Journal List > J Korean Foot Ankle Soc > v.24(1) > 1144012

J Korean Foot Ankle Soc. 2020 Mar;24(1):9-13. Korean.
Published online Mar 13, 2020.  https://doi.org/10.14193/jkfas.2020.24.1.9
Copyright © 2020 Korean Foot and Ankle Society
Treatment of Metatarsalgia after a Surgery
Dong-il Chun,
Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.

Corresponding Author: Dong-il Chun. Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. Tel: 82-2-709-9250, Fax: 82-2-710-3191, Email: orthochun@gmail.com
Received Feb 17, 2020; Revised Feb 24, 2020; Accepted Feb 27, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Metatarsalgia is a generalized term used to describe forefoot pain. The possible etiologies can range from direct to indirect pathologies. Metatarsalgia has several causes. This paper evaluates the recent literature to provide an in-depth review of metatarsalgia after forefoot surgery.

Keywords: Metatarsalgia; Osteotomy

Figures


Figure 1
Hallux vagus with 1st Tarso-Metatarsal joint hypermobility. (A) Severe hallux valgus with 2nd Metatarsophalangeal joint subluxation and 1st Tarsometatarsal joint hypermobility. (B) Correction was made by 1st Tarsometatarsal arthrodesis using plate & screw and Weil osteotomy on 2nd metatarsal head.
Click for larger image


Figure 2
Distal metatarsal osteotomy (Weil osteotomy). After an osteotomy parallel to the supporting surface, distal fragment is repositioned proximally and fixed with the dorsal fragment.
Click for larger image


Figure 3
Metatarsal shaft osteotomy (lesser toes). (A) Oblique osteotomy: after an oblique osteotomy of metatarsal shaft on sagittal plane, rotate the distal fragment from dorsoplantar plane to medial plane. (B) Scalf osteotomy (5th metatarsal bone): after an Z-shaped osteotomy of the metatarsal shaft on the sagittal plane, medially translate and dorsally rotate the distal fragment.
Click for larger image


Figure 4
Proximal metatarsal osteotomy (5th metatarsal bone). (A) Chevron osteotomy: after a chevron osteotomy of the proximal metatarsal bone on the sagittal plane, medially translate and dorsally rotate the distal fragment. (B) Wedge osteotomy: after a medial wedge osteotomy on the dorsoplantar plane, medially rotate the distal fragment.
Click for larger image

Tables


Table 1
Different Types of Metatarsalgia
Click for larger image

Notes

Financial support:None.

Conflict of interest:None.

