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Nishikawa DRC, Duarte FA, Saito GH, da Silva DA, Mann TS, de Miranda BR, Mendes AAM, Prado MP. Is there a tolerance for extension of the first metatarsal after the Lapidus procedure? A clinical, functional, and hindfoot radiographic analysis. Int Orthop 2024; 48:103-109. [PMID: 37582981 DOI: 10.1007/s00264-023-05932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023]
Abstract
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.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Hospital Do Servidor Público Municipal de São Paulo, 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil.
- Department of Orthopaedic Surgery, Clínica de Ortopedia E Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil.
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Clínica de Ortopedia E Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP: 01308-050, Brazil
| | - Daniel Araújo da Silva
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil
| | - Tânia Szejnfeld Mann
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Hospital Do Servidor Público Municipal de São Paulo, 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
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Bobrov DS, Rigin NV, Lychagin AV, Artemov KD, Slinjakov LJ, Kachesov AV. Surgical Treatment of Metatarsalgia and Severe Instability of Lesser Metatarsophalangeal Joints. J Foot Ankle Surg 2024; 63:85-91. [PMID: 37714290 DOI: 10.1053/j.jfas.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 06/27/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
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.
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Affiliation(s)
- Dmitry S Bobrov
- The Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Botkin City Clinical Hospital, Moscow, Russian Federation
| | | | - Alexey V Lychagin
- The Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Botkin City Clinical Hospital, Moscow, Russian Federation
| | - Kirill D Artemov
- The Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Botkin City Clinical Hospital, Moscow, Russian Federation.
| | | | - Anton V Kachesov
- University clinic of Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
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Iannuzzi R, Caravelli S, Pungetti C, Di Ponte M, Zaffagnini S, Mosca M. Orthopaedic and plastic surgery collaboration in resolution of plantar heloma and metatarsalgia using lipofilling: a retrospective evaluation. Musculoskelet Surg 2023; 107:123-126. [PMID: 36637611 DOI: 10.1007/s12306-023-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- R Iannuzzi
- Department of Plastic Surgery, INI Istituto Neurodermatologico Italiano, Grottaferrata, Rome, Italy
| | - S Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - C Pungetti
- Department of Orthopaedics and Traumatology, Ospedale Maggiore "A. Pizzardi", Bologna, Italy
| | - M Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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4
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Kurtuluş B, Çevik HB, Aydın E. Comparison of modified Mitchell and Chevron osteotomies for hallux valgus. Foot Ankle Surg 2023; 29:239-242. [PMID: 36754688 DOI: 10.1016/j.fas.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 12/26/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
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.
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Affiliation(s)
- Burhan Kurtuluş
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Hüseyin Bilgehan Çevik
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey.
| | - Erbil Aydın
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey
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Rodríguez-Zamorano P, Galán-Olleros M, Manrique E, Puerto Velázquez MG, García-Maroto R, Galeote Rodríguez E, Marco F, Cebrián-Parra JL. Synovial Sarcoma of the Foot as an Atypical Cause of Persistent Metatarsalgia: A Report of 3 Cases. JBJS Case Connect 2022; 12:01709767-202209000-00024. [PMID: 35977038 DOI: 10.2106/jbjs.cc.22.00282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
| | - María Galán-Olleros
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Manrique
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Roberto García-Maroto
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Fernando Marco
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico San Carlos, Madrid, Spain
- Surgery Department, Complutense University, Madrid, Spain
| | - Juan Luis Cebrián-Parra
- Department of Traumatology and Orthopaedic Surgery, Hospital Clínico San Carlos, Madrid, Spain
- Surgery Department, Complutense University, Madrid, Spain
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De Prado-Ripoll J, De Prado M, Forriol F. [Clinical results of treatment of mechanical metatarsalgia without first metatarsal involvement]. Acta Ortop Mex 2021; 35:411-416. [PMID: 35451249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the clinical results of metatarsalgia treated with percutaneous distal metatarsal metaphyseal osteotomies (DMMO). MATERIAL AND METHODS Prospective and continuous study of 29 patients with isolated unilateral mechanical metatarsalgia, operated on with DMMO, with a mean follow-up of 38 months. The mean age of the patients was 58 (range: 50-67) years and only two men. We use the AOFAS score, we obtained the digital and metatarsal formulas on the X-rays. We record the subjective assessment of the surgeon and the patient at the end of the treatment. RESULTS The improvement in the final score exceeded 80 points in all cases (p = 0.000), with a significant improvement in pain (p = 0.000) and calluses (p = 0.000), improving metatarsal-phalangeal joint stability and interphalangeal and metatarsal alignment. The type of footwear did not change after surgery, we found no variation in mobility, neither in the metatarsophalangeal joints (p = 0.382), nor in the interphalangeal joints (p = 0.672). After surgery increased the square foot morphology (p = 0.027) but the metatarsal formula underwent few modifications. Patients and surgeons were in 96% of the cases "very satisfied" or "satisfied". CONCLUSION DMMO achieves a high degree of satisfaction in patients and in the surgeon, pain and hyperkeratosis under the head of the painful metatarsals disappear and that significantly improves the functional capacity of patients.
