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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 metatarsophalangeal joints enable the weight-bearing foot to rotate over the toes when rising during gait. The metatarsal break is the oblique axis that lies through the second to fifth metatarsal heads (Figure 3.9), around which dorsiflexion of metatarsophalangeal joints occurs. The obliquity of the axis allows the weight to be distributed evenly across the metatarsal heads and toes, as an axis orthogonal to the longitudinal axis of the foot would lead to disproportionate loading of first and second metatarsals. The metatarsal break also facilitates external rotation of the leg at toe-off.3 The metatarsophalangeal joints are stabilised mainly by plantar plates, collateral ligaments, as well as by the joint capsule and deep transverse metatarsal ligament.
Surgery
Published in Seema Khan, Get Through, 2020
For each case below, choose the SINGLE most likely cause from the list of options. Each option may be used once, more than once or not at all. A 50-year-old man presents with pain over the medial calcaneum and pain on dorsiflexion and eversion of the forefoot.A 60-year-old man complains of continual pain in his forefoot worse when walking. A radiograph shows widening and flattening of the second metatarsal head and degenerative changes in the metatarsophalangeal joint.A 50-year-old woman complains of shooting pains in her right foot when walking. There is tenderness in the third/fourth toe interspace.A 30-year-old soldier complains of pain in his foot when weight bearing. A radiograph shows no fracture. There is tenderness around the proximal fifth metatarsal bone.A 20-year-old man complains of pain over the lateral aspect of his right foot. A radiograph shows a transverse fracture of the basal shaft of the fifth metatarsal bone.
The Musculoskeletal System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Gout is diagnosed by its painful arthritis, most frequently in the first toe joint (the metatarsophalangeal joint between the metatarsal and phalanx), along with an elevated serum urate level (hyperuricemia) and eventually tophi deposits and kidney stones (nephrolithiasis). If the uric acid level is not elevated, analysis of synovial fluid will still show urate crystals in the white blood cells. Acute gout is treated with colchicine, nonsteroidal anti-inflammatory agents, or corticosteroids. For recurrent episodes, uricosuric agents such as probenecid and sulfinpyrazone are utilized to prevent increased serum urate levels. Allopurinol is used to decrease uric acid production. Additional terms associated with this disorder include monosodium urate, purines, and podagra.
Sequential ultrasound in arthralgia patients at risk for inflammatory arthritis: is it of added value in risk stratification?
Published in Scandinavian Journal of Rheumatology, 2023
C Rogier, MC Kortekaas, AHM van der Helm-van Mil, PHP de Jong, E van Mulligen
Arthralgia patients were consecutively included in the Rotterdam clinically suspect arthralgia (CSA) cohort (2017–2020). At baseline and 4 months thereafter, a bilateral MSUS examination was performed of joints and tendon sheaths in the hands, wrists, and forefeet. Subclinical inflammation was defined as grey scale (GS) ≥ 2 and/or power Doppler (PD) > 0, scored according to OMERACT guidelines (5, 6). Results were corrected for findings based on a large MSUS study in a symptom-free population; the cut-off value for subclinical inflammation in metatarsophalangeal joint 2–3 was considered present if GS ≥ 3 and/or PD ≥ 1 (7). Patients were followed for 1 year for the development of IA, identified by physical examination by experienced rheumatologists. The value of MSUS was studied separately for patients with and without subclinical inflammation at first presentation. In a sensitivity analysis, an anti-citrullinated protein antibody (ACPA) stratification and a stratification for the presence of tender joints [tender joint count in 44 joints (TJC44)] were applied. The calculated percentages of IA development were based on the number of patients at baseline. Detailed descriptions of the cohort and MSUS protocol are presented in Supplementary file 1. Stata software version 17 was used to analyse the data.
The dysmorphic metatarsal parabola in diabetes—clinical examination and management: a narrative review
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
AT Thompson, B Zipfel, C Aldous
The metatarsal parabola functions to provide stability during the stance and propulsive portion of gait, as weight is transferred to the metatarsal heads.18 Morton’s concept of lateral movement of pressure states that, if the first metatarsal is too short, it cannot assume the body weight in a balanced way and thus compensatory changes in foot posture might occur.18 A study found that patients with a Morton’s toe registered higher pressures beneath the second metatarsal (mean of 320 kPa) compared with a non-Morton foot control group (mean 243 kPa).29 A further study found that 60% of patients who presented with metatarsalgia (ball-of-the-foot pain) displayed lesser metatarsophalangeal joint instability.30 One study considered that the cause of lesser metatarsophalangeal joint symptoms was a deficit in first ray weight-bearing.31 In a critical analysis of Morton’s concepts, a review found support for Morton’s notion that weight can shift laterally in individuals who have a short first ray.32
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
Lesser toe deformities should be referred to a foot and ankle orthopedic surgeon or podiatrist if the patient complains of severe pain, difficulty with wearing shoes, recurrent ulceration, interference with foot hygiene or their deformity progresses despite conservative treatments. Cosmetic concerns are not an indication for surgery. Surgical intervention is determined by the relative flexibility of the deformity and the presence or absence of associated metatarsophalangeal joint deformity or instability. Patients must have adequate vascularity to heal surgical sites before successfully addressing the deformity. Fixed hammer-toe/claw toes deformities can be successfully treated with proximal interphalangeal joint resection arthroplasty or fusion with high patient satisfaction and low complication rates.