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Hsu WK, Tie THA, Hsu WL, Chen YY. Minimally Invasive Chevron Akin (MICA) Osteotomy Corrects Radiographic Parameters but Not Central Metatarsal Loading in Moderate to Severe Hallux Valgus without Metatarsalgia. Life (Basel) 2024; 14:734. [PMID: 38929717 PMCID: PMC11204634 DOI: 10.3390/life14060734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature has reported the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA). METHODS A prospective cohort of 31 feet from 25 patients with moderate-to-severe symptomatic HV but without metatarsalgia underwent MICA and was evaluated using radiographic parameters and pedographic measurements (Footscan®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery. RESULTS The radiographic parameters of the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary's angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area. CONCLUSION MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia.
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Affiliation(s)
- Wei-Kuo Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (W.-K.H.); (T.-H.A.T.)
| | - Tung-Hee Albert Tie
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (W.-K.H.); (T.-H.A.T.)
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Yan-Yu Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Orthopaedic Surgery, Show Chwan Memorial Hospital, Changhua 500, Taiwan
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Miranda FC, e Castro ADA, Yoshimura FB, Godoy-Santos AL, Santos DDCB, Rosemberg LA, Taneja AK. Imaging Features of Plantar Vein Thrombosis: An Easily Overlooked Condition in the Differential Diagnosis of Foot Pain. Diagnostics (Basel) 2024; 14:126. [PMID: 38248003 PMCID: PMC10814699 DOI: 10.3390/diagnostics14020126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Plantar vein thrombosis is a venous disorder affecting deep plantar veins that can manifest with non-specific localized pain, plantar foot pain, swelling, and sensation of fullness. Plantar veins are not routinely assessed during sonographic scans for deep venous thrombosis, which makes plantar venous thrombosis a commonly missed diagnosis. This paper provides a comprehensive review of the venous anatomy of the foot and imaging findings of plantar venous thrombosis as well as discusses the current literature on the topic and its differential diagnoses.
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Affiliation(s)
- Frederico Celestino Miranda
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil; (F.C.M.); (A.d.A.e.C.); (F.B.Y.); (A.L.G.-S.); (D.d.C.B.S.); (L.A.R.)
| | - Adham do Amaral e Castro
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil; (F.C.M.); (A.d.A.e.C.); (F.B.Y.); (A.L.G.-S.); (D.d.C.B.S.); (L.A.R.)
- Department of Imaging Diagnosis, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
| | - Fábio Brandão Yoshimura
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil; (F.C.M.); (A.d.A.e.C.); (F.B.Y.); (A.L.G.-S.); (D.d.C.B.S.); (L.A.R.)
| | - Alexandre Leme Godoy-Santos
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil; (F.C.M.); (A.d.A.e.C.); (F.B.Y.); (A.L.G.-S.); (D.d.C.B.S.); (L.A.R.)
- Faculdade de Medicina, USP, São Paulo 05403-010, Brazil
| | - Durval do Carmo Barros Santos
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil; (F.C.M.); (A.d.A.e.C.); (F.B.Y.); (A.L.G.-S.); (D.d.C.B.S.); (L.A.R.)
| | - Laercio Alberto Rosemberg
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil; (F.C.M.); (A.d.A.e.C.); (F.B.Y.); (A.L.G.-S.); (D.d.C.B.S.); (L.A.R.)
| | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
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Lim S, Liem B. First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations. Curr Sports Med Rep 2023; 22:217-223. [PMID: 37294197 DOI: 10.1249/jsr.0000000000001076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT The first metatarsal-phalangeal joint plays a key role for athletes of various disciplines. When an athlete presents for evaluation of pain at this joint, there are several causes that should be considered. The purpose of this article is to review common injuries including turf toe, sand toe, extensor and flexor hallucis longus tendinopathy, sesamoiditis, and metatarsalgia and provide current evidence-based recommendations for diagnosis, management, and return to play considerations. Conditions not specific to athletes like gout and hallux rigidus also are discussed. Mechanism of injury, physical examination, and imaging such as weight-bearing radiographs and point-of-care ultrasound can help with diagnosis. Treatment of many of these injuries begins with nonsurgical management strategies including footwear or activity modification, physical therapy, and select interventions.
