Joint Preserving Procedure for Moderate Hallux Rigidus: Does the Metatarsal Index Really Matter?

Surgical treatment of moderate hallux rigidus remains controversial and the optimal surgical technique has yet to be defined. Decompressive metatarsal osteotomy is one of the procedures available; however, one of the potential drawbacks is the effect of the metatarsal shortening. We evaluated the global effect of the decompressive metatarsal osteotomy, accounting for the metatarsal index. We retrospectively evaluated 78 patients with stage II and III hallux rigidus who had undergone Youngswick osteotomy and analyzed their outcomes according to the metatarsal index. The candidates for inclusion underwent clinical and radiographic evaluation, including the visual analog scale foot and ankle score, first metatarsophalangeal joint range of motion, and first metatarsal protrusion distance to define the metatarsal index. Also, shortening of the first metatarsal was measured postoperatively, and the occurrence of metatarsalgia was considered a postoperative complication. The mean follow-up period was 53 ± 17 months. The groups stratified according to the metatarsal index (index plus, index plus minus, and index minus) presented with similar results (p > .05). The average preoperative visual analog scale foot and ankle score of 56.4 ± 13.8 points improved significantly to 84.1 ± 5.5 points postoperatively (p < .0001). Also, the mean preoperative dorsiflexion of 20.4° ± 1.5° improved to 37.3° ± 1.6° postoperatively (p < .0001). Of the 78 patients, 97% would recommend the procedure to a family member or friend. Four patients (6%) experienced postoperative metatarsal pain. We found consistent results with this procedure. The reported functional score and dorsiflexion improvement provide evidence that good outcomes and high levels of patient satisfaction can be achieved, regardless of the metatarsal length.

Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus.

BACKGROUND: Two concepts have been proposed to explain the etiology of metatarsalgia in hallux valgus patients: First, as the magnitude of hallux valgus increases, there is a mechanical overload of the lesser metatarsals. Second, increased relative lesser metatarsal length is a factor in the development of metatarsalgia. However, there is no current evidence that these structural factors lead to primary metatarsalgia. The purpose of the study was to evaluate the factors associated with metatarsalgia in hallux valgus patients. METHODS: A cross-sectional study of 121 consecutive adult patients with non-arthritic hallux valgus was carried out. Binary logistic regression was performed to identify the effect of the clinical and demographic factors on the occurrence of metatarsalgia. One hundred twenty-one patients (184 feet) with hallux valgus were analyzed. The median weight was 65 kg (interquartile range 58-72). RESULTS: Metatarsalgia was present in 84 (45.6%) feet. The binary logistic regression showed that lesser toe deformity (OR 2.6, 95% CI 0.2-0.5), gastrocnemius shortening (OR 5.8, 95% CI 2.8-12.3), metatarsal index (OR 0.3, 95% CI 0.2-0.5), and weight (OR 2.5, 95% CI 1.2-5.3) were significantly associated. CONCLUSION: Metatarsalgia occurs in almost half of hallux valgus patients. It has a multifactorial etiology. Our findings contradict the common theory that both the magnitude of hallux valgus deformity and an increased length of the lesser metatarsals, by themselves, lead to primary metatarsalgia. Metatarsalgia was associated with Achilles shortening, excessive weight, and associated lesser toe deformity. These factors should be addressed in order to treat this disorder adequately. LEVEL OF EVIDENCE: Level III, comparative series.

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...

Neuroma de Morton en paciente con metatarsalgia / MortonÆs 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...(AU)