scholarly journals Osteonecrosis of the Lesser Metatarsal Heads

2020 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Surgical Intervention ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Clinical Findings ◽  
Treatment Modalities ◽  
Joint Surface ◽  
Rapid Progression ◽  
Second Metatarsal ◽  
Freiberg’S Disease ◽  
Late Stages

Osteonecrosis of the lesser metatarsal heads may be detected in both children and adults. It is also defined as Freiberg’s disease. It is an uncommon syndrome whose etiology combines potential developmental anomalies, biomechanical stresses or traumatic events, subchondral fracture and vascular injury. The second metatarsal head is the most commonly involved. The disease is much more common in females and athletes. The diagnosis is based on the clinical findings and is confirmed with plain radiographs. On physical examination, the palpable swelling, the discomfort and the motion restriction are well localized at the affected metatarsophalangeal joint. The history may be one of exacerbations and remissions, with pain aggravated by activity and relieved by rest. However, in a group of patients the disorder escapes diagnosis, until the foot is radiographically examined for a totally different reason. Radiographically, the metatarsal head may have a flattened, enlarged appearance with areas of increased sclerosis, fragmentation and collapse, resulting in incongruity of the joint surface. In the long-standing disease, the affected metatarsophalangeal joint may be narrowed and prominent secondary degenerative changes may be evident. The goal of treatment is early identification and conservative treatment of the patient, to allow bone healing and prevent rapid progression to osteoarthritis. No operative treatment modalities are effective in the early stages but surgical intervention is usually required in the late stages of the disease. The purpose of this editorial is to retrospectively review the incidence of osteonecrosis of the lesser metatarsal heads in children and adults referred at our institution and to review the relevant publications.

Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

2018 ◽  
Vol 39 (8) ◽  
pp. 978-983
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
R. Frank Henn ◽  
Rebecca A. Cerrato
Keyword(s):  
Clinical Practice ◽  
Clinical Relevance ◽  
Articular Surface ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Lateral View ◽  
Joint Surface ◽  
Foot And Ankle ◽  
Kirschner Wires

Background: Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. Methods: Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. Conclusion: Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. Clinical Relevance: This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.

An Isolated Chronic Osteochondral Fracture of the Third Metatarsal Head Treated With Bioabsorbable Pins

2016 ◽  
Vol 9 (6) ◽  
pp. 555-559 ◽  
Author(s):  
Toshinori Kurashige ◽  
Seiichi Suzuki
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Reports ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Osteochondral Fracture ◽  
The Third ◽  
Freiberg’S Disease ◽  
Type Of Fracture

An osteochondral fracture of the metatarsal head is generally the result of direct trauma and is associated with additional proximal fractures of the medially adjacent metatarsals. An isolated osteochondral fracture of the metatarsal head is extremely rare, with only 10 published case reports. Open reduction and internal fixation was performed in 6 of 10 cases and in 2 of 4 chronic cases, each with different implants previously. The mechanism of injury was considered to be shear force in 5 of the reported cases. It is difficult to achieve and maintain reduction in these cases, and the best method for treatment of this type of fracture is unclear. We report a case of an isolated chronic osteochondral fracture of the third metatarsal head in a 14-year-old boy. The boy reported pain in his third metatarsophalangeal joint on dismounting from a bicycle 2 months prior to presentation. He could play soccer at first; however, the pain worsened after running long distances. Therefore, he was referred to our department. Magnetic resonance imaging revealed an osteochondral fracture of the metatarsal head without Freiberg’s disease. We achieved a good result 12 months postoperatively by using open reduction and internal fixation with 2 bioabsorbable thread pins. Levels of Evidence: Therapeutic, Level IV: Case study

Dorsal dislocation of the first metatarsophalangeal joint associated with fractured second metatarsal head

2011 ◽  
Vol 17 (2) ◽  
pp. e31-e33 ◽  
Author(s):  
Rachid Chafik ◽  
Jamal Bouslous ◽  
Hanane Elhaoury ◽  
Halim Saidi ◽  
Tarik Fikry
Keyword(s):  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
First Metatarsophalangeal Joint ◽  
Second Metatarsal

Effectiveness of the Fixtoe Device® in Plantar Pressure Reduction: A Preliminary Study.

2021 ◽  
Author(s):  
Maria Ruiz-Ramos ◽  
Ángel Manuel Orejana-García ◽  
Ignacio Vives-Merino ◽  
Carmen Bravo-Llatas ◽  
José Luis Lázaro-Martínez ◽  
...  
Keyword(s):  
Plantar Pressure ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Cross Sectional ◽  
Time Integral ◽  
Pressure Time ◽  
Second Metatarsal ◽  
Maximal Pressure ◽  
Taping Technique

Abstract Background: Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness.Methods: The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study. Maximal pressure (Kpa) and pressure-time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad. Results: Mean second metatarsal head maximal pressure and mean pressure-time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure-time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure-time integral reduction.Conclusions: The Fixtoe Device® reduces median maximal pressure and median pressure-time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.

