Materiały źródłowe

• #1 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. […] As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads. […] Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues. […] Hammertoe deformity causes metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal head. […] Some anatomic conditions may predispose individuals to forefoot problems, such as the following. […] Iatrogenic changes from surgeries such as osteotomies can change the anatomy of the foot, resulting in unequal force distribution and metatarsalgia.

• #1 [The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment] – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29308853/

  This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. […] Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

• #2 Managing metatarsalgia in athletic populations | Lower Extremity Review Magazine

  https://lermagazine.com/article/managing-metatarsalgia-in-athletic-populations

  Metatarsalgia is a common foot disorder. The term metatarsalgia refers to a pain syndrome in the forefoot and not to a specific diagnosis. Pain is confined to the area across the plantar forefoot, including the second through fourth metatarsal heads. However, it is frequently accompanied by deformity of the first and fifth rays, as well as the toes. Many different diagnoses have been identified as the cause of the painful forefoot. Excessive stress may result in ligamentous strain, synovitis, capsulitis, stress fracture, or degenerative arthritis. Metatarsalgia may be associated with a tight Achilles tendon (equinus), cerebral palsy, stroke, multiple sclerosis, or other neurological diseases. Metatarsalgia also results from pathological alterations in forefoot structure due to hallux valgus, hallux limitus, rheumatoid arthritis, osteomyelitis, or osteochondrosis (Freiberg disease). Circulatory or metabolic disorders may also be associated with metatarsalgia. Brachymetatarsia, an arrest of normal metatarsal growth and development with a resultant short ray, may cause symptoms. A Morton neuroma or other nerve injuries may be associated with forefoot pain. Hammertoes can occur in association with joint dislocation, and may contribute. Cavus foot and pes planus foot types have both been associated with metatarsalgia. Cavus foot type as well as pes planus with hypermobile first and fifth rays have been associated with increased shearing at the forefoot. Metatarsal weightbearing is increased with the cavus foot because a disproportionate amount of weight is borne by the heel and forefoot. It is not uncommon to observe retracted or clawed toes with cavus feet, which decreases the ability to unload the metatarsals at push-off. The pes planus foot type (resulting from genu valgum, rearfoot valgus, or forefoot varus) remains pronated during midstance and inhibits proper supination, which compromises the propulsive function of the forefoot. Although plantar fat pad loss makes sense intuitively as a cause of metatarsalgia, a study by Waldecker suggests the two may not be associated; more research needs to be done. Unintended iatrogenic metatarsalgia after bunion surgery can be the result of a short first metatarsal or elevation of the first ray. Primary metatarsalgia is structuralan anatomical abnormality resulting in increased pressure under the metatarsal heads. Examples include hallux rigidus, long or short metatarsal bones, and possibly pes cavus. Treatment should be focused on offloading the metatarsal heads and should mechanically direct force away from the point of pressure. Secondary metatarsalgia is defined as pain that does not originate within the metatarsal area. Conditions such as rheumatoid arthritis, sesamoiditis, and equinus can all lead to localized pain at the ball of the foot. The origin of metatarsalgia can be multifactorial. Scranton found that 31 of 98 patients had two or more mechanical etiologies for primary metatarsalgia, and that often, primary and secondary metatarsalgia existed together. Effective treatment will address the area of pain, the function of the foot, and, if necessary, the systemic disease. Scranton found 23 different diagnoses of metatarsalgia in 98 patients. Forty-five patients had primary metatarsalgia, 12 of whom had static disorders and 12 of whom had iatrogenic (postoperative) etiologies. Thirty-three patients had secondary metatarsalgia, 11 of whom had rheumatoid arthritis and 10 of whom had sesamoiditis. Metatarsalgia is common in sports, including rock climbing, running, and cycling. A potential cause of these injuries is excessive plantar pressure in the forefoot region. In particular, pain associated with metatarsal stress fracture has plagued military personnel throughout history but has now become more common in the civilian population with the increasing popularity of recreational long-distance running, aerobics, and jumping sports. Metatarsal stress fractures and metatarsalgia also are fairly common among competitive athletes, especially runners. Buda et al identified metatarsalgia in 12.5% of 144 rock climbers. Cycling is associated with metatarsalgia. Carbon fiber cycling shoes have become popular for their stiffness, but the stiffer material is also associated with 18% higher peak plantar pressures in the forefoot, leading Jarboe and Quesada to recommend that competitive or professional cyclists suffering from metatarsalgia or ischemia should be especially careful not to aggravate these foot conditions. Viladot has classified metatarsal pathomechanics as an overload of anterior support or an irregular distribution of the metatarsal load. Irregular metatarsal load syndromes are further separated into four groups: first ray overload, first ray insufficiency, central ray overload, and central ray insufficiency.

• #2 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. […] As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads. […] Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues. […] Hammertoe deformity causes metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal head. […] Some anatomic conditions may predispose individuals to forefoot problems, such as the following. […] Iatrogenic changes from surgeries such as osteotomies can change the anatomy of the foot, resulting in unequal force distribution and metatarsalgia.

• #3 Metatarsalgia – Wikipedia

  https://en.wikipedia.org/wiki/Metatarsalgia

  Metatarsalgia, literally 'metatarsal pain’ and colloquially known as a stone bruise, is any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals. […] Metatarsalgia is most often localized to the first metatarsal head the ball of the foot just behind the big toe. There are two small sesamoid bones under the first metatarsal head. The next most frequent site of metatarsal head pain is under the second metatarsal. This can be due to either too short a first metatarsal bone or to „hypermobility of the first ray” metatarsal bone and medial cuneiform bone behind it both of which result in excess pressure being transmitted into the second metatarsal head.

• #3 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. […] As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads. […] Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues. […] Hammertoe deformity causes metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal head. […] Some anatomic conditions may predispose individuals to forefoot problems, such as the following. […] Iatrogenic changes from surgeries such as osteotomies can change the anatomy of the foot, resulting in unequal force distribution and metatarsalgia.

