Incidencia de dedo flotante en la osteotomía metatarsiana distal percutánea con osteosíntesis para el tratamiento de la metatarsalgia con dedo en martillo rígido / Incidence of floating toe after distal minimally invasive metatarsal osteotomy with pin osteosynthesis for the treatment of metatarsalgia and rigid hammertoe

Introducción: La metatarsalgia central es una causa frecuente de dolor de antepié. La osteotomía de Weil es el tratamiento quirúrgico más popular y la osteotomía metatarsiana distal percutánea (OMDP) es la técnica percutánea más utilizada. La principal desventaja de estas técnicas es la aparición de dedo flotante que es aún mayor cuando se la asocia a artrodesis interfalángica proximal (AIFP). En esta serie de casos, se combinó la OMDP y la osteosíntesis con clavija de Kirschner para elevar el centro de rotación de la cabeza del metatarsiano con el objetivo de disminuir la presencia de dedos flotantes. Nuestra principal hipótesis fue que esta técnica generará menos dedos flotantes en los pacientes con diagnóstico de metatarsalgia mecánica y dedo en martillo rígido, comparada con la osteotomía de Weil. materiales y métodos: Se realizó un estudio retrospectivo en pacientes adultos con diagnóstico de metatarsalgia mecánica y dedo en martillo rígido. Se los sometió a una OMDP más fijación con clavija de Kirschner en combinación con AIFP. Finalmente, se comparó la presencia de dedos flotantes con un grupo de pacientes operados con la técnica de Weil y AIFP. Resultados: Se realizaron 39 OMDP más AIFP. La tasa de dedos flotantes fue del 31%. No hubo una diferencia estadísticamente significativa comparada con la técnica de Weil (36%, p= 0,634). Conclusión: La OMDP con elevación del centro de rotación asociada con AIFP no proporcionó una menor incidencia de dedos flotantes en comparación con la osteotomía de Weil. Nivel de Evidencia: IV

Introduction: Central metatarsalgia is a common cause of forefoot pain. The most common surgical treatment is Weil osteotomy and the most popular percutaneous technique is distal minimally invasive metatarsal osteotomy (DMMO). However, the main disadvantage of these techniques is the appearance of floating toes, which is even greater when associated with proximal interphalangeal arthrodesis. In this series of cases, DMMO was combined with a pin to elevate the center of rotation of the metatarsal head with the aim of reducing the presence of floating toes. Our main hypothesis was that this technique would result in a lower presence of floating toes in patients diagnosed with mechanical metatarsalgia and rigid hammertoe, compared to Weil osteotomies. Materials and methods: A retrospective observational study was carried out on consecutive adult patients diagnosed with mechanical metatarsalgia and rigid hammertoe. DMMO was performed with pin fixation in combination with proximal interphalangeal (PIP) arthrodesis. Finally, the presence of floating toes was compared with a group of patients operated on with the Weil technique and PIP arthrodesis. Results: A total of 39 DMMOs with PIP arthrodesis were performed. The percentage of floating toes was 31% . There was no statistically significant difference compared to the Weil technique (36%, p = 0.634). Conclusion: DMMO for elevation of the center of rotation associated with PIP arthrodesis fixed with a pin did not provide a lower incidence of floating toes compared to Weil osteotomy. Level of Evidence: IV

Case-control study on Scarf and double metatarsal osteotomy of the first metatarsal for the treatment of hallux valgus deformity / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus.@*METHODS@#Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed.@*RESULTS@#Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups(P>0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups(P>0.05) before and after operation. There was no significant difference in RLFM between two groups(P>0.05), while had significant difference in RLFM between two groups at final follow-up (P<0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group (P<0.05).@*CONCLUSION@#Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.

