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Biomechanics of the foot and ankle
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Sheraz S Malik, Shahbaz S Malik
The forefoot comprises metatarsophalangeal and interphalangeal joints. The first metatarsal is the broadest and shortest of all metatarsals and bears 50% of weight acting on the foot. The second metatarsal is usually the longest and as a part of the rigid second ray experiences high stresses, and consequently stress fractures are more common in this metatarsal.5
The ankle and foot
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
The forefoot. This is involved in the many causes of metatarsalgia, especially pes cavus, March fracture, hallux rigidus and Morton’s neurofibroma. Also, in the elderly, the fatty pad of the sole may degenerate, causing the patient to complain that it is like ‘walking on marbles’. Rheumatoid arthritis and gout may affect the forefoot, the latter condition most commonly affecting the first metatarsal joint of the great toe. Toe deformities such as hallux rigidus, hammer toes, claw toes and bunions all cause metatarsalgia.
The limbs and soft tissues
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Talipes equinovarus may be secondary to postural compression of the foot during the third trimester or an underlying neurological defect (e.g. spina bifida), but is more often an intrinsic abnormality of the foot. The forefoot is adducted and the entire foot is inverted and supinated. If clinical examination reveals limitation of passive movement, immediate treatment is required since the joints are lax in the first few weeks after birth, allowing rapid correction by serial casting or splints.
Surgical treatment of macrodactyly of the foot in children
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Lu Chen, Wei Huang, Wei Chen, Xiaofei Tian
Of the varied treatment options, we particularly focused on debulking and ray resection. Although it is recommended to stage an operation when two sides of the toe are involved, we performed debulking of both sides of the affected toe simultaneously, as this could reduce the number of surgical interventions; however, digital arteries needed to be protected carefully. Moreover, soft tissue debulking of the dorsal and plantar aspects of the forefoot, which is usually ignored [14], is very important, in order to reduce the height of the affected forefoot and improve shoe comfort. Kim et al. [18] introduced ray resection in patients with metatarsal involvement, a motionless toe, or the involvement of more than one toes as indicators for surgery. More items should be added to this list to account for the diverse clinical characteristics of pedal macrodactyly and enable cautious consideration of ray resection. In addition to the location of the involved metatarsal, the severity of the deformity, the location of the affected elements, and any additional pathology, as well as expectations of the patients or parents, must be taken into account. In the foot where the first metatarsal is involved, osteotomy, rather than resection of the first metatarsal, was performed, as the first toe substantially contributes to weight-bearing and normal gait.
Management of acute lesser toe pain
Published in Postgraduate Medicine, 2021
Jessyca Ray, Nicholas A. Andrews, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
Metatarsalgia is defined as pain on the plantar aspect of the forefoot most commonly under the 2nd and 3rd metatarsal heads and, more rarely, involves the 4th metatarsal head [7,19,20]. Metatarsalgia can be the result of anatomical abnormalities or trauma to the foot and ankle [8]. To correctly identify the cause of metatarsalgia, careful attention should be given to locate the exact point of maximal tenderness and pain on physical exam [7,21]. Any plantar keratoses should be noted as they are the result of abnormal loading on the metatarsal heads [8]. Typically, patients present with pain under the metatarsal heads that is increased upon walking or wearing tight shoes. The formation of calluses under the respective metatarsal heads may be seen as well.
Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery
Published in Modern Rheumatology, 2021
Koji Ohta, Jun-ichi Fukushi, Satoshi Ikemura, Satoshi Kamura, Hisa-aki Miyahara, Yasuharu Nakashima
The JSSF scales evaluate three major features: pain, function, and alignment [9]. In the present study, both the preoperative total and pain scores on the JSSF Lesser toe scales were significantly lower in the Delayed healing group. This provokes the question of how pain in the lesser toes affects wound healing after rheumatoid forefoot surgery. One possible explanation is that latent infection in the plantar callus causes pain preoperatively and impairs wound healing postoperatively. However, there were no signs suggestive of infection identified intraoperatively in the lesser toes. Moreover, all the deep wound infections that occurred in the present study (n = 5) were around the hallux (Table 2). Another plausible explanation is that postoperative higher skin tension is likely above joints with severe pain, because of preoperative joint contracture [12]. Indeed, an association between preoperative joint contracture and postoperative skin tension during wound healing following rheumatoid forefoot surgery has previously been suggested [4].