5years. RESULTS: The results of surgery in terms of relief of pain, cosmesis and use of regular footwear were satisfactory. Excellent and good subjective results were obtained in 39% and 37% of cases respectively. Radiological analysis revealed decrease in the intermetatarsal and first metatarsophalangeal angle in a significant number of cases. Final results assessed by Vallier's modification of Bonney and MacNab criteria, revealed excellent to good results in 87% of feet. A significant number of complications were noted but there was no association between the occurrence of complications and the final result or the subjective functional grade. There was no association between the amount of resection of proximal phalanx and occurrence of metatarsalgia or the final outcome. CONCLUSION: The results of this study suggest that Keller's arthroplasty has a role in patients with adult hallux valgus associated with degenerative changes in the first metatarsophalangeal joint.