The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment

Cover Page

Abstract


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

D. S. Bobrov

Sechenov First Moscow State Medical University

Author for correspondence.
Email: dsbmed@mail.ru
ORCID iD: 0000-0002-1190-7498

Russian Federation

Кандидат медицинских наук, доцент кафедры травматологии, ортопедии и хирургии катастроф лечебного факультета.

Адрес: 119991, Москва, ул. Трубецкая, д. 8, стр. 2

SPIN-код2712-8348

L. J. Slinjakov

Sechenov First Moscow State Medical University

Email: slinyakovleonid@mail.ru
ORCID iD: 0000-0002-1088-5522

Доктор медицинских наук, доцент, профессор кафедры травматологии, ортопедии и хирургии катастроф лечебного факультета.

Адрес: 119991, Москва, ул. Трубецкая, д. 8, стр. 2.

SPIN-код7483-3524

N. V. Rigin

Sechenov First Moscow State Medical University

Email: nikolarigin@mail.ru
ORCID iD: 0000-0003-4034-2171

Ассистент кафедры травматологии, ортопедии и хирургии катастроф лечебного факультета.

Адрес: 119991, Москва, ул. Трубецкая, д. 8, стр. 2.

SPIN-код6333-1460

  1. Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int. 2012;33(2):133–140. doi: 10.1016/j.fuspru.2012.05.002.
  2. Deland JT, Lee KT, Sobel M, et al. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int. 1995;16(8):480–486. doi: 10.1177/107110079501600804.
  3. Gregg J, Marks P, Silberstein M, et al. Histologic anatomy of the lesser metatarsophalangeal joint plantar plate. Surg Radiol Anat. 2007;29(2):141–147. doi: 10.1007/s00276-007-0188-2.
  4. Jackson JB, Saltzman CL, Nickisch F. Plantar plate pathology and repair. Techniques in Foot & Ankle Surgery. 2014;13(3):121–127. doi: 10.1097/btf.0000000000000041.
  5. Johnston RB, Smith J, Daniels T. The plantar plate of the lesser toes: an anatomical study in human cadavers. Foot Ankle Int. 1994;15(5):276–282. doi: 10.1177/107110079401500508.
  6. Suero EM, Meyers KN, Bohne WH. Stability of the metatarsophalangeal joint of the lesser toes: a cadaveric study. J Orthop Res. 2012;30(12):1995–1998. doi: 10.1002/jor.22173.
  7. Bardelli M, Turelli L, Scoccianti G. Definition and classification of metatarsalgia. Foot Ankle Surg. 2003;9(2):79−85. doi: 10.1016/s1268-7731(02)00002-4.
  8. Doty JF, Coughlin MJ. Metatarsophalangeal joint instability of the lesser toes and plantar plate deficiency. J Am Acad Orthop Surg. 2014;22(4):235–245. doi: 10.5435/jaaos-22-04-235.
  9. Murphy GA. Lesser toe abnormalities. Metatarsophalangeal joint instability. In: Canale ST, Beaty J. Campbell’s operative orthopaedics. 12th ed. USA: Mosby; 2012. p. 3979–3981. doi: 10.1016/b978-0-323-07243-4.00083-9.
  10. Черкес-Заде Д.И., Каменев Ю.Ф. Хирургия стопы. Изд. 2-е, перераб. и доп. ― М.: Медицина; 2002. — 328 с. [Cherkes-Zade DI, Kamenev YuF. Khirurgiya stopy. 2nd ed. Moscow: Meditsina; 2002. 328 p. (In Russ).]
  11. Stanley JC, Stephens MM. Metatarsalgia. Diagnosis. In: Bentley G, editor. European surgical orthopaedics and traumatology. Berlin: Springer Berlin Heidelberg; 2014. p. 3524−3525. doi: 10.1007/978-3-642-34746-7_241.
  12. Nery C, Coughlin MJ, Baumfeld D, Mann TS. Lesser metatarsophalangeal jointinstability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int. 2012;33(4):301−311. doi: 10.3113/fai.2012.0301.
  13. DeCarbo WT, Dial DK. The Weil osteotomy: a refresher. Techniques in Foot & Ankle Surgery. 2014;13(4):191−198. doi: 10.1097/btf.0000000000000061.
  14. Migues A, Slullitel G, Bilbao F, et al. Floating-toe deformity as a complication of the Weil osteotomy. Foot Ankle Int. 2004;25(9):609−613. doi: 10.1177/107110070402500902.