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Affiliation(s)
| | - M De Prado
- Hospital San Carlos, Quirón, Murcia, España
| | - F Forriol
- Facultad de Medicina, Universidad San Pablo-CEU, Campus de Montepríncipe, Madrid, España
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7
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Cobacho MT, Barcia JM, Freijó-Gutiérrez V, Caballero-Gómez F, Ferrer-Torregrosa J. A Predictive Model for Gastrocnemius Tightness in Forefoot Pain and Intractable Plantar Keratosis of the Second Rocker. J Am Podiatr Med Assoc 2021; 111:466720. [PMID: 34144595 DOI: 10.7547/18-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many people experience gastrocnemius tightness. Few studies demonstrate the relationship between gastrocnemius tightness and forefoot pathology. This study aimed to define the association between intractable plantar keratosis of the second rocker (IPK2) (also known as well-localized IPK or discrete keratosis) and metatarsalgia. METHODS The Silfverskiöld (ST) and lunge (LT) tests, used for measuring ankle dorsiflexion, were applied to diagnose gastrocnemius tightness. An instrument for measuring accurate performance and the force to be applied (1.7-2.0 kg of force to the ankle dorsiflexion) complemented the ST for clinical diagnosis and to obtain repeatedly reliable results (the authors apply force manually, which is difficult to quantify accurately). RESULTS Of 122 patients studied, 74 were used to devise a prediction model from a logistic regression analysis that determines the probability of presenting gastrocnemius tightness in each test (LT and ST) with the following variables: metatarsalgia, IPK2, and maximum static pressure (baropodometry). The IPK2 plays the principal role in predicting this pathology, with the highest Wald values (6.611 for LT and 5.063 for ST). Metatarsalgia induces a somewhat lower change (66.7% LT and 64.3% ST). The maximum pressure of the forefoot is equally significant (P = .043 LT and P = .025 ST), taking α < .05 as the significance level. CONCLUSIONS The results of this validation report confirm that a model composed of metatarsalgia, IPK2, and maximum pressure in static acts as a predictive method for gastrocnemius tightness.
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8
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Abstract
Metatarsus adductus (MA) is a congenital condition resulting in adduction of the forefoot at the tarsometatarsal joint, medial metatarsal deviation, supination of the hindfoot through the subtalar joint, and plantarflexed first ray. The exact underlying pathophysiology remains elusive. There is increasing evidence highlighting the importance of recognizing MA as an associated deformity that complicates management of hallux valgus (HV). Unfortunately, metatarsalgia and lesser toe pathology is also common in this population. We present a review regarding the epidemiology, pathomechanics, and a comprehensive surgical treatment algorithm to optimize the management of patients with MA, HV, lesser toe deformity, and metatarsalgia.
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Affiliation(s)
- Matthew Varacallo
- Department of Orthopaedic Surgery and Sports Medicine, Penn Highlands Healthcare System, 145 Hospital Avenue, Suite 301, DuBois, PA 15801, USA.
| | - Amiethab Aiyer
- University of Miami Miller School of Medicine, 900 Northwest 17th Street, Suite 10A, Miami, FL 33131, USA
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9
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Abstract
A fundamental etiologic component of metatarsalgia is the repetitive loading of a locally concentrated force in the forefoot during gait. In the setting of an isolated gastrocnemius contracture, weight-bearing pressure is shifted toward the forefoot. If metatarsalgia is considered an entity more than a symptom, evaluation of gastrocnemius contracture must be a part of the physical examination, and gastrocnemius recession via the Baumann procedure alone, or in combination with other procedures, considered as an alternative treatment in an attempt to restore normal foot biomechanics.
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Affiliation(s)
- Gastón Slullitel
- Department of Foot and Ankle Surgery, J Slullitel Institute of Orthopedics, San Luis 2534, Rosario 2000, Santa Fe, Argentina.
| | - Juan Pablo Calvi
- Department of Foot and Ankle Surgery, J Slullitel Institute of Orthopedics, San Luis 2534, Rosario 2000, Santa Fe, Argentina
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10
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Abstract
Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections. If conservative treatment fails, surgical options may be considered. [Orthopedics. 2019; 42(1):e138-e143.].
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Abstract
There are several forefoot conditions that can result in metatarsal head pain. Various points of the gait cycle can predispose the metatarsal heads to pain based on intrinsic and extrinsic imbalances. Metatarsalgia can further be classified according to primary, secondary, or iatrogenic etiologies. Within these groups, conservative management is the first line of treatment and can often obviate surgical intervention. Depending on the cause of pain, proper shoewear, orthoses, and inserts coupled with targeted physical therapy can alleviate most symptoms of metatarsalgia and lesser toe deformities.
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Affiliation(s)
- Andrew E Federer
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - David M Tainter
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Samuel B Adams
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Karl M Schweitzer
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA.
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12
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Abstract
Metatarsalgia is a common cause of plantar forefoot pain. Causes of metatarsalgia include foot anatomy, gait mechanics, and foot and ankle deformity. One specific cause, mechanical metatarsalgia, occurs because of gastrocnemius muscle contracture, which overloads the forefoot. Muscular imbalance of the gastrocnemius complex alters gait mechanics, which increases recruitment of the toe extensor musculature, thereby altering forefoot pressure. Patients with concomitant metatarsalgia and gastrocnemius contracture demonstrate ankle equinus and a positive Silfverskiold test. Nonoperative therapeutic modalities are mainstays of treatment. In patients in whom these treatments fail to provide metatarsalgia symptomatic relief, gastrocnemius muscle lengthening is a therapeutic option.