Weightbearing Forefoot Axial Radiography - Technical Description and Reproducibility Evaluation / Radiografia axial do antepé com carga - Descrição da técnica e avaliação da reprodutibilidade

Abstract Objective The present study aims to describe a new weightbearing radiographic method to visualize the heads of the five metatarsals on the coronal plane, evaluating their accuracy through intraclass correlation coefficients. Methods The subjects were evaluated, with weightbearing, with the ankle at 20 degrees of plantar flexion and the metatarsophalangeal joints at 10 degrees of extension, positioned on a wooden device. Two independent foot and ankle surgeons evaluated the radiography, with one of them doing it twice, at different moments, achieving an inter and intraobserver correlation, with intraclass correlation coefficients. Results We radiographed 63 feet, achieving an interobserver correlation coefficient of the radiographic method for the metatarsal heads heights in the coronal plane of the 1st, 2nd, 3rd, 4th, and 5th metatarsals of, respectively, 0.90, 0.85, 0.86, 0.83, 0.89. The intraobserver correlation coefficient were, respectively, 0.95, 0.93, 0.93, 0.86, 0.92. Conclusion Those correlations demonstrate that the method is accurate and can be used to investigate metatarsal head misalignments in this plane.

Resumo Objetivo Este estudo tem como objetivo descrever um novo método radiográfico com carga fisiológica para visualizar as cabeças dos cinco metatarsos no plano coronal. Métodos Os indivíduos foram radiograficamente avaliados com carga, com o tornozelo a 20º de flexão plantar e as articulações metatarsofalângicas a 10º de extensão, posicionadas em um dispositivo de madeira. As medidas foram aferidas por dois avaliadores independentes, sendo que um deles mediu em dois momentos distintos, obtendo a correlação inter e intraobservador, com o coeficiente de correlação intraclasses. Resultados Examinamos 63 pés, obtendo um coeficiente de correlação interobservador do método radiográfico para as alturas das cabeças dos metatarsos no plano coronal do 1º, 2º, 3º, 4º e 5º metatarsos de, respectivamente, 0,90, 0,85, 0,86, 0,83, 0,89. O coeficiente de correlação intraobservador foi, respectivamente, 0,95, 0,93, 0,93, 0,86, 0,92. Conclusão Essas correlações demonstram que o método é preciso e pode ser usado para investigar os desalinhamentos de cabeça dos metatarsos nesse plano.

Etiología y fisiopatología del Hallux Valgus / Etiology and phisiology of Hallux Valgus

El hallux valgus es uno de los motivos de consulta más frecuentes dentro de las patologías que afectan el pie, el 90% de los pacientes son mujeres. Se caracteriza por deformidad en varo de primer metatarsiano y valgo del primer dedo, dolor en la prominencia ósea medial y debajo de cabeza de los metatarsianos. Además, se puede acompañar de artejos menores en garra y metatarsalgia. El uso de calzado inadecuado, ya sea en punta y con tacón alto, así como el antecedente genético, se han descrito como las principales causas de esta patología. El tratamiento depende exclusivamente de la sintomatología y está encaminado inicialmente al uso de calzado amplio y cómodo, plantillas cuando hay metatarsalgia asociada. El tratamiento ortopédico puede mejorar el dolor más no la deformidad. Si este manejo no da resultado, se recurre al tratamiento quirúrgico. La cirugía tiene como objetivo realinear las estructuras óseas para corregir la deformidad mediante osteotomías y liberación de tejidos blandos, lo cual mejora el dolor y facilita el uso de calzado. Existen múltiples técnicas quirúrgicas descritas, que se escogen dependiendo de la severidad del hallux y de la experiencia del cirujano. Los resultados del tratamiento quirúrgico son exitosos aproximadamente en el 85% de los casos. Como en todas las patologías hay riesgo complicaciones post operatorias y estas pueden ocurrir en el 15% de los pacientes; las más frecuentes son la recidiva de la deformidad e infecciones superficiales. El riesgo de recidiva aumenta en deformidades severas, pacientes con pie plano o inestabilidad de articulación cuneo metatarsiana.