• #4 Metatarsalgia : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/metatarsalgia/

  – in the normal foot, metatarsal heads bear one half of a person’s body wt, when the foot is plantigrade; – the first metatarsal normally bears half the wt of the forefoot; – long 2nd metatarsal can contribute to pressure under metatarsal head; – limitation of dorsiflexion (from heel cord contracture or ankle impingement can contribute to diffuse metatarsalgia; – claw toe deformities will concentrate wt bearing on metatarsal heads; – hallux valgus: – as proximal phalanx moves into valgus, and the splay between first and second metatarsals increases, the first metatarsal base at first cuneiform-first metatarsal joint also moves into varus and elevates creating in many instances, less wt bearing than normal on 1st metatarsal head relative to the 2nd; – this set up a potential transfer lesion to the adjacent head; – hypermobility of the first MTC joint may also contribute to transfer metatarsalgia; – sesamoids: – tibial sesamoid normally assumes most of the wt bearing fx transmitted to the head of the first metatarsal; – because the sesamoids are eembedded in teh tendon of the FHB, which inserts into the base of the proximal phalanx, any degree of hallux valgus tends to rotate both sesamoids on the long axis; – fibular sesamoid tends to rotate into the 1st metatarsal interspace, thereby disposing of the possibility of its becoming a wt bearing focus;

• #5 Mechanical Basis of Metatarsalgia – EM consulte

  https://www.em-consulte.com/article/1326191/resume/mechanical-basis-of-metatarsalgia

  The 3-rocker mechanism of gait provides a framework to understand why patients have mechanical metatarsal pain and to differentiate between the various types of metatarsalgia. […] Second-rocker/nonpropulsive metatarsalgia is related with an abnormal inclination of a metatarsal in the sagittal plane, either anatomic or functional (equinism). […] Third-rocker/propulsive metatarsalgia is related to an abnormal length of a certain metatarsal with respect to the neighboring metatarsals in the transverse plane.

• #6 Mechanical Basis of Metatarsalgia – EM consulte

  https://www.em-consulte.com/article/1326191/resume/mechanical-basis-of-metatarsalgia

  The 3-rocker mechanism of gait provides a framework to understand why patients have mechanical metatarsal pain and to differentiate between the various types of metatarsalgia. […] Second-rocker/nonpropulsive metatarsalgia is related with an abnormal inclination of a metatarsal in the sagittal plane, either anatomic or functional (equinism). […] Third-rocker/propulsive metatarsalgia is related to an abnormal length of a certain metatarsal with respect to the neighboring metatarsals in the transverse plane.

• #7 Mechanical Basis of Metatarsalgia – EM consulte

  https://www.em-consulte.com/article/1326191/resume/mechanical-basis-of-metatarsalgia

  The 3-rocker mechanism of gait provides a framework to understand why patients have mechanical metatarsal pain and to differentiate between the various types of metatarsalgia. […] Second-rocker/nonpropulsive metatarsalgia is related with an abnormal inclination of a metatarsal in the sagittal plane, either anatomic or functional (equinism). […] Third-rocker/propulsive metatarsalgia is related to an abnormal length of a certain metatarsal with respect to the neighboring metatarsals in the transverse plane.

• #8 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. […] As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads. […] Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues. […] Hammertoe deformity causes metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal head. […] Some anatomic conditions may predispose individuals to forefoot problems, such as the following. […] Iatrogenic changes from surgeries such as osteotomies can change the anatomy of the foot, resulting in unequal force distribution and metatarsalgia.

• #9 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  The foot is frequently injured during sports activities that typically involve repetitive high-pressure loading on the forefoot. […] Athletes who participate in high-impact sports that involve the lower extremities commonly present with forefoot injuries, including metatarsalgia. […] Athletes, especially those who are middle-aged women, may experience a gradual onset of pain that is associated with improper footwear, a change in running terrain, or a rapid increase in training intensity. […] Body weight is transferred to the foot by gravity. This transfer of force is increased to the forefoot during the mid-stance and push-off phases of walking and running. […] Athletes who take part in high-impact sports that involve running or jumping are at high risk of forefoot injuries.

• #10 Metatarsalgia : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/metatarsalgia/

  – in the normal foot, metatarsal heads bear one half of a person’s body wt, when the foot is plantigrade; – the first metatarsal normally bears half the wt of the forefoot; – long 2nd metatarsal can contribute to pressure under metatarsal head; – limitation of dorsiflexion (from heel cord contracture or ankle impingement can contribute to diffuse metatarsalgia; – claw toe deformities will concentrate wt bearing on metatarsal heads; – hallux valgus: – as proximal phalanx moves into valgus, and the splay between first and second metatarsals increases, the first metatarsal base at first cuneiform-first metatarsal joint also moves into varus and elevates creating in many instances, less wt bearing than normal on 1st metatarsal head relative to the 2nd; – this set up a potential transfer lesion to the adjacent head; – hypermobility of the first MTC joint may also contribute to transfer metatarsalgia; – sesamoids: – tibial sesamoid normally assumes most of the wt bearing fx transmitted to the head of the first metatarsal; – because the sesamoids are eembedded in teh tendon of the FHB, which inserts into the base of the proximal phalanx, any degree of hallux valgus tends to rotate both sesamoids on the long axis; – fibular sesamoid tends to rotate into the 1st metatarsal interspace, thereby disposing of the possibility of its becoming a wt bearing focus;

• #11 Metatarsalgia : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/metatarsalgia/

  – in the normal foot, metatarsal heads bear one half of a person’s body wt, when the foot is plantigrade; – the first metatarsal normally bears half the wt of the forefoot; – long 2nd metatarsal can contribute to pressure under metatarsal head; – limitation of dorsiflexion (from heel cord contracture or ankle impingement can contribute to diffuse metatarsalgia; – claw toe deformities will concentrate wt bearing on metatarsal heads; – hallux valgus: – as proximal phalanx moves into valgus, and the splay between first and second metatarsals increases, the first metatarsal base at first cuneiform-first metatarsal joint also moves into varus and elevates creating in many instances, less wt bearing than normal on 1st metatarsal head relative to the 2nd; – this set up a potential transfer lesion to the adjacent head; – hypermobility of the first MTC joint may also contribute to transfer metatarsalgia; – sesamoids: – tibial sesamoid normally assumes most of the wt bearing fx transmitted to the head of the first metatarsal; – because the sesamoids are eembedded in teh tendon of the FHB, which inserts into the base of the proximal phalanx, any degree of hallux valgus tends to rotate both sesamoids on the long axis; – fibular sesamoid tends to rotate into the 1st metatarsal interspace, thereby disposing of the possibility of its becoming a wt bearing focus;

• #12 Metatarsalgia : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/metatarsalgia/

  – in the normal foot, metatarsal heads bear one half of a person’s body wt, when the foot is plantigrade; – the first metatarsal normally bears half the wt of the forefoot; – long 2nd metatarsal can contribute to pressure under metatarsal head; – limitation of dorsiflexion (from heel cord contracture or ankle impingement can contribute to diffuse metatarsalgia; – claw toe deformities will concentrate wt bearing on metatarsal heads; – hallux valgus: – as proximal phalanx moves into valgus, and the splay between first and second metatarsals increases, the first metatarsal base at first cuneiform-first metatarsal joint also moves into varus and elevates creating in many instances, less wt bearing than normal on 1st metatarsal head relative to the 2nd; – this set up a potential transfer lesion to the adjacent head; – hypermobility of the first MTC joint may also contribute to transfer metatarsalgia; – sesamoids: – tibial sesamoid normally assumes most of the wt bearing fx transmitted to the head of the first metatarsal; – because the sesamoids are eembedded in teh tendon of the FHB, which inserts into the base of the proximal phalanx, any degree of hallux valgus tends to rotate both sesamoids on the long axis; – fibular sesamoid tends to rotate into the 1st metatarsal interspace, thereby disposing of the possibility of its becoming a wt bearing focus;