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Affiliation(s)
- Rose E Cortina
- Department of Orthopedic surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Brandon L Morris
- Department of Orthopedic surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Bryan G Vopat
- Department of Orthopedic surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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13
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Darcy SJ. Primary lung cancer presenting as foot pain: Cautionary case report. Can Fam Physician 2017; 63:453-454. [PMID: 28615396 PMCID: PMC5471084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Stephen J Darcy
- Family doctor and Assistant Professor in the Discipline of Family Medicine at Memorial University of Newfoundland in St John's.
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Toepfer A, von Eisenhart-Rothe R, Harrasser N. [Metatarsalgia: Differential diagnosis and therapy]. Wien Med Wochenschr 2016; 167:285-292. [PMID: 26935709 DOI: 10.1007/s10354-016-0445-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/08/2016] [Indexed: 11/27/2022]
Abstract
Metatarsalgia refers to localized or generalized forefoot pain in the region of the metatarsal heads. Symptoms can be isolated or in combination with accompanying deformities occurring in the forefoot and/or hindfoot. Anamnesis and clinical investigation usually yield to the diagnosis, the underlying cause on the other hand is not always easy to identify. In the foreground of the treatment is the exhaustion of conservative forms of therapy to minimize the symptoms of local pressure increase and callus under the metatarsal heads. In addition, various surgical methods are available, such as corrective osteotomy of the metatarsale bone, soft tissue interventions and the correction of associated deformities. The indications for surgical intervention should be made with caution in order to avoid failures and complaints persisting after surgery. The most common problems are an inadequate indication for surgery, technical problems and insufficient postoperative treatment.
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Affiliation(s)
- Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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Harrasser N, Toepfer A, Mühlhofer H, Lenze U, von Eisenhart-Rothe R. [Metatarsalgia: non-specific pain under the ball of the foot]. MMW Fortschr Med 2015; 157:45-7. [PMID: 26049350 DOI: 10.1007/s15006-015-3218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Sektion Fußorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
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Maddali Bongi S, Del Rosso A, Mikhaylova S, Landi G, Ferretti B, Cavigli E, Baccini M, Matucci-Cerinic M. A comparison of two podiatric protocols for metatarsalgia in patients with rheumatoid arthritis and osteoarthritis. Clin Exp Rheumatol 2014; 32:855-863. [PMID: 25436661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 03/12/2014] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Susanna Maddali Bongi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy.
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Abstract
Metatarsalgia, pain around the metatarsophalangeal joints, may arise from mechanical causes spontaneously or iatrogenically. Nonunion or malunion of the first metatarsal can transfer weight-bearing forces and overload the lesser metatarsals. Transfer metatarsalgia after failed hallux valgus surgery is troublesome and more prevalent than would be expected. Clinical examination of the patient allows identifying the type of transfer metatarsalgia and pathomechanics involved. This review focuses on transfer metatarsalgia after hallux valgus surgery and provides a basic understanding of the pathomechanics, clinical examination, and image studies. It also addresses the options for both conservative and surgical treatment of this challenging condition.
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Affiliation(s)
- Ernesto Maceira
- Faculty of Medicine, Universidad Europea Madrid, Calle Diego De Velazquez, 28223 Pozuelo De Alarcon, Madrid, Spain; Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirón Madrid, Madrid, Spain
| | - Manuel Monteagudo
- Faculty of Medicine, Universidad Europea Madrid, Calle Diego De Velazquez, 28223 Pozuelo De Alarcon, Madrid, Spain; Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirón Madrid, Madrid, Spain.
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18
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Abstract
Forefoot pain in the adult often alters mobility and has a negative impact on quality of life. Metatarsalgia describes pain localized to the forefoot. Forefoot pain may be caused by conditions of the lesser toes themselves (eg, hammertoes, mallet toes, claw toes). The pathophysiology of lesser toe deformities is complex and is affected by the function of intrinsic and extrinsic muscle units. In addition to lesser toe and metatarsal abnormality, forefoot pain can be attributed to interdigital neuritis, disorders of the plantar skin, and gastrocsoleus contracture. Treatment of these conditions may include shoe modifications, appliances, therapeutic exercises, and surgical repair.
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Affiliation(s)
- John A DiPreta
- Division of Orthopaedic Surgery, Albany Medical Center, Albany Medical College, Capital Region Orthopaedics, 1367 Washington Avenue, Suite 200, Albany, NY 12206, USA.
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19
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Ray A. [Metatarsalgia: diagnosis and treatment]. Rev Med Suisse 2013; 9:2366-2370. [PMID: 24693585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
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.