The hallux valgus is one of the most frequent reasons for consultation within the pathologies that affect the foot, 90% of patients are women. It is characterized by varus deformity of the first metatarsal and valgus of the first toe, pain in the medial bony prominence and below the head of the metatarsals, in addition minor claw and metatarsalgia can be accompanied. The use of inappropriate shoes, narrow and high-heeled, as well as the genetic background have been described as the main causes of this pathology. The treatment depends exclusively on the symptomatology and is initially aimed at the use of wide and comfortable shoes, insoles when there is associated metatarsalgia. Orthopedic treatment can improve pain, not deformity. Surgical treatment is reserved for those patients who, despite performing adequate orthopedic treatment, do not improve. The aim of the surgical treatment is to realign the bony structures to correct the deformity by means of osteotomies and soft tissues release, this improves the pain and facilitates the use of footwear. There are multiple surgical techniques described, which are chosen depending on the severity of the hallux and the experience of the surgeon. The results of surgical treatment are successful in approximately 85% of cases. As in all pathologies there is a risk of post-operative complications, which may occur in 15% of patients; the most frequent are the recurrence of deformity and superficial infections.

Forefoot disorders and conservative treatment / 영남의대학술지

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

Comparison of health-related quality of life between patients with different metatarsalgia types and matched healthy controls: a cross-sectional analysis

ABSTRACT BACKGROUND: Metatarsalgia can be considered to be a common complaint in clinical practice. The aim of this study was to compare quality of life (QoL) between participants with different metatarsalgia types and matched-paired healthy controls. DESIGN AND SETTING: A cross-sectional analysis on a sample of 124 participants of median age ± interquartile range of 55 ± 22 years was carried out in the University Clinic of Podiatric Medicine and Surgery, Ferrol, Spain. They presented primary (n = 31), secondary (n = 31) or iatrogenic (n = 31) metatarsalgia, or were matched-paired healthy controls (n = 31). METHODS: Self-reported domain scores were obtained using the Foot Health Status Questionnaire (FHSQ) and were compared between the participants with metatarsalgia and between these and the healthy controls. RESULTS: Statistically significant differences were shown in all FHSQ domains (P ≤ 0.001). Post-hoc analyses showed statistically significant differences (P < 0.05) between the metatarsalgia types in relation to the matched healthy control group, such that the participants with metatarsalgia presented impaired foot-specific and general health-related QoL (lower FHSQ scores). CONCLUSION: This study demonstrated that presence of metatarsalgia had a negative impact on foot health-related QoL. Foot-specific health and general health were poorer among patients with metatarsalgia, especially among those with secondary and iatrogenic metatarsalgia, in comparison with matched healthy controls.

Acquired Change and Pain of Foot in Elderly People

As the aging of the foot progresses, the stiffness of the soft tissues, the reduction of the range of motion, the decrease of the muscle strength, and the flattening of foot are manifested. These changes increase the risk of foot pain, the problem of weight distribution and transmission, and the risk of falls, resulting in secondary complications and lowering quality of life. The most common deformities and diseases of the elderly foot are hallux valgus, hammertoes, hallux rigidus, Achilles tendinitis, plantar fasciitis, metatarsalgia, hyperkeratosis, and other deformities of the feet caused by chronic conditions. Systemic diseases that promote these foot problems include diabetes, peripheral nerve damage, repetitive ankle ligament injuries, deformities due to fractures, and obesity. Understanding the mechanisms of aging and the processing of biomechanics in the elderly will enable them to reach a healthy life through appropriate rehabilitation, exercise and educations during aging. In addition, it is necessary to promote the healthy life in elderly by customized exercise, training, and shoes.

Translation and cultural adaptation of the revised foot function index for the Portuguese language: FFI-R Brazil

ABSTRACT BACKGROUND: The revised foot function index (FFI-R) is used to evaluate the functionality of patients with conditions that affect the feet. The objective here was to produce the Brazilian Portuguese version of this index. DESIGN AND SETTING: Translation and validation study conducted at the Federal University of São Paulo, Brazil. METHODS: The translation and cultural adaptation process involved translation by two independent translators, analysis by an expert committee, back translation into the original language, analysis by the expert committee again and a pretest. The Portuguese-language version was administered to 35 individuals with plantar fasciitis and metatarsalgia to determine their level of understanding of the assessment tool. RESULTS: Changes were made to the terms and expressions of some original items to achieve cultural equivalence. Terms not understood by more than 10% of the sample were altered based on the suggestions of the patients themselves. CONCLUSION: The translation and cultural adaptation of the FFI-R for the Portuguese language were completed and the Brazilian version was obtained.

