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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.
Foot and ankle
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Metatarsalgia usually occurs secondary to joint problems, overload or irritation of a nerve. Morton’s neuroma is a painful condition which in most cases arises from compression of the common digital nerve between the third and fourth metatarsal heads and is usually secondary to other forefoot pathology.
Vascular
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Arthritis also causes pain in the foot or ankle at rest, but tends to be localised to the joints or areas proximal to the toes. Metatarsalgia can occur at night and is relieved by standing, and can be confused with vascular night pain. However, metatarsalgia tends to run a fluctuating course, causing symptoms for several days or weeks with similar asymptomatic periods. Confusion can occur when the two conditions co-exist.
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
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.
Patient-reported outcomes of joint-preserving surgery for moderate hallux rigidus: a 1-year follow-up of 296 patients from Swefoot
Published in Acta Orthopaedica, 2020
Marcus E Cöster, Fredrik Montgomery, Maria C Cöster
With decompression YOT there have been concerns regarding postoperative development of metatarsalgia due to the shortening of the metatarsal bone. We asked patients at the 1-year follow-up what degree of plantar forefoot problems they experienced and in fact tendencies were that the cheilectomy group experienced more symptoms. At the very least there was similar symptomatology in both groups. Although plantar forefoot problems are not directly transferrable to a diagnosis of metatarsalgia this is an indication that there were no obvious differences in experienced problems and thus the concerns regarding postoperative metatarsalgia after decompression osteotomy seems to be a minor issue when deciding on the procedure for moderate HR.