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20
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Zhang FQ, Pei BY, Wei ST, Zhao HT, Li ZY, Gao JG, Zhang YZ. [Correlative study between length of first metatarsal and transfer metatarsalgia after osteotomy of first metatarsal]. Zhonghua Yi Xue Za Zhi 2013; 93:3441-3444. [PMID: 24423907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the correlation between the length of first metatarsal, hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA1-2), plantar appearance, sesamoid position and postoperative 2-5 transfer metatarsalgia. METHODS Retrospective analysis was performed for the clinical data of 375 cases (626 feet) undergoing osteotomy of first metatarsal with mini-incision. All cases were examined radiographically via weight-bearing and lateral views. HVA, IMA1-2 and the length of first metatarsal were measured preoperatively and postoperatively. Forefoot plantar pressure was measured during walking by Foot scan system preoperatively and postoperatively. RESULTS After a mean follow-up period of 12-30 (18.5 ± 6.8) months, all patients had satisfactory bone healing without late healing or disunion. There were superficial wound infection (n = 1, 1 foot) and suture reaction (n = 1, 1 foot). HVA was 7.18° ± 4.55° postoperatively and corrected by 30.54°; IMA1-2 5.07° ± 1.70° and corrected by 12.33°. The number of shorting of first metatarsal during 0-2 mm was 424 feet, there was 1 case of transfer metatarsalgia at rays 4; the number during 2-4 mm was 186 feet, there were 5 cases of transfer metatarsalgia at rays 2. The center of pressure shifted laterally; the number during 2-4 mm was 16 feet, there were 4 cases of transfer metatarsalgia at rays 2 and 3. The center of pressure shifted evidently medially; the shorting of first metatarsal was 4.8 ± 0.46 mm. A negative correlation was found between length of metatarsal and transfer metatarsalgia at rays 2 and 3. No correlation existed between transfer metatarsalgia at rays 2 and 5, HVA and IMA1-2. A positive correlation existed between HVA decrease and patient satisfaction with their postoperative foot alignment. There was no correlation between lengthening of metatarsal and IMA1-2 decrease. CONCLUSION Length preservation of first metatarsal seems to prevent the postoperative transfer metatarsalgia on second and third rays. The shorting of first metatarsal should be no more than 2 mm.
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Affiliation(s)
- Feng-qi Zhang
- Department of Foot & Ankle, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China.
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21
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Abstract
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.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
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22
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Chadchavalpanichaya N, Katchamart W, Charatrungolan T, Nualnim P. The efficacy of adjustable toe splint on decreasing metatarsalgia in patients with lesser toe deformity: a prospective, randomized single-blinded controlled trial. J Med Assoc Thai 2012; 95:1575-1582. [PMID: 23390790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study the effectiveness in application of adjustable toe splint in decreasing metatarsalgia in patients with lesser toe deformity and the complication of adjustable toe splint usage. MATERIAL AND METHOD Thirty-six patients who had claw toes or hammer toes with metatarsalgia were enrolled in aprospective, randomized single-blinded controlled trial at the Out Patient Rehabilitation Medicine Clinic, Siriraj Hospital, Bangkok, Thailand between March and September 2011. Patients were randomized into two groups, the study group (using adjustable toe splint for 2 weeks) and the control group. Patients in both groups were advised as well to use proper shoes. RESULTS All patients in each group completed the study. The baseline characteristics of the patients in both groups were similar The present study group reported more decrease pain at metatarsal heads and dorsum of toes than the control group (p < 0.05). Two patients reported complications from toe splint usage as toe abrasions. CONCLUSION Using adjustable toe splint can decrease the metatarsalgia in patient with lesser toe deformity.
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Affiliation(s)
- Navaporn Chadchavalpanichaya
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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23
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Butts JF, Gebke KB. Getting injured runners back on track. J Fam Pract 2011; 60:646-652. [PMID: 22049346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
With more people running--and incurring lower extremity injuries--than ever before, you'll have many occasions to use this handy diagnostic and treatment guide.
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Affiliation(s)
- Jessica Favero Butts
- Department of Family Medicine and Sports Medicine, Indiana University Health Physicians, IN, USA.
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24
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Abstract
The purpose of this article is to address the isolated causes of osseous central metatarsalgia that are related to an elongated metatarsal and brachymetatarsalgia. The authors focus on surgically addressing shortened and elongated metatarsals, surgical complications, and revisional surgery.
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Affiliation(s)
- Catherine A Casteel
- Department of Podiatry, Hunt Regional Medical Center of Greenville, 4215 Joe Ramsey Boulevard, Greenvillle, TX 75401, USA.
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25
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Affiliation(s)
- A K Tausche
- Department of Internal Medicine, Section of Endocrinology and Rheumatology, University Clinic Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, Dresden, Germany.
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26
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Tsujii M, Hasegawa M, Hirata H, Uchida A. Subchondral insufficiency fracture of the second metatatarsal head in an elderly woman treated with autologous osteochondral transplantation. Arch Orthop Trauma Surg 2008; 128:689-93. [PMID: 17680255 DOI: 10.1007/s00402-007-0381-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Indexed: 11/30/2022]
Abstract
Freiberg's infraction is a rare disorder that arises mostly in adolescent athletes. We describe a 77-year-old woman with the collapse of second metatarsal head with similar clinical appearance to Freiberg's infraction. Radiological findings at initial visit of our hospital were normal. Her condition was obscure and magnetic resonance imaging showed the subchondral insufficiency fracture with bone marrow edema to the second metatarsal head. Despite the conservative treatment, the second metatarsal head collapsed. She was surgically treated with an osteochondral autograft without complications relating surgery. Furthermore, the histological findings showed that the site of collapse was considered to be secondary lesions resulting from the subchondral insufficiency fracture.