Resultados funcionales a corto plazo de la osteotomía de Weil en pacientes con metatarsalgia propulsiva / Short-term results of Weil's osteotomy in patients with propulsive metatarsalgia

Resumen: Introducción: La metatarsalgia es el motivo de consulta más frecuente en patología ortopédica del pie. La clave de su tratamiento radica en la correcta determinación del síntoma, que son alteraciones biológicas, morfológicas y mecánicas responsables del dolor. La osteotomía de Weil es comúnmente utilizada para múltiples patologías del antepié, incluyendo las metatarsalgias. Material y métodos: Se estudiaron pacientes intervenidos por síndrome de insuficiencia del primer rayo y deformidades asociadas productoras de metatarsalgia mecánica. El seguimiento mínimo fue de seis meses. Se entrevistó a todos los individuos con un cuestionario estandarizado basado en la AOFAS, una encuesta para saber su grado de satisfacción acerca de la cirugía. Resultados: Se obtuvieron 12 sujetos femeninos con un promedio de 51 años de edad en el período entre Marzo y Septiembre de 2013. Siete pies derechos, cinco izquierdos. Los valores de AOFAS mejoraron sólo en seis, se obtuvo un resultado excelente; cinco los calificaron como buenos y seis como no satisfactorio. Conclusiones: En una serie muy pequeña, se identificaron complicaciones postquirúrgicas cuando el acortamiento del metatarsiano es mayor a cuatro milímetros, con la aparición de rigidez (dedo flotante).

Abstract: Introduction: Metatarsalgia is the most common reason for consultation in orthopedic pathology of the foot. The key to its treatment lies in the correct determination of the symptoms, which are biological, morphological and mechanical alterations responsible for pain. Weil´s osteotomy is commonly used for multiple forefoot pathologies, including metatarsalgias. Material and methods: We included patients with first-line failure syndrome and associated mechanical metatarsalgia-producing deformities. The minimum follow-up was six months. All individuals were interviewed with a standardized questionnaire based on the AOFAS, a survey to know their degree of satisfaction about the surgery. Results: Twelve female subjects with a mean age of 51 years were recruited between March and September of 2013. Seven right feet, five left. The AOFAS values ​​improved only in six, in which an excellent result was obtained; five rated them as good and six as unsatisfactory. Conclusions: In a very small series, postoperative complications were observed when the shortening of the metatarsal was greater than four millimeters, with the appearance of stiffness (floating finger).

Metatarsalgia in a patient with chronic hemiparetic stroke managed with alcohol block of the tibial nerve: A case report

We report the case of a patient with a hemiparetic stroke whose metatarsalgia was successfully managed by reducing the spasticity of plantar flexor using neurolysis with 20% ethyl alcohol. A 57-year-old female patient with left hemiparesis following an infarct of the right corona radiata and basal ganglia one year previously presented with pain (numeric rating scale: 7) in the forefoot under the second to fourth metatarsal heads for six months. We diagnosed her with metatarsalgia and considered that the forefoot pain was associated with mechanical stress around the metatarsal head due to the spasticity (Modified Ashworth Scale: 1+) of the ankle plantar flexor. We performed neurolysis of the medial and lateral motor branches of the tibial nerve to the gastrocnemius muscle with 20% ethyl alcohol. After the alcohol block, foot pain and spasticity significantly reduced (numeric rating scale: 1; Modified Ashworth Scale: 0). Moreover, this effect persisted for at least three months. Clinicians should consider the possibility that spasticity can contribute to the development of foot pain in a patient with stroke.

Cause of Metatarsalgia / 대한족부족관절학회지

Metatarsalgia is one of the most common causes of patients complaining of pain in their feet. This pain is the plantar forefoot, including the second to fourth metatarsal heads and arises from either mechanical or iatrogenic causes. On the other hand, it is frequently accompanied by a deformity of the toes as well as of the first and fifth rays. The pain has a variety of causes, and sometimes the cause is difficult to distinguish. The variability of possible causative factors necessitates an individualized approach to treatment. To determine these causes, this paper presents an overview of the gait mechanics, plantar pressure, and the classification according to the etiology.