• #13 Metatarsalgia : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/metatarsalgia/

  – unless the foot is free to deviate laterally, the second metatarsal takes an undue share of the body wt at push off; – absolute weakness of intrinsic muscles may also concentrate body wt on 2nd metatarsal due to decreased ability to depress adequately more mobile metatarsals; – note how the 2nd metatarsal is wedged between the three cuniform bones, making it relatively immobile in relation to the midfoot; – insufficient supination of the forefoot at push off because of functional abnormality of the mid foot and hindfoot;

• #14 Windlass Mechanism : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/windlass-mechanism/

  – great toe provides stability to the medial aspect of the foot thru Windlass mechanism of the plantar aponeurosis; – windlass mechanism becomes much less effective, both in depressing metatarsal head and in the wt transfer to the hallux itself w/ result of creating transfer metatarsalgia; […] – removal of the base of the proximal phalanx of the hallus (Keller) disrupts the windlass mechanism and transfers weight to the second metatarsal head; […] – osteotomy that shortens first metatarsal more than 7-10 mm or results in dorsiflexion of first metatarsal likewise results in decreased wt bearing and hence wt transfer to lateral side of the foot.

• #15 Windlass Mechanism : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/windlass-mechanism/

  – great toe provides stability to the medial aspect of the foot thru Windlass mechanism of the plantar aponeurosis; – windlass mechanism becomes much less effective, both in depressing metatarsal head and in the wt transfer to the hallux itself w/ result of creating transfer metatarsalgia; […] – removal of the base of the proximal phalanx of the hallus (Keller) disrupts the windlass mechanism and transfers weight to the second metatarsal head; […] – osteotomy that shortens first metatarsal more than 7-10 mm or results in dorsiflexion of first metatarsal likewise results in decreased wt bearing and hence wt transfer to lateral side of the foot.

• #16 Orthotic intervention for metatarsalgia relief | Lower Extremity Review Magazine

  https://lermagazine.com/article/orthotic-intervention-for-metatarsalgia-relief

  Multiple pathologies of mechanical origin that produce pain occur in the vicinity of the metatarsal heads, and these are lumped into a general category called metatarsalgia. Metatarsalgia is defined as pain from the area of five different metatarsal heads, five different metatarsophalangeal joints, and a variety of soft-issue structures in between. It usually occurs plantarly. Although commonly thought of as a symptom secondary to a more specific pathology, metatarsalgia is frequently categorized as both a symptom and a diagnosis. […] Primary metatarsalgia is defined as pain related directly to structure or function that results in a chronic imbalance of the pressure through the forefoot. Common diagnoses of primary metatarsalgia include second metatarsal stress syndrome, hallux valgus, brachymetatarsia, plantar flexed metatarsal, and iatrogenic symptoms secondary to a surgical procedure. Pain from primary metatarsalgia originates from a specific mechanical origin, and treatment should focus on accommodating or redirecting the specific mechanism.

• #17

  https://trauma.zaslavsky.com.ua/index.php/journal/article/view/799

  Metatarsalgia is the term for pain in the forefoot. Central metatarsalgia arises from structural and functional changes that lead to excessive pressure in the area of metatarsal heads. […] Using combined osteotomy techniques as well as taking into account structural and functional pathologic changes of the forefoot and repair of metatarsophalangeal joint ligaments will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

• #18 Orthotic intervention for metatarsalgia relief | Lower Extremity Review Magazine

  https://lermagazine.com/article/orthotic-intervention-for-metatarsalgia-relief

  Multiple pathologies of mechanical origin that produce pain occur in the vicinity of the metatarsal heads, and these are lumped into a general category called metatarsalgia. Metatarsalgia is defined as pain from the area of five different metatarsal heads, five different metatarsophalangeal joints, and a variety of soft-issue structures in between. It usually occurs plantarly. Although commonly thought of as a symptom secondary to a more specific pathology, metatarsalgia is frequently categorized as both a symptom and a diagnosis. […] Primary metatarsalgia is defined as pain related directly to structure or function that results in a chronic imbalance of the pressure through the forefoot. Common diagnoses of primary metatarsalgia include second metatarsal stress syndrome, hallux valgus, brachymetatarsia, plantar flexed metatarsal, and iatrogenic symptoms secondary to a surgical procedure. Pain from primary metatarsalgia originates from a specific mechanical origin, and treatment should focus on accommodating or redirecting the specific mechanism.

• #19 Orthotic intervention for metatarsalgia relief | Lower Extremity Review Magazine

  https://lermagazine.com/article/orthotic-intervention-for-metatarsalgia-relief

  Secondary metatarsalgia is considered pain related to a problem that does not originate within the metatarsal area. This outside force then produces problems or a mechanical imbalance affecting the metatarsophalangeal joint (MPJ) area. Typical etiologies for secondary metatarsalgia include rheumatoid arthritis, seronegative arthropathy, gout, infection, and equinus deformities. Treatment must be focused on both the systemic diagnosis and the local forefoot pain. […] Although many causes are possible, it seems that the mechanical origin component is common to both primary and secondary metatarsalgia, regardless of the original etiology. Even causes such as infection or iatrogenic postoperative problems ultimately result in a mechanical disruption of the metatarsophalangeal joint apparatus, and this mechanical dysfunction seems to produce the symptoms of metatarsalgia.

• #20 Orthotic intervention for metatarsalgia relief | Lower Extremity Review Magazine

  https://lermagazine.com/article/orthotic-intervention-for-metatarsalgia-relief

  Secondary metatarsalgia is considered pain related to a problem that does not originate within the metatarsal area. This outside force then produces problems or a mechanical imbalance affecting the metatarsophalangeal joint (MPJ) area. Typical etiologies for secondary metatarsalgia include rheumatoid arthritis, seronegative arthropathy, gout, infection, and equinus deformities. Treatment must be focused on both the systemic diagnosis and the local forefoot pain. […] Although many causes are possible, it seems that the mechanical origin component is common to both primary and secondary metatarsalgia, regardless of the original etiology. Even causes such as infection or iatrogenic postoperative problems ultimately result in a mechanical disruption of the metatarsophalangeal joint apparatus, and this mechanical dysfunction seems to produce the symptoms of metatarsalgia.

• #21 Metatarsalgia: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15890-metatarsalgia

  Metatarsalgia refers to pain and inflammation in the ball of your foot, or forefoot. Metatarsalgia can cause sharp, shooting, aching or burning pain in the ball of your foot. […] Metatarsalgia has a number of different causes, including: Foot deformities. Health conditions involving your foot or ankle. Sports and other activities involving running or jumping. Wearing shoes that are too tight or too loose. […] Foot and ankle surgeons divide metatarsalgia causes into three groups: primary, secondary and iatrogenic. […] Primary metatarsalgia can develop if there’s an issue with your metatarsals that affects their relationship with other parts of your foot. […] Secondary metatarsalgia can happen if you have health issues or do activities that increase pressure on your forefoot. […] Iatrogenic metatarsalgia is a complication of forefoot surgery.