  15. Highlander P, VonHerbulis E, Gonzalez A, et al. Complications of the Weil osteotomy. Foot Ankle Spec. 2011;4(3):165−170. doi: 10.1177/1938640011402822.
  16. Trnka HJ, Mühlbauer M, Zettl R, et al. Comparison of the results of the Weil and Helal osteotomies for the treatment of metatarsalgia secondary to dislocation of the lesser metatarsophalangeal joints. Foot Ankle Int. 1999;20(2):72−79. doi: 10.1177/107110079902000202.
  17. Trnka HJ, Gebhard C, Mühlbauer M, et al. The Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints: good outcome in 21 patients with 42 osteotomies. Acta Orthop Scand. 2002;73(2):190−194. doi: 10.1080/000164702753671795.
  18. Vandeputte G, Dereymaeker G, Steenwerckx A, Peeraer L. The Weil osteotomy of the lesser metatarsals: a clinical and pedobarographic follow-up study. Foot Ankle Int. 2000;21(5):370−374. doi: 10.1177/107110070002100502.
  19. Rochwerger A, Launay F, Piclet B, et al. [Static instability and dislocation of the 2nd metatarsophalangeal joint. Comparative analysis of 2 different therapeutic modalities. (In French).] Rev Chir Orthop Reparatrice Appar Mot. 1998;84(5):433−439.
  20. Davies MS, Saxby TS. Metatarsal neck osteotomy with rigid internal fixation for the treatment of lesser toe metatarsophalangeal joint pathology. Foot Ankle Int. 1999;20(10):630−635. doi: 10.1177/107110079902001003.
  21. O’Kane C, Kilmartin TE. The surgical management of central metatarsalgia. Foot Ankle Int. 2002;23(5):415−419. doi: 10.1177/107110070202300508.
  22. Jarde O, Hussenot D, Vimont E, et al. [Weil’s cervicocapital osteotomy for median metatarsalgia. Report of 70 cases. (In French).] Acta Orthop Belg. 2001;67(2):139−148.
  23. Gibbard KW, Kilmartin TE. The Weil osteotomy for the treatment of painful plantar keratosis. Foot (Edinb). 2003;13(4):199−203. doi: 10.1016/s0958-2592(03)00061-0.
  24. Podskubka A, Stědrý V, Kafuněk M. [Distal shortening osteotomy of the metatarsals using the Weil technique: surgical treatment of metatarsalgia and dislocation of the metatarsophalangeal joint. (In Czech).] Acta Chir Orthop Traumatol Cech. 2002;69(2):79−84.
  25. García-Rey E, Cano J, Guerra P, Sanz-Hospital FJ. The Weil osteotomy for median metatarsalgia. A short-term study. Foot Ankle Surg. 2004;10(4):177−180. doi: 10.1016/j.fas.2004.07.002.
  26. Gregg J, Silberstein M, Clark C, Schneider T. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot Ankle Surg. 2007;13(3):116−121. doi: 10.1016/j.fas.2007.01.001.
  27. Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int. 2008;29(8):871−879. doi: 10.3113/fai.2008.0000x.
  28. DePrado M. Minimally invasive foot surgery: a paradigm shift. In: Maffulli N, Easley M, editors. Minimally invasive surgery of the foot and ankle. London: Springer London; 2010. p. 3−11. doi: 10.1007/978-1-84996-417-3_1.
  29. Haque S, Kakwani R, Chadwick C, et al. Outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for lesser toe metatarsalgia. Foot Ankle Int. 2016;37(1):58−63. doi: 10.1016/j.fuspru.2016.04.002.
  30. Barg A, Courville XF, Nickisch F, et al. Role of collateral ligaments in metatarsophalangeal stability: a cadaver study. Foot Ankle Int. 2012;33(10):877−882. doi: 10.3113/fai.2012.0877.
  31. Бобров Д.С., Слиняков Л.Ю., Якимов Л.А., и др. Диафизарная корригирующая остеотомия scarf в лечении деформаций стоп // Кафедра травматологии и ортопедии. ― 2012. — №1 — С. 16–19. [Bobrov DS, Slinyakov LYu, Yakimov LA, et al. Diafizarnaya korrigiruyushchaya osteotomiya scarf v lechenii deformatsii stop. Kafedra travmatologii i ortopedii. 2012;(1):16−19. (In Russ).]

Views

Abstract - 19

PDF (Russian) - 10

Cited-By


PlumX



Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.