Lesser Metatarsal Osteotomies for Metatarsalgia / 대한족부족관절학회지

Metatarsalgia means the pain under the lesser metatarsal heads. The many causes of metatarsalgia can be categorized into three groups: local disease in the region, altered forefoot biomechanics, and systemic disease affecting the region. Surgical options need to be considered if nonsurgical treatment fails. The metatarsal osteotomies are designed primarily to reduce the weightbearing forces on the metatarsal head by elevating or shortening the metatarsal. Many lesser metatarsal osteotomies have been described, and their success depends on many factors. Regardless of the method employed, it is important to maintain or restore the metatarsal cascade to maintain an even pressure under the lesser metatarsal heads and prevent transfer lesions. The surgeon must understand the effects of the metatarsal osteotomy on the forefoot patho-biomechanics and decide, using a combination of clinical examinations and imaging, whether the desired effect of the osteotomy is to shorten or elevate the metatarsal head or both.

Outcome of Extraarticular Dorsal Closing Wedge Osteotomy for Freiberg's Disease / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the result of extraarticular dorsal closing wedge osteotomy in Freiberg's disease. MATERIALS AND METHODS: Between February 2012 and July 2014, total 10 patients who underwent dorsal closing wedge osteotomy and followed up more than 1 year were selected for inclusion. Average age was 16.3 years, and average follow-up period was 15.5 months. The diagnosis was made using magnetic resonance imaging of those with a limitation in walking or usual activity due to pain in the metatarsal head. During operation, we removed loose body, and synovectomy was done. Osteotomy at the metatarsal neck and fixation with Kirschner wire were performed. X-ray was taken to check shortening of 2nd metatarsal and bone union. Moreover, we checked the active range of motion of 2nd metatarsophalangeal joint before and after surgery. At the last follow-up, the shortening of metatarsal, American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), and patient's subjective satisfaction were evaluated. RESULTS: According to the Smillie's stage, there were 3 cases of stage II, 4 cases of stage III, and 3 cases of stage IV. Average bone union time on the osteotomy site was 8 weeks. Average shortening of metatarsal was 2.53 mm. Average AOFAS score improved significantly from 56.9 to 82.8 points at final follow-up (p<0.05), and average VAS score also improved significantly from 6.4 to 1.4 points at final follow-up (p<0.05). Average active range of motion at metatarsophalangeal joint improved from 28.0° preoperatively to 46.5° at the final follow-up. Other complications, such as metatarsalgia and arthritis, were not found; however, there was 1 case of delayed union with no symptom. CONCLUSION: In Freiberg's disease, dorsal closing wedge osteotomy is recommended for the improvement of clinical symptoms and range of motion.

Tratamiento quirúrgico de las metatarsalgias mecánicas mediante cirugía percutánea / Traitement chirurgical des métatarsalgies mécaniques par chirurgie percutanée / Surgical treatment of mechanical metatarsalgias through percutaneous surgery

Introducción: las metatarsalgias mecánicas refractarias a tratamiento ortopédico precisan de tratamiento quirúrgico. Presentamos nuestra experiencia mediante la cirugía percutánea. Objetivo: mostrar la efectividad de las osteotomías distales percutáneas (DMMO) en el tratamiento de las metatarsalgias mecánicas. Método: estudio retrospectivo de 100 pacientes intervenidos de metatarsalgias mecánicas entre enero de 2012 y diciembre de 2013, con una media de edad de 57 años. El seguimiento mínimo fue de 1 año de evolución. Las metatarsalgias mecánicas se clasificaron según la fase de la marcha en segundo y tercer rocker. Se valoró clínicamente la desaparición de las queratosis plantares, la desaparición del dolor plantar con la deambulación, el abandono de las plantillas previas, y radiográficamente la fórmula metatarsal y la consolidación de las osteotomías. Resultados: en las metatarsalgias de segundo rocker se obtuvo un 90 % de buenos o muy buenos resultados con un 10 por ciento de complicaciones, principalmente metatarsalgia de transferencia. En las metatarsalgias de tercer rocker un 85 por ciento de buenos o muy buenos resultados y un 15 por ciento de complicaciones predominantemente la metatarsalgia de transferencia. Conclusiones: las osteotomías distales percutáneas parecen ser una técnica aceptable para el tratamiento de les metatarsalgias mecánicas al proporcionar unos buenos resultados clínicos y radiológicos. Es importante la curva de aprendizaje dado que no es una técnica exenta de complicaciones(AU)