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Affiliation(s)
- Masaya Tsujii
- Department of Orthopaedic Surgery, Mie University Faculty of Medicine, Tsu city, Mie prefecture, Japan
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27
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Nemitz N, Van Linthoudt D. [What is your diagnosis? Aseptic necrosis of the medial sesamoid (Renander disease) and internal left sub-metatarsal bursitis]. Praxis (Bern 1994) 2007; 96:1342-4. [PMID: 17894117 DOI: 10.1024/1661-8157.96.36.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- N Nemitz
- Service de Rhumatologie, Médecine physique et Réhabilitation, Hôpital neuchâtelois, La Chaux-de-Fonds.
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28
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Abstract
Plantar interdigital neuroma, also called Morton neuroma, neuralgia, or metatarsalgia, is a perineural fibrosis that induces severe intermittent pain and paresthesia, most frequently between the third and fourth metatarsal heads. This compression syndrome or entrapment neuropathy involves one branch of the common plantar digital nerves. Diagnosis is based essentially on clinical examination. Imaging techniques may be useful in the diagnosis of atypical cases and postoperative recurrences. In most case, conservative treatment (such as orthotic shoes or devices or injections) is successful. When they do not succeed, surgery (neurolysis, neurectomy) may be considered.
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Affiliation(s)
- Patrick Decherchi
- Laboratoire des déterminants physiologiques de l'activité physique (UPRES EA 3285), Université de la Méditerranée (Aix-Marseille II), Institut fédératif de recherche Etienne-Jules Marey, CC910, Marseille.
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29
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Abstract
BACKGROUND Shortening of the first metatarsal is known to occur during hallux valgus surgeries. If the shortened first ray disrupts the normal weight transfer, then transfer metatarsalgia may result. After failed conservative treatment, a common operative option is an osteotomy of the lesser metatarsals. However, osteotomies of normal metatarsals further alter the normal anatomy and can significantly shorten the forefoot. Restoration of first metatarsal length using distraction osteogenesis may more closely restore normal foot anatomy and biomechanics and subsequently treat transfer metatarsalgia. METHODS Five patients had distraction osteogenesis for a shortened first metatarsal that resulted from a previous hallux valgus surgery. A four-pin single-plane external fixator was applied to the first metatarsal to lengthen the metatarsal under the principles of distraction osteogenesis. Lengthening was complete once the affected first metatarsal was equal to the length of the adjacent second metatarsal. RESULTS The mean consolidation period was 15.8 weeks. Preoperative and postoperative length of the first metatarsal was expressed as a percentage of the length of the ipsilateral second metatarsal. The preoperative mean was 77.1% and the postoperative mean was 93.8%. All osteotomies went on to consolidation, and no grafting or secondary procedures were needed. There were no postoperative infections, malrotation, or malalignment. All patients reported reduction in their forefoot pain and returned to a nonantalgic, full weightbearing gait. CONCLUSIONS This small series depicts the potential success of distraction osteogenesis for the iatrogenically shortened first metatarsal and associated transfer metatarsalgia.
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Affiliation(s)
- Jason M Hurst
- Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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30
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Tóth K, Huszanyik I, Kellermann P, Boda K, Róde L. The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy. Foot Ankle Int 2007; 28:61-3. [PMID: 17257540 DOI: 10.3113/fai.2007.0011] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of this study were to determine the severity of metatarsalgia of the second through fifth rays after shortening of the first ray for correction of hallux valgus deformity and patient satisfaction of the cosmetic results. METHODS Two hundred and forty metatarsal osteotomies (Wilson osteotomy as modified by Lindgren and Turan) were evaluated 4.19+/-1.29 years postoperatively. The procedure involved a slightly oblique subcapital osteotomy of the first metatarsal and fixation with one screw. RESULTS The average decrease in the hallux valgus angle was 26+/-5 degrees, the 1-2 intermetatarsal angle was 8.4+/-4 degrees, and the average shortening of the first metatarsal was 3.8+/-1.8 mm. Positive correlations were found between metatarsalgia of the second through fourth rays and first ray shortening (p<0.001 second ray, p<0.001 third ray, and p<0.001 fourth ray); there was no correlation between the fifth ray and first ray shortening. No correlation was found between a decrease in the hallux valgus angle or 1-2 intermetatarsal angle and metatarsalgia in the second through fifth rays. A positive correlation was detected between postoperative foot alignment and decrease in the hallux valgus (p<0.001) and a negative correlation between postoperative foot alignment and first ray shortening (p<0.01). No correlation was noted between postoperative foot alignment and the 1-2 intermetatarsal angle. CONCLUSION Excessive shortening of the first metatarsal should be avoided to decrease the occurrence of postoperative transfer metatarsalgia. We found a greater patient satisfaction with foot alignment in patients who had a greater decrease in the hallux valgus angle and less shortening of the first ray.
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Affiliation(s)
- Kálmán Tóth
- Department of Orthopaedics, University of Szeged, 6. Semmelweis Street, Szeged 6723, Hungary.