• #22 Metatarsal Lengthening in Revision Hallux Valgus Surgery | Musculoskeletal Key

  https://musculoskeletalkey.com/metatarsal-lengthening-in-revision-hallux-valgus-surgery/

  Some metatarsal shortening occurs with the majority of all first metatarsal osteotomies performed during hallux valgus correction. An iatrogenically shortened first metatarsal can disrupt the normal forefoot weight transfer mechanism and cause a pathologic overload of the adjacent metatarsals. […] Relative dorsiflexion of the metatarsal head can also occur after hallux valgus correction with metatarsal osteotomy, exacerbating the mechanical disadvantage of the shortened metatarsal and further contributing to transfer metatarsalgia.

• #23 Metatarsal Lengthening in Revision Hallux Valgus Surgery | Musculoskeletal Key

  https://musculoskeletalkey.com/metatarsal-lengthening-in-revision-hallux-valgus-surgery/

  Some metatarsal shortening occurs with the majority of all first metatarsal osteotomies performed during hallux valgus correction. An iatrogenically shortened first metatarsal can disrupt the normal forefoot weight transfer mechanism and cause a pathologic overload of the adjacent metatarsals. […] Relative dorsiflexion of the metatarsal head can also occur after hallux valgus correction with metatarsal osteotomy, exacerbating the mechanical disadvantage of the shortened metatarsal and further contributing to transfer metatarsalgia.

• #24 Windlass Mechanism : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/windlass-mechanism/

  – great toe provides stability to the medial aspect of the foot thru Windlass mechanism of the plantar aponeurosis; – windlass mechanism becomes much less effective, both in depressing metatarsal head and in the wt transfer to the hallux itself w/ result of creating transfer metatarsalgia; […] – removal of the base of the proximal phalanx of the hallus (Keller) disrupts the windlass mechanism and transfers weight to the second metatarsal head; […] – osteotomy that shortens first metatarsal more than 7-10 mm or results in dorsiflexion of first metatarsal likewise results in decreased wt bearing and hence wt transfer to lateral side of the foot.

• #25 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. […] As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads. […] Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues. […] Hammertoe deformity causes metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal head. […] Some anatomic conditions may predispose individuals to forefoot problems, such as the following. […] Iatrogenic changes from surgeries such as osteotomies can change the anatomy of the foot, resulting in unequal force distribution and metatarsalgia.

• #26 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Metatarsalgia-Causes.aspx

  There are several possible causative factors associated with metatarsalgia, also commonly known as forefoot pain. […] In some cases, a single factor is sufficient to cause the pain, whereas in other cases multiple factors are involved in the pathogenesis of the condition. […] Intense training or physical activity that places significant strain on the foot is a common cause of metatarsalgia. […] The natural foot shape of some individuals places more pressure on the metatarsals and, as a result, they are at risk of experiencing related pain. […] Additionally, deformities of the feet such as claw foot, hammertoe or bunions can also cause metatarsalgia. […] Similarly, previous fractures to the metatarsal can change the structure of the foot and the way the weight is distributed. […] Mortons neuroma is a health condition that involves the growth of fibrous tissue around one of the nerves in the foot, typically between the third and fourth metatarsal heads. […] Other related health conditions include: Freibergs disease, Arthritis, Gout, Diabetes. […] Obesity can also be a causative factor for metatarsalgia. […] Poorly fitting shoes that alter the natural distribution of weight on your foot can also cause metatarsalgia.

• #27 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Metatarsalgia-Causes.aspx

  There are several possible causative factors associated with metatarsalgia, also commonly known as forefoot pain. […] In some cases, a single factor is sufficient to cause the pain, whereas in other cases multiple factors are involved in the pathogenesis of the condition. […] Intense training or physical activity that places significant strain on the foot is a common cause of metatarsalgia. […] The natural foot shape of some individuals places more pressure on the metatarsals and, as a result, they are at risk of experiencing related pain. […] Additionally, deformities of the feet such as claw foot, hammertoe or bunions can also cause metatarsalgia. […] Similarly, previous fractures to the metatarsal can change the structure of the foot and the way the weight is distributed. […] Mortons neuroma is a health condition that involves the growth of fibrous tissue around one of the nerves in the foot, typically between the third and fourth metatarsal heads. […] Other related health conditions include: Freibergs disease, Arthritis, Gout, Diabetes. […] Obesity can also be a causative factor for metatarsalgia. […] Poorly fitting shoes that alter the natural distribution of weight on your foot can also cause metatarsalgia.

• #28 Metatarsalgia – Wikipedia

  https://en.wikipedia.org/wiki/Metatarsalgia

  Metatarsalgia, literally 'metatarsal pain’ and colloquially known as a stone bruise, is any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals. […] Metatarsalgia is most often localized to the first metatarsal head the ball of the foot just behind the big toe. There are two small sesamoid bones under the first metatarsal head. The next most frequent site of metatarsal head pain is under the second metatarsal. This can be due to either too short a first metatarsal bone or to „hypermobility of the first ray” metatarsal bone and medial cuneiform bone behind it both of which result in excess pressure being transmitted into the second metatarsal head.

• #29 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. […] As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads. […] Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues. […] Hammertoe deformity causes metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal head. […] Some anatomic conditions may predispose individuals to forefoot problems, such as the following. […] Iatrogenic changes from surgeries such as osteotomies can change the anatomy of the foot, resulting in unequal force distribution and metatarsalgia.

• #30 Metatarsalgia : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/metatarsalgia/

  – in the normal foot, metatarsal heads bear one half of a person’s body wt, when the foot is plantigrade; – the first metatarsal normally bears half the wt of the forefoot; – long 2nd metatarsal can contribute to pressure under metatarsal head; – limitation of dorsiflexion (from heel cord contracture or ankle impingement can contribute to diffuse metatarsalgia; – claw toe deformities will concentrate wt bearing on metatarsal heads; – hallux valgus: – as proximal phalanx moves into valgus, and the splay between first and second metatarsals increases, the first metatarsal base at first cuneiform-first metatarsal joint also moves into varus and elevates creating in many instances, less wt bearing than normal on 1st metatarsal head relative to the 2nd; – this set up a potential transfer lesion to the adjacent head; – hypermobility of the first MTC joint may also contribute to transfer metatarsalgia; – sesamoids: – tibial sesamoid normally assumes most of the wt bearing fx transmitted to the head of the first metatarsal; – because the sesamoids are eembedded in teh tendon of the FHB, which inserts into the base of the proximal phalanx, any degree of hallux valgus tends to rotate both sesamoids on the long axis; – fibular sesamoid tends to rotate into the 1st metatarsal interspace, thereby disposing of the possibility of its becoming a wt bearing focus;