Introduction: mechanical metatarsalgias difficult to orthopedic treatment require surgical treatment. We report our experience with percutaneous surgery. Objectivs: show the effectiveness of percutaneous distal osteotomy in the treatment of mechanical metatarsalgias. Methods: a retrospective study of 100 patients undergoing mechanical metatarsalgias from January to December 2013, with an average age of 57 years. Minimum follow-up was 1 year of evolution. Mechanical metatarsalgias were classified according to the stage of walking, second and third rocker. It was clinically assessed the disappearance of plantar keratosis, plantar pain when walking, as well as abandoning previous templates. Radiographically the metatarsal formula and consolidation of the osteotomy were evaluated. Results: in second rocker metatarsalgias, 90 percent had good or excellent results with 10 percent complications, mainly transfer metatarsalgia. In third rocker metatarsalgias 85 percent had good or very good results and 15 percent complications, mainly the transfer metatarsalgia. Conclusions: percutaneous distal osteotomies appear to be an acceptable technique for mechanical metatarsalgias treatment to provide good clinical and radiological results. Learning curve is important since it is not free of complications(AU)

Introduction: les métatarsalgies mécaniques de nature réfractaire exigent un traitement chirurgical. Nous présentons ici notre expérience avec la chirurgie percutanée. Objectif: le but de ce travail est de montrer l'efficacité des ostéotomies distales percutanées dans le traitement des métatarsalgies de type mécanique. Méthode: une étude rétrospective de 100 patients (âge moyen de 57 ans) atteints de métatarsalgies d'origine mécanique a été réalisée entre janvier et décembre 2013. Le suivi minimal a eu un an de durée. Les métatarsalgies mécaniques ont été classées selon phase de la marche (phase 2, second-rocker et phase 3, third-rocker). On a évalué du point de vue clinique la disparition des kératoses plantaires, la disparition de la douleur plantaire au cours de la marche et l'abandon des semelles, et du point de vue radiographique la formule métatarsienne et la consolidation des ostéotomies. Résultats: dans les métatarsalgies de second-rocker (métatarsalgies statiques), on a obtenu de bons et très bons résultats (90 pourcent) et très peu de complications (10 pourcent) telles que les métatarsalgies de transfert. Dans les métatarsalgies de third-rocker (métatarsalgies propulsives), on a obtenu de bons et très bons résultats (85 pourcent) et très peu de complications (15 pourcent), telles que les métatarsalgies de transfert. Conclusions: l'ostéotomie distale percutanée semble être la technique appropriée pour le traitement des métatarsalgies mécaniques, car elle prodigue de très bons résultats cliniques et radiologiques. L'apprentissage est très important, parce que cette technique n'est pas exceptée de complications(AU)

Tradução e adaptação cultural do Foot Function Index para a língua portuguesa: FFI - Brasil / Translation and cross-cultural adaptation of FFI to Brazilian Portuguese version: FFI - Brazil

RESUMOObjetivo:Realizar a tradução e a adaptação cultural do questionário Foot Functional Index (FFI), que avalia a funcionalidade do pé, para a versão em língua portuguesa do Brasil.Métodos:A versão brasileira do FFI foi baseada no protocolo proposto por Guillemin. O processo aplicado consistiu em: (1) tradução; (2) retrotradução; (3) análise do comitê de especialistas; (4) pré-teste. A versão brasileira foi aplicada em 40 pessoas, homens e mulheres com idade superior a 18 anos, com fasciíte plantar e metatarsalgia, para verificar o nível de compreensão do instrumento. A versão final foi definida após se obter menos de 15% de “não compreensão” em cada item.Resultados:Foram alterados termos e expressões para obter equivalência cultural do FFI. As alterações feitas foram baseadas nas sugestões dos pacientes.Conclusão:Após a tradução e adaptação cultural do questionário, foi concluída a versão da língua portuguesa do Brasil do FFI.