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Affiliation(s)
- Sara Lim
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Risks of injury in distal metatarsal minimally invasive osteotomy when comparing standard and modified techniques: A cadaveric study. Foot Ankle Surg 2022; 28:956-961. [PMID: 35153129 DOI: 10.1016/j.fas.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/06/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objectives of the study were to evaluate the structures at risk in distal metatarsal mini-invasive osteotomy (DMMO) and to compare standard and intraosseous approaches. METHODS DMMO was performed on the second and fourth metatarsals of 11 fresh-frozen cadaveric specimens. The standard technique was performed in 11 metatarsals. It was then compared to a modified intraosseous technique that entails starting inside the bone in 11 other metatarsals. The cadavers were dissected to identify unintentional injury to soft tissue structures. RESULTS In the standard group the most injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group injured the EDL (27%), not the MJC (0%) and the EDB (0%). Distances between osteotomies and the dorsal metatarsal head articular surface (DMHAS) were 6.08 ± 3.99 mm in the standard and 9.92 ± 3.42 mm in the modified (p = 0.02). CONCLUSION The DMMO techniques most frequently injured the EDL. Intra-articular positioning of the osteotomy was more observed in the standard. Overall, it appears the modified method could be an alternative to the standard DMMO. CLINICAL RELEVANCE The modified minimally invasive DMMO has a comparable rate of potential iatrogenic injuries. This intraosseous procedure may present as an option when planning surgery to the lesser metatarsals. LEVEL OF EVIDENCE Level III. Comparative Cadaveric Study.
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Fatima M, Ektas N, Scholes C, Symes M, Wines A. The effect of osteotomy technique (flat-cut vs wedge-cut Weil) on pain relief and complication incidence following surgical treatment for metatarsalgia in a private metropolitan clinic: protocol for a randomised controlled trial. Trials 2022; 23:690. [PMID: 35986383 PMCID: PMC9389692 DOI: 10.1186/s13063-022-06591-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/23/2022] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Michael Symes
- Department of Orthopaedic Surgery, St George Hospital, Sydney, Australia.
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia.
- Sydney Orthopaedic Foot and Ankle Research Institute, Sydney, Australia.
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, Australia.
- St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia.
| | - Andrew Wines
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
- Sydney Orthopaedic Foot and Ankle Research Institute, Sydney, Australia
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, Australia
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Naranjo-Ruiz C, Martínez-Nova A, Canel-Pérez MDLÁ, López-Vigil M, Ferrer-Torregrosa J, Barrios C. Influence of Foot Type on the Clinical Outcome of Minimally Invasive Surgery for Metatarsalgia. A Prospective Pilot Study. Front Surg 2021; 8:748330. [PMID: 34621784 PMCID: PMC8490922 DOI: 10.3389/fsurg.2021.748330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background and aims: Surgical procedures for central metatarsalgia seek to harmonise the metatarsal parabola with osteotomies that can be performed by minimally invasive techniques. However, the possible relationship of the foot type and the mid-term postoperative outcome is poorly described. The objective of this prospective pilot study was therefore to determine whether the foot type (pronate, neutral, or supinate) conditions the postoperative mid-term functional outcome. Methods: A series of 28 patients (6 men, 22 women) were treated for primary central metatarsalgia by means of minimally invasive distal metaphyseal osteotomy (DMMO). Results: Their functional outcomes at 6 and 12 months were assessed by the self-reporting AOFAS scale. Pre-surgery, the patients' scores were 42.82 ± 15.60. Scores improved at 6 months to 86.50 ± 8.6 and to 92.93 ± 8.6 at 12 months (p < 0.001 in both cases). There were no differences either by sex or by foot type in these overall values, although there was only a slight limitation of interphalangeal mobility in the supinated feet (p = 0.03) at 6-month follow-up as compared to other foot types. Conclusion: Hence, DMMO provides an optimal clinical and functional outcome for the surgical treatment of metatarsalgia, regardless of the patient's foot posture. The occurrence of adverse events was minimal and clinically irrelevant. Trial registration: The study was authorised by the Research Ethics Committee of the Universidad Católica de Valencia San Vicente Mártir, with the registry UCV/2018-2019/019.
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Affiliation(s)
- Carmen Naranjo-Ruiz
- Doctorate School, Catholic University of Valencia "San Vicente Mártir", Valencia, Spain.,Podiatry Department, Catholic University of Valencia "San Vicente Mártir", Valencia, Spain
| | - Alfonso Martínez-Nova
- Nursing Department, Podiatric Clinic of the University of Extremadura, Plasencia, Spain
| | | | | | | | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Catholic University of Valencia "San Vicente Mártir", Valencia, Spain
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Cooke R, Manning C, Palihawadana D, Zubairy AI, Khan SH. Metatarsalgia: anatomy, pathology and management. Br J Hosp Med (Lond) 2021; 82:1-8. [PMID: 34601927 DOI: 10.12968/hmed.2021.0348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metatarsalgia is a common presentation, particularly in middle-aged women. This review discusses the anatomical basis and classifies the different pathologies into primary, secondary and iatrogenic. The key elements to differentiate the pathologies within each classification which could cause a patient to suffer with metatarsalgia are outlined. Further investigations are briefly covered, but a linked article discusses the investigations of metatarsalgia in more detail. The article gives an overview of metatarsalgia to help clinicians to investigate and manage these symptoms.
