Effect of toe exercises and toe grip strength on the treatment of primary metatarsalgia
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(2020) 15:580
RESEARCH ARTICLE
Open Access
Effect of toe exercises and toe grip strength on the treatment of primary metatarsalgia Kentaro Amaha* , Tatsuya Arimoto and Nobuto Kitamura
Abstract Background: The relationship of metatarsalgia and toe function is poorly understood. We investigated the efficacy of toe exercises for the treatment of metatarsalgia. Methods: Forty-one (56 feet) metatarsalgia patients (mean age ± SD: 63.4 ± 10.6) underwent toe strength measurement. We recorded pre- and post-treatment VAS score, AOFAS score, marble pickup, single-leg standing time (SLST), and compared in two subgroups to evaluate impact of disease duration on treatment outcome. Results: Post treatment, toe plantarflexion strength improved (all p < 0.01); VAS scores decreased (p < 0.01); AOFAS scores, marble pickup, and SLST improved (all p < 0.01). Patients symptomatic for > 1 year had significantly lower changes in VAS scores (p < 0.01). Multivariate analysis showed patients with longer disease duration, and larger body mass index had significantly lower improvement in VAS scores (p = 0.029 and p = 0.036, respectively). Device consistency assessed by ICC was excellent (0.89–0.97). Conclusion: Toe function and metatarsalgia are improved by toe exercises, suggesting that they are closely related. Keywords: Toe exercise, Metatarsalgia, Conservative treatment, Toe grip strength, Chronic pain
Introduction Muscle mass decreases after approximately age 50 [1]. This age-related loss of muscle mass is termed “sarcopenia” and has been a focus of constant attention because of its association with mortality [2]. Lower ambulatory performance with aging is closely related to sarcopenia [3, 4]. In the lower extremities, the toes play a crucial role and assist stability during gait and balance tasks [5]. However, elderly patients tend to have decreased toe grip strength (TGS) of approximately 30%, compared to younger patients [6]. Loss of toe-muscle strength leads to impaired balance, thereby increasing the risk of falls [5]. Furthermore, toe grip weakness has been theorized
* Correspondence: [email protected] Department of Orthopedic Surgery, St Luke’s International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo 104-8560, Japan
to be associated with a range of forefoot deformities and disorders [7]. Metatarsalgia is one among the commonest conditions causing forefoot pain, characterized by pain in the front part of the foot, under the heads of the metatarsal bones. Metatarsalgia has various causes, including mechanical and iatrogenic factors [8]. Mechanical overload of the weightbearing structure is the fundamental etiology of primary metatarsalgia. Excessive forefoot loading is related to intrinsic abnormalities of metatarsal anatomy and gait mechanics [9]. With regard to gait mechanics, the toes play an important role in maintaining floor contact, which is shared with the metatarsal area during the toe-off phase in the gait cycle [10]. Therefore, the load on the forefoot is affected by the load on the toes. Thus, metatarsalgia seems to b
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