ABSTRACTObjective:Perform the translation and cultural adaptation of the questionnaire Foot Functional Index (FFI), which assesses the functionality of the foot, to the Brazilian Portuguese version.Method:The Brazilian version development of FFI questionnaire was based on the guideline proposed by Guillemin. The applied process consisted of: (1) translation; (2) back-translation; (3) committee review; (4) pretesting. The Portuguese version was applied to 40 patients, both genders, aged over 18 years old, with plantar fasciitis and metatarsalgia to verify the level of the instrument comprehension. The final Brazilian version of the FFI was set after getting less than 15% of “not understanding” on each item.Results:Some terms and expressions were changed to obtain cultural equivalence for FFI. The terms that were incomprehensible were changed in accordance of patient suggestions.Conclusion:After the translation and cultural adaptation of the questionnaire, the final Portuguese version of FFI was concluded.

Corrective Osteotomy of Metatarsal Bone for Surgical Treatment of Morton's Neuroma / 대한족부족관절학회지

PURPOSE: The purpose of this report is to investigate the clinical and radiological results of corrective osteotomy of the 3rd metatarsal bone for shortening and dorsal displacement without exposure around neuroma. MATERIALS AND METHODS: Twelve cases of patients who underwent corrective osteotomy of metatarsal bone for a Morton's neuroma from November 2013 to September 2014 were retrospectively reviewed. Corrective osteotomy was performed through a dorsal approach at the 3rd metatarsal bone base and distal metatarsal bone was displaced dorsally and proximally. Preoperative and postoperative pain assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and radiographs were evaluated. RESULTS: The mean age of patients was 41.4 years, and the mean follow-up period was 10.7 months. AOFAS score improved from 52 preoperatively to 90 postoperatively. The 3rd metatarsal bone was shortened by an average of 3.39 mm and elevated by 2.38 mm. CONCLUSION: Corrective osteotomy of metatarsal bone can be regarded as a new surgical option for Morton's neuroma without exposure around neuroma.

Neuroma de Morton en paciente con metatarsalgia / Morton’s neuroma in patients with metatarsalgia

Se reporta un caso de un neuroma de Morton en una paciente de 50 años con antecedente de metatarsalgia de un año de evolución que es evaluada por el servicio de Ortopedia y Traumatología solicitando ecografía por sospecha de neuroma de Morton. Se diagnostica la presencia de una formación nodular, sólida, hipoecogénica y de forma fusiforme en el tercer espacio interdigital del pie derecho. Se realiza tratamiento quirúrgico confirmando el diagnóstico por anatomía patológica...

Correlative analysis on metatarsalgia and the X-ray measurement indexes under weight-bearing and non-weight-bearing of hallux valgus / 中国骨伤

<p><b>OBJECTIVE</b>To study changes in the radiographic appearance during weight-bearing and non-weigh-bearing in hallux valgus, and to analyse the correlation between the elasticity of plantar soft tissue of hallux valgus and the pain under the metatarsal head.</p><p><b>METHODS</b>From May 2012 to October 2012, 240 feet of 120 patients with hallux valgus were enrolled in the study. The degrees of the pian under the metatarsal head of all the patients were observed. AP and lateral X-ray films of feet were taken on the condition of weight-bearing and non-weight-bearing. So the hallux valgus angle (HVA), the inter-metatarsal angle between the first and second metatarsals (IM1-2), the inter-metatarsal angle between the first and fifth metatarsals (IM1-5), top angle of the medial longitudinal arch (TAOTMLA),and anterior angle of the medial longitudinal arch (AAOTMLA) were measured on the X-ray films. The differences of HVA, IM1-2, IM1-5, TAOTMLA and AAOTMLA between two groups were compared, and the correlation between the changes of IM1-2, IM 1-5, TAOTMLA, AAOTMLA and the degree of the pain under the metatarsal head were analysed.</p><p><b>RESULTS</b>One hundred and forty-eight feet had the pain under the metatarsal head. The IM1-2, IM1-5 and TAOTMLA increased on weight-bearing position compared with those on non-weight-bearing position, but the HVA and AAOTMLA decreased on weight-bearing position compared with those on non-weight-bearing position. There was a moderate relationship between the changes of IM 1-2,IM1-5 and the degree of the hallux valgus deformity, as well as the relationship between the different of IM1-5 and the degree of the pian under the metatarsal head.</p><p><b>CONCLUSION</b>The degree of the collapse of the arch of foot with hallux valgus becomes serious with its deformity increasing. The pain under the metatarsal head of hallux valgus increases with the increased changes of IM 1-2,IM 1-5 and TAOTMLA. Analysis of the X-ray observation indexes of hallux valgus on weight-bearing position and non-weight-bearing position has important significance in evaluating the degree of the collapse of the arch of foot with hallux valgus,preventing and curing the the pain under the metatarsal head.</p>