• #31 Metatarsalgia : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/orthopaedics/metatarsalgia/

  – in the normal foot, metatarsal heads bear one half of a person’s body wt, when the foot is plantigrade; – the first metatarsal normally bears half the wt of the forefoot; – long 2nd metatarsal can contribute to pressure under metatarsal head; – limitation of dorsiflexion (from heel cord contracture or ankle impingement can contribute to diffuse metatarsalgia; – claw toe deformities will concentrate wt bearing on metatarsal heads; – hallux valgus: – as proximal phalanx moves into valgus, and the splay between first and second metatarsals increases, the first metatarsal base at first cuneiform-first metatarsal joint also moves into varus and elevates creating in many instances, less wt bearing than normal on 1st metatarsal head relative to the 2nd; – this set up a potential transfer lesion to the adjacent head; – hypermobility of the first MTC joint may also contribute to transfer metatarsalgia; – sesamoids: – tibial sesamoid normally assumes most of the wt bearing fx transmitted to the head of the first metatarsal; – because the sesamoids are eembedded in teh tendon of the FHB, which inserts into the base of the proximal phalanx, any degree of hallux valgus tends to rotate both sesamoids on the long axis; – fibular sesamoid tends to rotate into the 1st metatarsal interspace, thereby disposing of the possibility of its becoming a wt bearing focus;

• #32 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Metatarsalgia-Causes.aspx

  There are several possible causative factors associated with metatarsalgia, also commonly known as forefoot pain. […] In some cases, a single factor is sufficient to cause the pain, whereas in other cases multiple factors are involved in the pathogenesis of the condition. […] Intense training or physical activity that places significant strain on the foot is a common cause of metatarsalgia. […] The natural foot shape of some individuals places more pressure on the metatarsals and, as a result, they are at risk of experiencing related pain. […] Additionally, deformities of the feet such as claw foot, hammertoe or bunions can also cause metatarsalgia. […] Similarly, previous fractures to the metatarsal can change the structure of the foot and the way the weight is distributed. […] Mortons neuroma is a health condition that involves the growth of fibrous tissue around one of the nerves in the foot, typically between the third and fourth metatarsal heads. […] Other related health conditions include: Freibergs disease, Arthritis, Gout, Diabetes. […] Obesity can also be a causative factor for metatarsalgia. […] Poorly fitting shoes that alter the natural distribution of weight on your foot can also cause metatarsalgia.

• #33 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  The foot is frequently injured during sports activities that typically involve repetitive high-pressure loading on the forefoot. […] Athletes who participate in high-impact sports that involve the lower extremities commonly present with forefoot injuries, including metatarsalgia. […] Athletes, especially those who are middle-aged women, may experience a gradual onset of pain that is associated with improper footwear, a change in running terrain, or a rapid increase in training intensity. […] Body weight is transferred to the foot by gravity. This transfer of force is increased to the forefoot during the mid-stance and push-off phases of walking and running. […] Athletes who take part in high-impact sports that involve running or jumping are at high risk of forefoot injuries.

• #34 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  The foot is frequently injured during sports activities that typically involve repetitive high-pressure loading on the forefoot. […] Athletes who participate in high-impact sports that involve the lower extremities commonly present with forefoot injuries, including metatarsalgia. […] Athletes, especially those who are middle-aged women, may experience a gradual onset of pain that is associated with improper footwear, a change in running terrain, or a rapid increase in training intensity. […] Body weight is transferred to the foot by gravity. This transfer of force is increased to the forefoot during the mid-stance and push-off phases of walking and running. […] Athletes who take part in high-impact sports that involve running or jumping are at high risk of forefoot injuries.

• #35 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/85864-overview

  The foot is frequently injured during sports activities that typically involve repetitive high-pressure loading on the forefoot. […] Athletes who participate in high-impact sports that involve the lower extremities commonly present with forefoot injuries, including metatarsalgia. […] Athletes, especially those who are middle-aged women, may experience a gradual onset of pain that is associated with improper footwear, a change in running terrain, or a rapid increase in training intensity. […] Body weight is transferred to the foot by gravity. This transfer of force is increased to the forefoot during the mid-stance and push-off phases of walking and running. […] Athletes who take part in high-impact sports that involve running or jumping are at high risk of forefoot injuries.

• #36 Metatarsal Fractures (1st-4th) | Ankleinfo

  https://www.ankleinfo.net/metatarsal-fractures-1st-4th

  Mechanism of injury may be direct, indirect or repetitive trauma. Direct injuries include falls, motor vehicle accidents, crush injuries or a fall of heavy objects. Indirect injuries include falls on plantarflexed and fixed foot or inversion injuries. Repetitive strain can cause stress type fractures. […] Sagittal plane displacement is poorly tolerated as it alters the weight-bearing relationship of the metatarsal heads and may result in painful callus and metatarsalgia. […] 56% patients had metatarsalgia. Poor outcomes were considered associated with comminution, sagittal plane displacement, open fractures, or severe soft tissue injury.

• #37 Metatarsal Fractures (1st-4th) | Ankleinfo

  https://www.ankleinfo.net/metatarsal-fractures-1st-4th

  Mechanism of injury may be direct, indirect or repetitive trauma. Direct injuries include falls, motor vehicle accidents, crush injuries or a fall of heavy objects. Indirect injuries include falls on plantarflexed and fixed foot or inversion injuries. Repetitive strain can cause stress type fractures. […] Sagittal plane displacement is poorly tolerated as it alters the weight-bearing relationship of the metatarsal heads and may result in painful callus and metatarsalgia. […] 56% patients had metatarsalgia. Poor outcomes were considered associated with comminution, sagittal plane displacement, open fractures, or severe soft tissue injury.

• #38 Pain in the Ball of the Foot – Metatarsalgia & Bunions

  https://walkwithoutpain.com.au/blog/pain-in-the-ball-of-the-foot-metatarsalgia/

  All of these problems go together and are best described together to make sense. The forefoot (or ball of the foot) has five long metatarsal bones in it that touch the ground. Together they make up a surprisingly small surface area of ~ 6 cm² or a couple of square inches. Around 40% of the population has a problem that they were born with where the clipping mechanism that should hold the 1st metatarsal in place doesn’t work properly. Instead of it standing on the ground bearing weight, it pivots up away from the ground, leaving the other four bones to do its work as well as their own. This changes the pressure map like this: […] You can see now that the 2nd metatarsal, which is quite a fine bone, is bearing far more weight than it should. This can lead to pain in the 2nd, 4th or 3rd metatarsals (in order of likelihood) as the bone bears too much pressure and becomes bruised. If it goes too far, the bone can break at its weakest point which is called a stress fracture. This can occur in anyone but is especially likely in women after menopause. With the 1st metatarsal in the up position, the big toe can’t pivot around the metatarsal as it should as the topside edges of the two bones jam into each other. This leads to a lot of pressure in the joint. Depending on the physical shape of the bones, it is this forceful grinding that will cause extra bone to grow around the joint. Under one set of circumstances, a bone bump grows to the side, the 1st metatarsal starts to pivot away from the foot and the big toe crowds in towards the 2nd toe. This is called a bunion or hallux abducto-valgus or HAV. Under other conditions, the bone collar will grow around the topside surface of the 1st joint. This will lead to a permanent limitation to how far the toe can bend. This condition is called Hallux Limitus (HL) and, while it doesn’t look as troublesome as a bunion, it is actually more debilitating in time and often results in lower back pain and stress fractures to the forefoot.

