Metatarsalgia and Toe Deformities
1. Generally, abnormal plantar pressure distribution around forefoot is thought to be a cause of metatarsalgia and etiologic factors of primary metatarsalgia proposed for metatarsalgia include incompetence of first ray, a long second metatarsal, excessive
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Metatarsalgia and Toe Deformities Dong Yeon Lee, Dong-Oh Lee, and Hong-Geun Jung
Keywords
Metatarsalgia • Intractable plantar keratosis • Morton’s neuroma • Freiberg disease • Sesamoid lesions • Lesser toe deformities • Metatarsal osteotomy
Intractable Plantar Keratosis (IPK) Introduction Pain localized to the forefoot region on weight bearing, which is called as metatarsalgia, has various etiologies. Etiologies of metatarsalgia can be classified as primary, secondary, and iatrogenic. Metatarsalgia is often accompanied with plantar keratosis (Table 3.1). Primary metatarsalgia includes conditions that are related to the anatomy of the metatarsals and the metatarsal correlation and the relative relationship D.Y. Lee, MD, PhD Department of Orthopedic Surgery, Foot and Ankle Service, Seoul National University Hospital, Seoul, Korea e-mail: [email protected] D.-O. Lee, MD Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea e-mail: [email protected] H.-G. Jung, MD, PhD (*) Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea e-mail: [email protected]
of metatarsal with rest of foot and ankle. Many of them may be associated with disorders of the hallux and lesser toes [21]. However, conditions of the midfoot, hindfoot, ankle, and lower leg also can contribute to development of metatarsalgia. Generally, abnormal plantar pressure distribution around forefoot due to anatomical predisposition is thought to be a cause of metatarsalgia. Etiologic factors of primary metatarsalgia proposed include Table 3.1 Classification of etiologies for metatarsalgia Primary metatarsalgia Relatively long lesser MT (2nd or 3rd) Plantar-flexed lesser MT Prominent fibular condyle of metatarsal head Hallux valgus with incompetence of first ray Cavus foot Ankle equinus Forefoot varus Secondary metatarsalgia Morton’s neuroma Freiberg disease Sesamoid lesions Lesser toe deformities due to inflammatory arthritis or neuromuscular imbalance Iatrogenic metatarsalgia
© Springer-Verlag Berlin Heidelberg 2016 H.-G. Jung (ed.), Foot and Ankle Disorders: An Illustrated Reference, DOI 10.1007/978-3-642-54493-4_3
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Fig. 3.1 Long 2nd metatarsal is often important etiology for lesser toe metatarsalgia with IPK
incompetence of first ray, a long second metatarsal, excessive plantar flexion of the forefoot, subluxated or dislocated metatarsophalangeal joint, abnormal foot postures, and contracture of the Achilles tendon complex. The metatarsal formula is based on the relative lengths of the first and second metatarsals [72]. When the first metatarsal is shorter than the second, the foot is known as the “index minus” type; when the first metatarsal is longer than the second, it is of the “index plus” type; and when the first and second metatarsals are of equal length, it is labeled “plus minus.” The “index minus” type is the most common metatarsal formula of about 60 % incidence and it forms the most common type of the primary metatarsalgia with relatively long lesser metatars
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