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31
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I'm 73 and in generally good health. Lately I've been experiencing a burning sensation and pain in the ball of my foot when I walk or stand. The problem occurs even when I'm barefoot or in socks and can be quite painful. The only thing that helps is getting off my feet. What's going on? Mayo Clin Health Lett 2006; 24:8. [PMID: 16865803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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32
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Potes CS, Neto FL, Castro-Lopes JM. Administration of baclofen, a γ-aminobutyric acid type B agonist in the thalamic ventrobasal complex, attenuates allodynia in monoarthritic rats subjected to the ankle-bend test. J Neurosci Res 2006; 83:515-23. [PMID: 16400658 DOI: 10.1002/jnr.20737] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
gamma-Aminobutyric acid type B (GABAB) receptors are involved in the modulation of neuronal activity in response to chronic noxious input. However, the effect of their activation in chronic inflammatory pain in relay thalamic nuclei such as the ventrobasal complex (VB) is not known. In this study, experimental groups of 2, 4, and 14 days monoarthritic (MA) rats were injected with saline (controls) or baclofen (0.875 microg), a specific GABAB receptor agonist, in the VB contralateral to the inflamed joint, and the ankle-bend test was performed. Ankle-bend scores in control animals were near the maximum and were rather constant throughout the entire experimental period, indicating severe nociception. The same was observed in 2 days MA rats injected with baclofen. In the 4 days MA group, the response to baclofen injection was inconsistent among different animals, whereas, in 14 days MA rats, baclofen caused clear antinociceptive effects. Additionally, a 0.5 microg dose of baclofen was tested in 14 days MA rats, but no effect was observed, whereas a 1.25 mug dose produced visible side effects. Baclofen injections that did not target the VB but reached neighboring nuclei were ineffective in reducing nociception. Data demonstrate that the activation of the GABAB receptors by baclofen in the VB of MA rats leads to a decrease of nociception. Moreover, the response depends on the time course of the disease, suggesting the occurrence of different excitatory states of thalamic VB neurons. In conclusion, GABAB receptors in the VB play an important role in chronic inflammatory pain processing.
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Affiliation(s)
- Catarina Soares Potes
- Institute of Histology and Embryology, Faculty of Medicine and IBMC, University of Porto, Porto, Portugal
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33
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Abstract
OBJECTIVE To evaluate the effectiveness of foot orthoses using the foot function index (FFI) in a group of patients with rheumatoid arthritis (RA) during a period of 6 months. METHODS Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient's needs. All the patients were evaluated 30, 90 and 180 days after the baseline visit. FFI values, daily time of wearing the orthoses and adverse effects were noted at each appointment. The Stanford Health Assessment Questionnaire (HAQ) was used at the initial visit to evaluate the influence of physical condition on FFI response. RESULTS With the use of foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation). This reduction was noted in the first month and was maintained throughout the trial. Those using EVA (ethyl-vinyl acetate; n = 28) orthoses presented results similar to those for the total group. Patients wearing made-to-measure orthoses (n = 8) exhibited higher initial FFI values and worse evolution during the trial, significant for pain and disability but not for activity limitation. Minor adverse reactions were noted; none required interruption of treatment. There was no relation between HAQ and FFI evolution. CONCLUSIONS Foot orthoses were effective as an adjuvant in the management of rheumatoid foot. They significantly reduced pain, disability and activity limitation, as measured by the FFI, with minor adverse effects.
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Affiliation(s)
- E de P Magalhães
- Disciplina de Reumatologia, Departamento de Clínica Médica, FCM/UNICAMP, Campinas (SP), Postal 6111-CEP 13083-970, Brazil.
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34
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Abstract
We prospectively evaluated the one- and seven-year results of the Weil osteotomy for the treatment of metatarsalgia with subluxed or dislocated metatarsophalangeal joints in 25 feet of 24 patients. Good to excellent results were achieved in 21 feet (84%) after one year and in 22 (88%) after seven years. The American Orthopaedic Foot and Ankle Society score significantly improved from 48 (sd 15) points before surgery to 75 (sd 24) at one year, and 83 (sd 18) at seven years. The procedure significantly reduced pain, diminished isolated plantar callus formation and increased the patient’s capacity for walking. Redislocation of the metatarsophalangeal joint was seen in two feet (8%) after one year and in three (12%) after seven years. Although floating toes and restricted movement of the metatarsophalangeal joint may occur, the Weil osteotomy is safe and effective.
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35
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Abstract
OBJECTIVE To determine whether foot shape (flat, normal, or cavus feet) affects functioning among military recruits. METHODS A total of 230 Royal Australian Air Force recruits embarking on a 10-week basic training course took part in a prospective cohort study of foot shape and its effect on functioning. Recruits were divided into three groups based on their foot shape, i.e., flat feet (n = 22), normal feet (n = 139), and cavus feet (n = 44), with the diagnosis being made from the arch index measured from their footprints. The groups were assessed at baseline and week 8. Outcome measures included pain, injury, foot health, and quality of life. RESULTS There were no significant differences in outcome measures at baseline. At the end of the trial, foot shape was not related to injury. The flat feet group had significantly poorer subjective physical health than did the normal feet group (p = 0.001). CONCLUSION This study provides high-level evidence that foot shape has little impact on pain, injury, and functioning among military recruits.
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Affiliation(s)
- Adrian Esterman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Bedford Park, South Australia, SA 5042, Australia
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36
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Abstract
For the correction of hallux valgus, as one of the most common deformities of the lower limbs, a modified Lapidus arthrodesis is applied at the base of the hallux. After using a lateral tissue technique with medial capsular reefing, a general arthrodesis of the tarsometatarsal 1 joint is carried out. An unstable hallux is the indication for a classic Lapidus arthrodesis. Before determination of the indication, an exact clinical x-ray examination should be made in the dorsoplanar position as well as laterally standing. Complications associated with the Lapidus arthrodesis are postoperative metatarsalgia and pseudoarthrosis. Advantages of this technique are, for example, a high correction potential and better healing, although the surgical technique and post-operative care are more time consuming than for other methods.