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Affiliation(s)
- Robert Cooke
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christopher Manning
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Dhanushka Palihawadana
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Aamir I Zubairy
- Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Shah Hm Khan
- Department of Radiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Andrews NA, Ray J, Dib A, Harrelson WM, Khurana A, Singh MS, Shah A. Diagnosis and conservative management of great toe pathologies: a review. Postgrad Med 2021; 133:409-420. [PMID: 33622169 DOI: 10.1080/00325481.2021.1895587] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute great toe (Hallux) pain is a common complaint encountered by the primary care physician. Pathological conditions can vary from acute trauma to acute exacerbation of underlying chronic conditions. Delay in treatment or misdiagnosis can lead to debilitating loss of function and long-lasting pain. This review endeavors to discuss the pertinent history, physical exam findings, radiographic evidence, conservative treatment options, and surgical management for the musculoskeletal causes of acute and acute on chronic great toe pain in the adult population. The acute pathologies discussed in this review are hallux fractures and dislocations, turf toe, sand toe, and sesamoid disorders. The chronic pathologies discussed include hallux rigidus, hallux valgus, and chronic sesamoiditis.
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Affiliation(s)
- Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessyca Ray
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aseel Dib
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ankit Khurana
- Department of Orthopaedic Surgery, Dr. BSA Medical College, Rohini, Delhi, India
| | - Maninder Shah Singh
- Department of Orthopaedic Surgery, Indian Spinal Injuries Centre, Rohini, Delhi, India
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Żłobiński T, Stolecka-Warzecha A, Hartman-Petrycka M, Błońska-Fajfrowska B. The Influence of Short-Term Kinesiology Taping on Foot Anthropometry and Pain in Patients Suffering from Hallux Valgus. ACTA ACUST UNITED AC 2021; 57:medicina57040313. [PMID: 33810238 PMCID: PMC8066713 DOI: 10.3390/medicina57040313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Hallux valgus, one of the most common foot disorders, contributes to the formation of pain, changes foot proportions and hinders everyday functioning. In this study we wanted to verify if kinesiology taping improves hallux valgus and affects the position as well as reducing pain. Materials and Methods: Forty feet with hallux valgus were examined and the parameters were measured at three stages: before the kinesiology taping was applied, just after its application and after a month of use. Measurements were taken with a 3D scanner and a baropodometric platform. Results: When taping was applied, the hallux valgus angle decreased statistically significantly compared with pre-taping (p < 0.01). The use of taping for a month significantly reduced this angle compared with pre-taping (p < 0.05). Parameters such as foot length, the surface of the hindfoot and forefoot and hindfoot pressure on the ground changed. A change in the hallux position due to the taping produced significant changes in the perception of pain (p < 0.001). Conclusion: Kinesiology taping acts on the hallux valgus and foot position mechanically. This makes kinesiology taping an effective method of conservative treatment for patients who are not qualified for surgery.
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Ray J, Andrews NA, Dib A, Harrelson WM, Khurana A, Singh MS, Shah A. Management of acute lesser toe pain. Postgrad Med 2021; 133:320-329. [PMID: 33406375 DOI: 10.1080/00325481.2021.1873581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with foot pain commonly present to their primary care physicians for their initial management and treatment. These patients and their respective foot or lesser toe pain can present the physician with a complex problem with a long differential list. Depending on the timing of the pain and underlying pathology, these differentials can be divided into acute and acute exacerbation of chronic conditions. This review categorizes the history, physical exam, radiological findings, conservative treatment, and surgical management for each major cause of lesser toe pain, whether acute or chronic. The acute conditions surrounding lesser toe pain in the adult population discussed are toe fractures, toe dislocations, and metatarsal head and neck fractures. The chronic pathologies surrounding lesser toe pain in the adult population evaluated in this review include metatarsalgia, Morton's neuroma, Freiberg infraction, brachymetatarsia, bunionettes, and lesser toe disorders.
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Affiliation(s)
- Jessyca Ray
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aseel Dib
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ankit Khurana
- Department of Orthopaedic Surgery, Dr. BSA Medical College, Delhi, India
| | - Maninder Shah Singh
- Department of Orthopaedic Surgery, Indian Spinal Injuries Centre, Delhi, India
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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