• #39 Pain in the Ball of the Foot – Metatarsalgia & Bunions

  https://walkwithoutpain.com.au/blog/pain-in-the-ball-of-the-foot-metatarsalgia/

  All of these problems go together and are best described together to make sense. The forefoot (or ball of the foot) has five long metatarsal bones in it that touch the ground. Together they make up a surprisingly small surface area of ~ 6 cm² or a couple of square inches. Around 40% of the population has a problem that they were born with where the clipping mechanism that should hold the 1st metatarsal in place doesn’t work properly. Instead of it standing on the ground bearing weight, it pivots up away from the ground, leaving the other four bones to do its work as well as their own. This changes the pressure map like this: […] You can see now that the 2nd metatarsal, which is quite a fine bone, is bearing far more weight than it should. This can lead to pain in the 2nd, 4th or 3rd metatarsals (in order of likelihood) as the bone bears too much pressure and becomes bruised. If it goes too far, the bone can break at its weakest point which is called a stress fracture. This can occur in anyone but is especially likely in women after menopause. With the 1st metatarsal in the up position, the big toe can’t pivot around the metatarsal as it should as the topside edges of the two bones jam into each other. This leads to a lot of pressure in the joint. Depending on the physical shape of the bones, it is this forceful grinding that will cause extra bone to grow around the joint. Under one set of circumstances, a bone bump grows to the side, the 1st metatarsal starts to pivot away from the foot and the big toe crowds in towards the 2nd toe. This is called a bunion or hallux abducto-valgus or HAV. Under other conditions, the bone collar will grow around the topside surface of the 1st joint. This will lead to a permanent limitation to how far the toe can bend. This condition is called Hallux Limitus (HL) and, while it doesn’t look as troublesome as a bunion, it is actually more debilitating in time and often results in lower back pain and stress fractures to the forefoot.

• #40 Morton neuroma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/morton-neuroma-1?lang=us

  Morton neuromas, also known as interdigital or intermetatarsal neuromas, are focal areas of symptomatic perineural fibrosis around a common plantar digital nerve of the foot. The condition is thought to be due to chronic entrapment of the nerve by the intermetatarsal ligament. […] The term neuroma is a misnomer because the abnormality is non-neoplastic and does not represent a true neuroma. It may more correctly be known as Morton metatarsalgia. […] Morton’s neuromas occur at a distal common plantar nerve, just proximal to the division into the proper digital nerves. […] Morton neuromas are characterized by neural degeneration with epineural and endoneurial vascular hyalinisation and perineural fibrosis around a plantar digital nerve. […] The 3rd web space (between 3rd and 4th metatarsal heads) is the most commonly affected site. The 2nd webspace is less often involved while the remaining web spaces are rarely involved.

• #41 Morton neuroma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/morton-neuroma-1?lang=us

  Morton neuromas, also known as interdigital or intermetatarsal neuromas, are focal areas of symptomatic perineural fibrosis around a common plantar digital nerve of the foot. The condition is thought to be due to chronic entrapment of the nerve by the intermetatarsal ligament. […] The term neuroma is a misnomer because the abnormality is non-neoplastic and does not represent a true neuroma. It may more correctly be known as Morton metatarsalgia. […] Morton’s neuromas occur at a distal common plantar nerve, just proximal to the division into the proper digital nerves. […] Morton neuromas are characterized by neural degeneration with epineural and endoneurial vascular hyalinisation and perineural fibrosis around a plantar digital nerve. […] The 3rd web space (between 3rd and 4th metatarsal heads) is the most commonly affected site. The 2nd webspace is less often involved while the remaining web spaces are rarely involved.

• #42 Morton’s metatarsalgia: Pathogenesis, aetiology and current management

  http://www.actaorthopaedica.be/archive/volume-71/issue-6/review-article/mortons-metatarsalgia-pathogenesis-aetiology-and-current-management/

  The aetiology and pathogenesis of Mortons Neuroma remain controversial. […] It is not true neuroma and therefore, it is better referred to as Mortons metatarsalgia. […] This article reviews the various thoughts regarding the pathogenesis of this condition. Chronic trauma, ischaemia, bursitis and entrapment neuropathy have been proposed as possible aetiologic factors.

• #43 [논문]Morton’s metatarsalgia: pathogenesis, aetiology and current management.

  https://scienceon.kisti.re.kr/srch/selectPORSrchArticle.do?cn=NART27463985

  Morton’s metatarsalgia: pathogenesis, aetiology and current management. […] The aetiology and pathogenesis of Morton’s Neuroma remain controversial. It is not true neuroma and therefore, it is better referred to as Morton’s metatarsalgia. This article reviews the various thoughts regarding the pathogenesis of this condition. Chronic trauma, ischaemia, bursitis and entrapment neuropathy have been proposed as possible aetiologic factors. […] The success of neurectomy rarely exceeds 83%. When surgery is considered, the dorsal approach is associated with less wound complications than the plantar approach. […] For recurrent neuromas, a plantar approach is appropriate.

• #44 Scientific Discussion of Morton’s Neuroma

  https://www.mortonsneuroma.com/mortons-neuroma/metatarsalgia-science/

  The exact pathogenesis of how an entrapped digital plantar nerve results in Mortons neuroma pain is not known and is the subject of much debate. Most investigators consider it to be an entrapment neuropathy, specifically direct pressure on the nerve leading to a chronic fibrotic reaction. […] However, some studies show that chronic repetitive low-grade trauma is also present and conclude that Mortons neuroma is due to a chronic mechanical overload of the entire webspace. […] These two are not mutually exclusive and we believe that Mortons neuroma is due to a combination of chronic mechanical trauma of the webspace and an entrapment neuropathy of the nerve. […] The increased tissue volume caused by accumulated mucoid ground substance within the confined intermetatarsal web space results in increased pressure and increased mechanical forces.