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37
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Abstract
Metatarsalgia is explained as localized or more diffuse tenderness beneath the metatarsal heads. The pain may be attributed to various etiologies. Pathological changes affecting the positional relationship of the metatarsals in the sagittal plane can cause increased pressure and friction forces during weight bearing. Since the length of the metatarsals displays a wide range of disparity only a few pathological settings, i.e., brachymetatarsia, require surgical correction. Beside those disorders of positional relationship, metatarsalgia may be due to lesser toe deformities, osteonecrosis of a lesser metatarsal head (Koehler's disease), and neurological disorders (Morton's neuroma). Apart from the etiology increased load, which is transferred to the central metatarsals, can be treated successfully with orthotic devices. If conservative measures fail, surgical treatment can be indicated. Prior to any operative therapy it is mandatory to perform a detailed analysis of the underlying pathology to avoid persistent pain or recurrence of the deformity.
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Affiliation(s)
- R A Fuhrmann
- Orthopädie, Rudolf-Elle-Krankenhaus Jena, Friedrich-Schiller-Universität, Eisenberg.
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38
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Hakimi R. [Comprehensive radiologic-nuclear imaging to evaluate pain in the right foot]. Versicherungsmedizin 2004; 56:200. [PMID: 15633775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- R Hakimi
- HALLESCHE Krankenversicherung a. G., Stuttgart
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39
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Abstract
This study reviews historical and biomedical aspects of soldier load carriage. Before the 18th century, foot soldiers seldom carried more than 15 kg while on the march, but loads have progressively risen since then. This load increase is presumably due to the weight of weapons and equipment that incorporate new technologies to increase protection, firepower, communications, and mobility. Research shows that locating the load center of mass as close as possible to the body center of mass results in the lowest energy cost and tends to keep the body in an upright position similar to unloaded walking. Loads carried on other parts of the body result in higher energy expenditures: each kilogram added to the foot increases energy expenditure 7% to 10%; each kilogram added to the thigh increases energy expenditure 4%. Hip belts on rucksacks should be used whenever possible as they reduce pressure on the shoulders and increase comfort. Low or mid-back load placement might be preferable on uneven terrain but high load placement may be best for even terrain. In some tactical situations, combat load carts can be used, and these can considerably reduce energy expenditure and improve performance. Physical training that includes aerobic exercise, resistance training targeted at specific muscle groups, and regular road marching can considerably improve road marching speed and efficiency. The energy cost of walking with backpack loads increases progressively with increases in weight carried, body mass, walking speed, or grade; type of terrain also influences energy cost. Predictive equations have been developed, but these may not be accurate for prolonged load carriage. Common injuries associated with prolonged load carriage include foot blisters, stress fractures, back strains, metatarsalgia, rucksack palsy, and knee pain. Load carriage can be facilitated by lightening loads, improving load distribution, optimizing load-carriage equipment, and taking preventive action to reduce the incidence of injury.
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Affiliation(s)
- Joseph J Knapik
- Directorate of Epidemiology and Disease Surveillance, U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010, USA
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40
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Trzeciak T, Pucher A. [Morton's Metatarsalgia--a case report]. Chir Narzadow Ruchu Ortop Pol 2004; 69:413-5. [PMID: 15913029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors describe the case of a 51 years old woman with interdigital neuroma at a level of II and IV metatarsal heads--Morton's Metatarsalgia.
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Affiliation(s)
- Tomasz Trzeciak
- Katedra i Klinika Ortopedii, Akademia Medyczna im. Karola Marcinkowskiego w Poznaniu
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41
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Abstract
In the reconstruction of the hip, knee, or any other joint, preoperative planning is necessary for avoiding mistakes during surgery. Since 1995, the authors have been doing this before forefoot surgery to increase the accuracy of the surgery. As much as possible, they try to correct only the lesion and to avoid preventive or extensive surgery on adjacent rays, except if the correction leads to a modified dysharmonious new morphotype with high risk of transfer lesion. The tolerance length seems to be 2 mm, particularly on the middle metatarsals (M2 and M3). This surgery should be performed only if the midfoot and backfoot are correct and if the gastrocnemius muscle has been checked on to eliminate a retraction needing stretching exercises before and generally after surgery.
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Affiliation(s)
- Michel Maestro
- Les Balcons Port de St. Laurent, 139 Avenue Mauice Donat, 06700 Saint Laurent Du Var, France.