Arthroscopic treatment of painful heel syndrome with radio-frequency / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate therapy effect of radiofrequency in the treatment of painful heel syndrome under arthroscopy.</p><p><b>METHODS</b>From January 2006 to December 2011, 13 patients with painful heel syndrome being admitted into our hospital were studied. There were 5 males and 8 femals, ranging in age from 35 to 68 years. All these surgeries were performed under local anesthesia. After constructing a man-made lacouna in the subcutaneous tissue above plantar fascia, a medial and a lateral portal were established on both sides of plantar fascia and at the anterior edge of calcaneal tuberosity. Hyperplasia and torn fiber tissue of plantar fascia, and plantar calcaneal bursa were removed with radiofrequency probe under arthroscopy. Then penetration of the plantar fascia was carried out in a reticulation-shaped pattern with a special radiofrequency probe TOPAZ. Each patient was assessed with VAS pain evaluation criteria and AOFAS ankle-hindfoot score system (AOFAS-AH) before and after operation. All the patients were followed up, and the duration ranged from 6 to 12 months.</p><p><b>RESULTS</b>All the 13 patients got excellent recovery with their heel pain relieved significantly. VAS score was 8.71 +/- 1.64 before operation, 6.27 +/- 2.53 at the 1st month after operation, and 2.30 +/- 2.69 at the 6th month after operation. AOFAS-AH score was 56.43 +/- 3.72 preoperation, 68.15 +/- 7.38 at 1st month post operation, and 84.51 +/- 2.93 at 6th month after operation. There were no perioperative and postoperative complications related to the procedure, such as blood vessel and nerve injury, and infection.</p><p><b>CONCLUSION</b>Plantar fasciitis and plantar calcaneal bursitis are main factors of painful heel syndrome. Due to advantages of being easy to operate, having definite effect and no use to do spur removal or plantar fasciotomy. Endoscopy assisted plantar calcaneal bursa removal and plantar fascia penetration by radiofrequency technique can be a satisfactory treatment method for painful heel syndrome.</p>

Short Scarf Osteotomy for Moderate Hallux Valgus / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the radiographic and clinical results of short scarf osteotomy that has minimized longitudinal cut for moderate hallux valgus. MATERIALS AND METHODS: Total 12 patients (12 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 41.5 years. The mean followup time was 21.2 months. We modified original scarf osteotomy by shortening the longitudinal cut to 15~20 mm in length. Additionally, Akin osteotomy of the first proximal phalanx was done in 7 feet and Weil osteotomy of the second metatarsal was done in 4 feet. First-second intermetatarsal and hallux valgus angles were analyzed radiographically before and after the operation. And the clinical result was assessed by AOFAS (American Orthopaedic Foot and Ankle Society) hallux score. RESULTS: First-second intermetatarsal and hallux valgus angles were reduced from the mean preoperative values of 14.6degrees and 32.8degrees to 6.5degrees and 11.2degrees, respectively. The mean AOFAS hallux score was increased from 52.4 points preoperatively to 88.2 points at followup. Three complications were found: metatarsal fracture during the operation, painful scar around second metatarsal head after Weil osteotomy and postoperative neuralgia. There was no transfer metatarsalgia or recurrence of hallux valgus during followup. CONCLUSION: Short scarf osteotomy would be an effective surgical procedure for moderate hallux valgus with the benefits of minimized soft tissue dissection and stable fixation.