• #45 Scientific Discussion of Morton’s Neuroma

  https://www.mortonsneuroma.com/mortons-neuroma/metatarsalgia-science/

  The exact pathogenesis of how an entrapped digital plantar nerve results in Mortons neuroma pain is not known and is the subject of much debate. Most investigators consider it to be an entrapment neuropathy, specifically direct pressure on the nerve leading to a chronic fibrotic reaction. […] However, some studies show that chronic repetitive low-grade trauma is also present and conclude that Mortons neuroma is due to a chronic mechanical overload of the entire webspace. […] These two are not mutually exclusive and we believe that Mortons neuroma is due to a combination of chronic mechanical trauma of the webspace and an entrapment neuropathy of the nerve. […] The increased tissue volume caused by accumulated mucoid ground substance within the confined intermetatarsal web space results in increased pressure and increased mechanical forces.

• #46 Scientific Discussion of Morton’s Neuroma

  https://www.mortonsneuroma.com/mortons-neuroma/metatarsalgia-science/

  Furthermore, the compressed nerve causes reduced blood flow in the vessels supplying the nerve with blood (the vasa nervorum). This causes local ischaemia, which decreases the ability of the nerve axons to transmit. As the compression becomes more severe over time, focal demyelination occurs, followed by axonal damage and finally, fibrotic scarring within the nerve. […] As the fibrosis continues, the fibrotic mass within the nerve progressively enlarges leading to greater entrapment and increased frictional forces. […] The mucoid degeneration in the intermetatarsal space is indicative of a connective tissue response to chronic repetitive low-grade trauma such as the trauma that would result from a mechanical overload in the webspace due to a nerve entrapment.

• #47 Scientific Discussion of Morton’s Neuroma

  https://www.mortonsneuroma.com/mortons-neuroma/metatarsalgia-science/

  Furthermore, the compressed nerve causes reduced blood flow in the vessels supplying the nerve with blood (the vasa nervorum). This causes local ischaemia, which decreases the ability of the nerve axons to transmit. As the compression becomes more severe over time, focal demyelination occurs, followed by axonal damage and finally, fibrotic scarring within the nerve. […] As the fibrosis continues, the fibrotic mass within the nerve progressively enlarges leading to greater entrapment and increased frictional forces. […] The mucoid degeneration in the intermetatarsal space is indicative of a connective tissue response to chronic repetitive low-grade trauma such as the trauma that would result from a mechanical overload in the webspace due to a nerve entrapment.

• #48 Metatarsalgia/Morton’s neuroma/Intermetatarsal Neuropathy – GraMedica

  https://gramedica.com/products/hyprocure/hyprocure-patient-education/what-does-hyprocure-treat/metatarsalgia-mortons-neuroma-intermetatarsal-neuropathy/

  The Schwann cell and fibroblast proliferation are signs that the nerve is trying to repair itself from the trauma but at the same time there is also more scar tissue thickening. […] A stable ankle bone on the heel bone means a stable foot structure. […] Ankle bone instability pushes the inner column of foot bones away from the outer column of bones. […] The excessive motion, even a slight amount, is going to put a strain on the ligaments between the heads/necks of the 3rd and 4th metatarsal bone. […] That strain is the micro-trauma that is inflicted on the nerve. […] It is usually when they are over 40 years old. […] The nerve damage will continue to get worse with every step taken. […] The best way to treat a nerve that is being compressed and strangulated is to cut the noose that causing the damage. […] The nerve will continue to form a callus and create more and more pain.

• #49 Metatarsalgia/Morton’s neuroma/Intermetatarsal Neuropathy – GraMedica

  https://gramedica.com/products/hyprocure/hyprocure-patient-education/what-does-hyprocure-treat/metatarsalgia-mortons-neuroma-intermetatarsal-neuropathy/

  The Schwann cell and fibroblast proliferation are signs that the nerve is trying to repair itself from the trauma but at the same time there is also more scar tissue thickening. […] A stable ankle bone on the heel bone means a stable foot structure. […] Ankle bone instability pushes the inner column of foot bones away from the outer column of bones. […] The excessive motion, even a slight amount, is going to put a strain on the ligaments between the heads/necks of the 3rd and 4th metatarsal bone. […] That strain is the micro-trauma that is inflicted on the nerve. […] It is usually when they are over 40 years old. […] The nerve damage will continue to get worse with every step taken. […] The best way to treat a nerve that is being compressed and strangulated is to cut the noose that causing the damage. […] The nerve will continue to form a callus and create more and more pain.

• #50 Muscle strength and foot pressure vary depending on the type of foot pain | Scientific Reports

  https://www.nature.com/articles/s41598-024-56490-8

  This study compared muscle strength and foot pressure among patients with metatarsalgia, patients with plantar fasciitis, and healthy controls. […] Compared with the healthy control group, plantar flexor strength was significantly reduced in the affected feet of the metatarsalgia and plantar fasciitis groups; however, hip strength was significantly decreased only in the affected feet of the metatarsalgia group. […] The PTI was lower in the forefeet of the affected feet in the metatarsalgia and plantar fasciitis groups. […] Foot AI was significantly reduced only in the metatarsalgia group. […] Our findings showed the weakest plantar flexor and hip muscle strength in patients with metatarsalgia. […] Metatarsalgia was also associated with low forefoot pressure. […] Our results showed that metatarsalgia was associated with cavus foot posture (foot AI0.21, high-arched foot) and differed from healthy controls.

• #51 Muscle strength and foot pressure vary depending on the type of foot pain | Scientific Reports

  https://www.nature.com/articles/s41598-024-56490-8

  This study compared muscle strength and foot pressure among patients with metatarsalgia, patients with plantar fasciitis, and healthy controls. […] Compared with the healthy control group, plantar flexor strength was significantly reduced in the affected feet of the metatarsalgia and plantar fasciitis groups; however, hip strength was significantly decreased only in the affected feet of the metatarsalgia group. […] The PTI was lower in the forefeet of the affected feet in the metatarsalgia and plantar fasciitis groups. […] Foot AI was significantly reduced only in the metatarsalgia group. […] Our findings showed the weakest plantar flexor and hip muscle strength in patients with metatarsalgia. […] Metatarsalgia was also associated with low forefoot pressure. […] Our results showed that metatarsalgia was associated with cavus foot posture (foot AI0.21, high-arched foot) and differed from healthy controls.

• #52 Muscle strength and foot pressure vary depending on the type of foot pain | Scientific Reports

  https://www.nature.com/articles/s41598-024-56490-8

  Taken together, the results of this study and those of previous studies may explain the higher plantar pressure on the rearfoot in patients with metatarsalgia and plantar fasciitis. […] Compared with the healthy controls, patients with foot pain, such as metatarsalgia and plantar fasciitis, showed decreased plantar flexor and hip muscle strength. […] In particular, compared with patients with plantar fasciitis and the healthy controls, patients with metatarsalgia demonstrated weaker plantar flexor and hip muscles, low forefoot pressure, and high foot posture.