References
1. Feibel JB, Tisdel CL, Donley BG. Lesser metatarsal osteotomies. A biomechanical approach to metatarsalgia. Foot Ankle Clin 2001;6:473–489. [doi: 10.1016/s1083-7515(03)00108-6]
2. Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int 2008;29:871–879. [doi: 10.3113/FAI.2008.0000]
3. Hirvensalo E, Böstman O, Törmälä P, Vainionpää S, Rokkanen P. Chevron osteotomy fixed with absorbable polyglycolide pins. Foot Ankle 1991;11:212–218.
4. Mann RA, Rudicel S, Graves SC. Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up. J Bone Joint Surg Am 1992;74:124–129.
5. Lapidus PW. A quarter of a century of experience with the operative correction of the metatarsus varus primus in hallux valgus. Bull Hosp Joint Dis 1956;17:404–421.
6. Coughlin MJ, Mann RA. In: Surgery of the foot and ankle. 7th ed. St. Louis (MO): Mosby; 1999.
7. Beauchamp CG, Kirby T, Rudge SR, Worthington BS, Nelson J. Fusion of the first metatarsophalangeal joint in forefoot arthroplasty. Clin Orthop Relat Res 1984;(190):249–253.
8. Chana GS, Andrew TA, Cotterill CP. A simple method of arthrodesis of the first metatarsophalangeal joint. J Bone Joint Surg Br 1984;66:703–705.
9. Coughlin MJ. Arthrodesis of the first metatarsophalangeal joint with mini-fragment plate fixation. Orthopedics 1990;13:1037–1044.
10. Coughlin MJ. Rheumatoid forefoot reconstruction. A long-term follow-up study. J Bone Joint Surg Am 2000;82:322–341.
11. Coughlin MJ, Abdo RV. Arthrodesis of the first metatarsophalangeal joint with Vitallium plate fixation. Foot Ankle Int 1994;15:18–28. [doi: 10.1177/107110079401500105]
12. Goucher NR, Coughlin MJ. Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int 2006;27:869–876. [doi: 10.1177/107110070602701101]
13. Henry AP, Waugh W, Wood H. The use of footprints in assessing the results of operations for hallux valgus. A comparison of Keller's operation and arthrodesis. J Bone Joint Surg Br 1975;57:478–481.
14. Kumar S, Pradhan R, Rosenfeld PF. First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw. Foot Ankle Int 2010;31:797–801. [doi: 10.3113/FAI.2010.0797]
15. Mann RA, Oates JC. Arthrodesis of the first metatarsophalangeal joint. Foot Ankle 1980;1:159–166. [doi: 10.1177/107110078000100305]
16. Mann RA, Schakel ME 2nd. Surgical correction of rheumatoid forefoot deformities. Foot Ankle Int 1995;16:1–6. [doi: 10.1177/107110079501600101]
17. Mann RA, Thompson FM. Arthrodesis of the first metatarsophalangeal joint for hallux valgus in rheumatoid arthritis. J Bone Joint Surg Am 1984;66:687–692.
18. Moynihan FJ. Arthrodesis of the metatarso-phalangeal joint of the great toe. J Bone Joint Surg Br 1967;49:544–551.
19. Sung W, Kluesner AJ, Irrgang J, Burns P, Wukich DK. Radiographic outcomes following primary arthrodesis of the first metatarsophalangeal joint in hallux abductovalgus deformity. J Foot Ankle Surg 2010;49:446–451. [doi: 10.1053/j.jfas.2010.06.007]
20. Thompson FR, McElvenny RT. Arthrodesis of the first joint. J Bone Joint Surg 1940;22:555–558.
21. Khurana A, Kadamabande S, James S, Tanaka H, Hariharan K. Weil osteotomy: assessment of medium term results and predictive factors in recurrent metatarsalgia. Foot Ankle Surg 2011;17:150–157. [doi: 10.1016/j.fas.2010.04.003]
22. Leventen EO, Pearson SW. Distal metatarsal osteotomy for intractable plantar keratoses. Foot Ankle 1990;10:247–251. [doi: 10.1177/107110079001000501]
23. O'Kane C, Kilmartin TE. The surgical management of central metatarsalgia. Foot Ankle Int 2002;23:415–419. [doi: 10.1177/107110070202300508]
24. Pearce CJ, Calder JD. Metatarsalgia: proximal metatarsal osteotomies. Foot Ankle Clin 2011;16:597–608. [doi: 10.1016/j.fcl.2011.08.007]
25. Schuh R, Trnka HJ. Metatarsalgia: distal metatarsal osteotomies. Foot Ankle Clin 2011;16:583–595. [doi: 10.1016/j.fcl.2011.08.009]
26. Grimes J, Coughlin M. Geometric analysis of the Weil osteotomy. Foot Ankle Int 2006;27:985–992. [doi: 10.1177/107110070602701121]
27. Wolf MD. Metatarsal osteotomy for the relief of painful metatarsal callosities. J Bone Joint Surg Am 1973;55:1760–1762.
28. Trnka HJ, Kabon B, Zettl R, Kaider A, Salzer M, Ritschl P. Helal metatarsal osteotomy for the treatment of metatarsalgia: a critical analysis of results. Orthopedics 1996;19:457–461.
29. Fleischli JE, Anderson RB, Davis WH. Dorsiflexion metatarsal osteotomy for treatment of recalcitrant diabetic neuropathic ulcers. Foot Ankle Int 1999;20:80–85. [doi: 10.1177/107110079902000203]