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42
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Abstract
AIM The purpose of the prospective study is to evaluate the results of Weil osteotomy in painful overloaded central forefoot with dislocation of the MTP joint. METHOD 19 left and 16 right feet underwent the Weil osteotomy. In 10 patients the procedure was performed on both feet. In 15 cases only one metatarsal was corrected (the 2 (nd) in 12 and the 3 (rd) in 3 cases), in 17 cases both the 2 (nd) and the 3 (rd) metatarsals and in 4 cases also with the 4 (th) one together. The simultaneous correction of hallux valgus was performed in 19 forefeet. The mean follow-up was 31 months (range, 19 to 41 months). RESULTS All patients were satisfied with the result of the operation. The results were excellent in 29 cases (83 %) and good in 6 cases (17 %). The plantar callus disappeared in 27 feet (77 %) and decreased in 8 feet (23 %). In one patient the new callus formed under the head of the neighbouring metatarsal bone. The sufficient MTP joint reduction was found in 31 cases (89 %). CONCLUSION It is possible with the Weil osteotomy to correct the metatarsal length accurately according to the preoperative planning. This results in the prevention of new callus formation under the neighbouring metatarsal head. Stable internal fixation allows the early mobilisation of the MTP joint.
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Affiliation(s)
- R Hart
- Unfallkrankenhaus, Universitätsklinik für Unfallchirurgie, Brno, Czech Republic.
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Sharp RJ, Wade CM, Hennessy MS, Saxby TS. The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms. ACTA ACUST UNITED AC 2003; 85:999-1005. [PMID: 14516035 DOI: 10.1302/0301-620x.85b7.12633] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated 29 cases, diagnosed clinically as having Morton’s neuroma, who had undergone MRI and ultrasound before a neurectomy. The accuracy with which pre-operative clinical assessment, ultrasound and MRI had correctly diagnosed the presence of a neuroma were compared with one another based on the histology and the clinical outcome. Clinical assessment was the most sensitive and specific modality. The accuracy of the ultrasound and MRI was similar and dependent on size. Ultrasound was especially inaccurate for small lesions. There was no correlation between the size of the lesion and either the pre-operative pain score or the change in pain score following surgery. Reliance on single modality imaging would have led to inaccurate diagnosis in 18 cases and would have only benefited one patient. Even imaging with both modalities failed to meet the predictive values attained by clinical assessment. There is no requirement for ultrasound or MRI in patients who are thought to have a Morton’s neuroma. Small lesions, < 6 mm in size, are equally able to cause symptoms as larger lesions. Neurectomy provides an excellent clinical outcome in most cases.
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Affiliation(s)
- R J Sharp
- The Brisbane Foot and Ankle Centre, Queensland, Australia
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Keogh C, Torreggiani WC, Al-Ismail K, Munk PL. Musculoskeletal case 25. Morton's neuroma. Can J Surg 2002; 45:448, 467-8. [PMID: 12500922 PMCID: PMC3684661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Affiliation(s)
- Ciaran Keogh
- Department of Radiology, Vancouver General Hospital, Vancouver, BC
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Abstract
The purpose of this study was to analyze the plantar loading patterns in patients with hallux valgus (HV) with and without symptoms of metatarsalgia in order to find predictive pressure variabilities which are likely to result in metatarsalgia. Two groups of subjects (100 feet) volunteered for this study. Both groups provided the diagnosis of HV deformity. Group A (50 feet) exhibited a metatarsalgia symptomatology, whereas group B was asymptomatic. Plantar loading patterns were assessed using the two-step method and data were collected by the use of a capacitive pressure measurement platform. For each patient, 10 acceptable trials were collected. For the analysis, the foot was divided into six plantar regions: heel, midfoot, medial forefoot, lateral forefoot, medial toe, and lateral toe. Maximal peak pressure (PP, N/cm2), pressure-time integral (P/T integral, N/cm2*s), and force-time integral (%) were calculated. In group A, loading patterns (PP, P/T integral) of the lateral forefoot were significantly higher than in group B. The mediolateral pressure transfer from the big toe to the lateral metatarsal region was significantly greater in group A compared to group B. Regarding the lateral forefoot, a pressure time integral < 10 N/cm2*s was indicative of asymptomatic HV feet, whereas in symptomatic HV feet, a pressure time integral >28 N/cm2*s was observed. These results were statistically significant at the p < .01 level.
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Affiliation(s)
- Ute Waldecker
- Orthopaedic Department, Werra Klinik, Allendorf, Germany.
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Abstract
The purpose of this study was to consider the causes of patient dissatisfaction following foot surgery and review whether poor outcomes are more commonly associated with particular techniques. Two hundred forty-four patients who had previously undergone foot surgery were referred to a podiatric surgery service because of continued pain, disability, footwear-fitting problems, and cosmetic concerns. The majority of cases had previously undergone first ray surgery to correct hallux valgus. The most common reason for referral was transfer metatarsalgia followed by recurrence of hallux valgus and lesser digit deformity. Thirty-two patients were treated with conservative measures, including orthoses and cortisone injections. Eight patients (25%) were completely satisfied with conservative treatment, 20 patients (63%) were satisfied with reservations, and four patients (12.5%) were dissatisfied. One hundred seventy-six patients underwent revision surgery. High patient satisfaction was achieved with surgical revision with 123 patients (69%) completely satisfied at an average 5.6-month follow-up, 43 patients (24%) were satisfied with reservations, while 10 patients (6%) were dissatisfied. Complications occurred in 23 patients (13%) with nine cases developing a superficial postoperative infection. In reviewing this series of patients, it is apparent that poor surgical outcomes and the need for revision surgery could in many cases be prevented with selection of surgical techniques that avoid joint destruction, excessive shortening of single metatarsals, and digital amputation.
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Affiliation(s)
- T E Kilmartin
- Department of Podiatric Surgery, Ilkeston Hospital, UK.
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