• #53 Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00388-x

  Metatarsal domes reduce plantar pressure in the forefoot in older people with a history of forefoot pain. […] All metatarsal dome conditions significantly reduced peak pressure in the forefoot, however metatarsal domes that were positioned 5mm proximal to the metatarsal heads provided the best balance of reducing plantar pressure distal to the metatarsal heads, where the pressure is at its greatest, but not adversely increasing plantar pressure proximally, where the bulk of the pad is positioned. […] The Emsold metatarsal dome was more effective than the Langer PPT metatarsal pad. […] The results of our current study show that the metatarsal domes did reduce forefoot plantar pressure in comparison to the control (no metatarsal dome) condition, and this was most notable in the order of 4560kPa under the area of the forefoot where the highest plantar pressures were recorded, which was distal to the metatarsal heads.

• #54 Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00388-x

  Metatarsal domes reduce plantar pressure in the forefoot in older people with a history of forefoot pain. […] All metatarsal dome conditions significantly reduced peak pressure in the forefoot, however metatarsal domes that were positioned 5mm proximal to the metatarsal heads provided the best balance of reducing plantar pressure distal to the metatarsal heads, where the pressure is at its greatest, but not adversely increasing plantar pressure proximally, where the bulk of the pad is positioned. […] The Emsold metatarsal dome was more effective than the Langer PPT metatarsal pad. […] The results of our current study show that the metatarsal domes did reduce forefoot plantar pressure in comparison to the control (no metatarsal dome) condition, and this was most notable in the order of 4560kPa under the area of the forefoot where the highest plantar pressures were recorded, which was distal to the metatarsal heads.

• #55 Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00388-x

  Our data demonstrates that two of the metatarsal dome conditions achieved this the Emsold metatarsal dome positioned proximally and the Langer PPT metatarsal pad positioned proximally. […] The anatomically-based masking protocol that we used for this study provided data to enhance our understanding of the mechanism of action of the metatarsal dome. […] To achieve a reduction in plantar pressure, forefoot pads must reduce force and/or increase contact area on the plantar surface of the foot. […] The pad achieves this by increasing the area over which the force is distributed. […] The finding that more proximally positioned forefoot pads reduce plantar pressure more than distally positioned forefoot pads contrasts with our earlier study. […] Reductions in plantar pressure measured in our study were in the order of 4560kPa or approximately 13 to 17%.

• #56 Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00388-x

  Our data demonstrates that two of the metatarsal dome conditions achieved this the Emsold metatarsal dome positioned proximally and the Langer PPT metatarsal pad positioned proximally. […] The anatomically-based masking protocol that we used for this study provided data to enhance our understanding of the mechanism of action of the metatarsal dome. […] To achieve a reduction in plantar pressure, forefoot pads must reduce force and/or increase contact area on the plantar surface of the foot. […] The pad achieves this by increasing the area over which the force is distributed. […] The finding that more proximally positioned forefoot pads reduce plantar pressure more than distally positioned forefoot pads contrasts with our earlier study. […] Reductions in plantar pressure measured in our study were in the order of 4560kPa or approximately 13 to 17%.

• #57 [The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment] – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29308853/

  This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. […] Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

• #58 The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment – Bobrov – Annals of the Russian academy of medical sciences

  https://vestnikramn.spr-journal.ru/jour/article/view/756

  This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. […] Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. […] Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

• #59 [논문]Morton’s metatarsalgia: pathogenesis, aetiology and current management.

  https://scienceon.kisti.re.kr/srch/selectPORSrchArticle.do?cn=NART27463985

  Morton’s metatarsalgia: pathogenesis, aetiology and current management. […] The aetiology and pathogenesis of Morton’s Neuroma remain controversial. It is not true neuroma and therefore, it is better referred to as Morton’s metatarsalgia. This article reviews the various thoughts regarding the pathogenesis of this condition. Chronic trauma, ischaemia, bursitis and entrapment neuropathy have been proposed as possible aetiologic factors. […] The success of neurectomy rarely exceeds 83%. When surgery is considered, the dorsal approach is associated with less wound complications than the plantar approach. […] For recurrent neuromas, a plantar approach is appropriate.

• #60 Metatarsalgia | The Foot and Ankle Online Journal

  http://faoj.org/tag/metatarsalgia/

  Scarf osteotomy is a versatile osteotomy to correct varying degrees of mild to moderate hallux valgus deformity. It can also be used to lengthen the first ray as a revision procedure to treat transfer metatarsalgia in patients with a short first metatarsal. […] One of the complications of some first metatarsal osteotomy is metatarsalgia secondary to shortening of the first metatarsal. […] Lengthening Scarf osteotomy is one of the procedures that is used for the treatment of iatrogenic metatarsalgia. […] Lengthening of the short first metatarsal could put significant stretch of the soft tissues along with the blood vessels which can affect the blood supply to the first metatarsal head resulting in avascular necrosis (AVN) and subsequent arthritis. […] Lengthening scarf osteotomy may be associated with premature osteoarthritis in the first MTPJ. Both surgeons and patients should be aware of this potential complication.

• #61 Metatarsalgia | The Foot and Ankle Online Journal

  http://faoj.org/tag/metatarsalgia/

  Scarf osteotomy is a versatile osteotomy to correct varying degrees of mild to moderate hallux valgus deformity. It can also be used to lengthen the first ray as a revision procedure to treat transfer metatarsalgia in patients with a short first metatarsal. […] One of the complications of some first metatarsal osteotomy is metatarsalgia secondary to shortening of the first metatarsal. […] Lengthening Scarf osteotomy is one of the procedures that is used for the treatment of iatrogenic metatarsalgia. […] Lengthening of the short first metatarsal could put significant stretch of the soft tissues along with the blood vessels which can affect the blood supply to the first metatarsal head resulting in avascular necrosis (AVN) and subsequent arthritis. […] Lengthening scarf osteotomy may be associated with premature osteoarthritis in the first MTPJ. Both surgeons and patients should be aware of this potential complication.

• #62 Metatarsalgia | The Foot and Ankle Online Journal

  http://faoj.org/tag/metatarsalgia/

  Scarf osteotomy is a versatile osteotomy to correct varying degrees of mild to moderate hallux valgus deformity. It can also be used to lengthen the first ray as a revision procedure to treat transfer metatarsalgia in patients with a short first metatarsal. […] One of the complications of some first metatarsal osteotomy is metatarsalgia secondary to shortening of the first metatarsal. […] Lengthening Scarf osteotomy is one of the procedures that is used for the treatment of iatrogenic metatarsalgia. […] Lengthening of the short first metatarsal could put significant stretch of the soft tissues along with the blood vessels which can affect the blood supply to the first metatarsal head resulting in avascular necrosis (AVN) and subsequent arthritis. […] Lengthening scarf osteotomy may be associated with premature osteoarthritis in the first MTPJ. Both surgeons and patients should be aware of this potential complication.

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