Metatarsalgia Flashcards Preview

Biomechanics & Surgery Exam 3 > Metatarsalgia > Flashcards

Flashcards in Metatarsalgia Deck (44):

what is metatarsalgia?

forefoot pain under metatarsal heads


what are some bony causes of metatarsalgia?

-long metatarsal
-plantarflexed met
-enlarged met head
-Freiberg's infarction
-stress fx


what are some soft tissue causes of metatarsalgia?

-plantar plate pathology
-hypermobile 1st ray


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?

1. 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


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
-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


what diagnostic testing do you need for a neuroma?

(usually not necessary)
1. x-rays to rule out stress fx; Sullivan's sign
2. ultrasound: ovoid mass with hypoechoic signal
3. MRI- T1 image is best


what is sullivan's sign?

splaying of toes in the involved interspace when WB


conservative treatment options on neuroma?

-wider shoes
-metatarsal pad
-steroid injection
-sclerosing injection


what are the advatnages of a dorsal incision for a surgical tx for neuroma?

-immediate WB
-no plantar scar or wound dehiscence


what are teh disadvantages of a dorsal incision for a surgical treatment for neuroma?

need meticulous dissection (can lead to hematoma or hammertoe formation)


what is the advantages of plantar incision for surgical tx of neuroma?

-better visualization
-less incidence of hematoma and hamemrtoe formation


what are the disadvantages of plantar incision?

NWB for 3 weeks
-potential plantar scar


plantar plate pathology commonly affects which metatarsal?

2nd met (bc it is the longest)


s/s of plantar plate pathology?

-pain worse w/ walking
-feels like walking on a stone bruise
-change in position of toes (medial deviation is common)


etiologies of plantar plate?

-long 2nd met/ short 1st met
-1st ray hypermobility
-overloading due to equinus or high heels


what are the physical exam findings of plantar plate pathology?

-pain w/ palpation directily plantar at joint line
-focal edema over joint
-possible loss of purchase of toe
-vertical stress test


what is vertical stress test?

(for plantar plate pathology)
is (+) with 2mm or more displacement of the toe


what is stage 1 of predislocation syndrome (aka plantar plate pathology)?

-mild edema dorsal and plantar
-very painful
-joint is still aligned


what occurs in stage 2 of predislocation syndrome?

-moderate edema
-deviaition of digit both clinically and radiographically
-loss of toe purchase, noticeable in WB


what occurs in stage 3 predislcoation syndrome?

-moderate edema
-subluxation/ dislocation is pronounced


how does the bone scan compare between plantar plate tear and stress fx?

will be (-) in phase 3 of plantar plate tear but (+) for stress fx bc it of bone involvement


conservative tx for plantar plate tears?

-metatarsal pads
-budin splint
-crossover taping
-ice, stiff shoes, CAM boot


surgical treatment for plantar plate tear?

-direct repair
-indirect stabilization
(in addition, may fuse PIPJ or do metatarsal osteotomy; may even do 2nd MPJ fusion)


describe the direct repair for a plantar plate tear.

can be a dorsal or plantar incision, although most people approach it from plantar side. The tear is usually on the phalanx side; can suture end-to-end or use anchor in proximal phalanx base. stabilize with K-wire.
*post-op: NWB for 3 wks


describe the indirect repair of plantar plate tear.

1. isolate flexor tendon and split in half, bring up over toe and suture to itself and periosteum dorsally
2. isolate tendon and insert into bone and secure to itself, periosteum, or use anchor