Metatarsalgia Flashcards
what is metatarsalgia?
forefoot pain under metatarsal heads
what are some bony causes of metatarsalgia?
- long metatarsal
- plantarflexed met
- hammertoe
- enlarged met head
- arthritis
- Freiberg’s infarction
- stress fx
what are some soft tissue causes of metatarsalgia?
- calluses
- neuroma
- capsulitis
- plantar plate pathology
- hypermobile 1st ray
- equinus
what are indications for metatarsal osteotomies?
- long metatarsal
- plantarflexed metatarsal
- contracted digit that cannot be reduced w/o dec metatarsal length
- angular deformity
what are contraindications for metatarsal osteotomies?
- pain of unknown etiology
- parabola correction w/o underlying pain or sx
- severe osteopenia
what are contraindications for metatarsal osteotomies?
- pain of unknown etiology
- parabola correction w/o underlying pain or sx
- severe osteopenia
what is the weil osteotomy?
a shortening osteotomy where you make a cut parallel to WB surface at cartilage surface, causing the soft tissue to shrink back
when is the plantar condylectomy procedure used?
- used in older patients w/ prominent metatarsal head due to fat pad atrophy
- used in diabetic patients with chronic callus/ulcer
when is the V metatarsal osteotomy indicated?
for a purely plantarflexed metatarsal and you just want to raise it up
what are two procedures that correct a plantarflexed metatarsal?
- V metatarsal osteotomy
2. dorsiflexory wedge osteotomy
what are the indications for a weil osteotomy?
long metatarsal
for distal procedures, what is the post-op directions?
WB in post-op shoe for 6 weeks if fixated
if not fixated, may consider NWB
for proximal procedures, what is the post-op directions?
NWB for 6-8 weeks
what are complications of metatarsal osteotomy?
- floating toe
- transfer lesions onto adjacent met heads
- delayed or nonunions w/o fixation
what is freiberg’s ifnarction?
avascular necrosis of the 2nd metatarsal head leading to collapses of articuarl sruface
what do late changes of freiberg’s infarction look like on radiographs?
flattening of met head, spurring, sclerosis
conservative treatment for freiberg’s infarction?
- initially: immobilization
- chronic tx: steroid injection, rocker bottom shoes, carbon plate for shoes
surgical treatment for freiberg’s infarction?
- metatarsal head resection
- graft
- implant
how do you diagnose stress fracture?
- pain with palpation dorsally
- pain with tuning fork application over the site itself
- may have edema
- initial x-rays negative
- bone scan will have uptake in 3rd phase
conservative treatment for stress fx?
-immobilize in boot or post-op shoe for 4-6 weeks
surgical treatment for stress fx?
only done if it goes to full fracture or there is excessive callus formation
s/s of neuroma?
- burning pain
- tingling/numbness
- wrinkled sock sensation
- sharp or radiating pain to toes
- symptoms worse with tight shoes
which interspace is commonly affected (aka Morton’s neuroma) and why?
3rd interspace
bc of communicating branch btwn medial and lateral plantar nerves
what physical exam findings do you expect with morton’s neuroma?
- pain on direct palpation to intersapce
- Mulder’s sign: a palpable click is heard when you squeeze forefoot while applying plantar and dorsal pressure
- gauthier test: pain with just squeezing foot
- usually no edema noted