Freiberg’s Avascular Necrosis: A Case Report

2020 ◽  
Author(s):  
Amir Sabaghzadeh ◽  
Hossein Mohebi ◽  
Shiva Momen ◽  
Morteza Gholipour ◽  
Seyyed-Mohsen Hosseininejad
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
Metatarsal Head ◽  
Local Pain ◽  
Trauma History ◽  
Second Metatarsal ◽  
Previous Trauma ◽  
Uncommon Condition ◽  
Freiberg’S Disease

Background: Freiberg’s disease is an uncommon condition typified by bony infarction of the second metatarsal head with a vague multifactorial etiology which tends to mostly occur in women. Case Report: A 22-year-old woman presented with second metatarsal head local pain exacerbating while walking without any prominent previous trauma history; clinical and imaging workups revealed metatarsal head osteonecrosis of Freiberg’s infarction. Conclusion: It should be kept in mind that for those complaining of forefoot discomfort, especially in the region of metatarsal heads, Freiberg’s avascular necrosis (AVN) could be a potential pathology

Silicone Implant Arthroplasty for Second Metatarsophalangeal Joint Disorders with and without Hallux Valgus Deformities

Foot & Ankle ◽  
1988 ◽  
Vol 9 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Andrea Cracchiolo ◽  
Harold B. Kitaoka ◽  
Edward O. Leventen
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Degenerative Joint Disease ◽  
Silicone Implant ◽  
Joint Disease ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal ◽  
Second Toe

Subluxation or dislocation of the second metatarsophalangeal joint (MTPJ) is usually associated with a hammertoe deformity and, frequently, with a significant hallux valgus deformity. Although the joint itself may be painful, there is also pain in the hammertoe deformity, especially when the patient is wearing closed shoes. A painful intractable plantar keratosis is usually present. We reviewed all of our patients with second MTPJ subluxation or dislocation, in whom a double-stem silicone implant had been used to relocate the joint. In 31 feet of 28 patients, 32 implants were used. All but six feet with advanced degenerative joint disease secondary to Freiberg's infraction had severe associated forefoot pathology that necessitated surgical correction. Several feet had previous bunion operations as well as operations on the second toe. In addition to the second toe, we performed hallux valgus corrections in 23 feet, seven of which were revision procedures. At an average follow-up time of 37 months, good results were seen in 20 feet (63%), good results with reservations in eight feet (25%), and failure in four feet (12%). Transfer metatarsalgia was the most frequent complication. The implants remained stable, and in only one was there a suspected fracture. More optimum results might have been achieved had there been better correction of the hallux valgus deformities, more frequent correction of the hammertoe deformity, and less resection of the second metatarsal head. These patients with pathology usually involving both the first and second MTPJ are difficult to treat, therefore. Their results are less predictable and not as favorable as those achieved for patients with isolated similar deformities.

scholarly journals Retrospective analysis of 5 years results of first metatarsophalangeal joint arthroplasty, Single surgeon series

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Khalid Merghani Saleh Mohammed ◽  
Yasser Aljabi ◽  
Ara Francis ◽  
Robert Flavin
Keyword(s):  
Retrospective Analysis ◽  
Weight Bearing ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Joint Arthroplasty ◽  
Joint Surface ◽  
X Rays ◽  
Medium Term ◽  
First Metatarsophalangeal Joint

Category: Bunion Introduction/Purpose: First Metatarsophalangeal joint (MTPJ) osteoarthritis is a common forefoot disease. It leads to joint surface destruction and erosions limiting function and causing pain. The disease can be classified to mobile and non mobile or traumatic and atraumatic disease. The gold standard for treatment of stage III and IV remains MTPJ arthrodesis. In this case series we demonstrate MTPJ arthroplasty in mobile MTPJ with stable first interphalangeal joint (IPJ) can achieve short and medium-term results that are comparable to arthrodesis with high satisfaction rate. Methods: Retrospective analysis of 48 MTPJ arthroplasties performed by single surgeon in the period between 2011 to 2016. Patient were included if they had mobile first MTPJ osteoarthritis in the absence of IPJ hypermobility. The Surgical procedure included resurfacing the 1st metatarsal head using Arthrosurface® Hemicap implant and Extensor Digitorum Brevis (EDB) graft on the phalangeal surface of the joint. Radiological parameters collected using weight bearing x-rays prior to surgery, immediate radiological correction after surgery, 6 month and 2 years radiological analysis following the index surgery. Physiotherapy data were collected by senior physiotherapist prospectively during the time of postoperative rehabilitations and it included AOFAS and VAS scores. Results: 48 patients underwent 1st MTP joint arthroplasty using Arthrosurface® Hemicap implant for the metatarsal head with EDB graft on the phalangeal aspect. 44 patients had primary OA of the 1st MTP joint, 4 were conversion of MTPJ arthrodesis to arthroplasty and 3 were treated for non-union of MTP joint arthrodesis. Average postoperative ROM in the sagittal plane was 30 degrees and no valgus deformity in the coronal plane. 3 Patients (0.68%) had residual pain following the surgery due to soft tissue impingement and required further surgical intervention. 1 patient remained dissatisfied after the revision surgery. Conclusion: In short to medium-term follow up, the first MTP joint arthroplasty with Arthrosurface® implant and EDB graft provides an excellent functional outcome in the management of moderate to severe OA. In some selected cases this can be an option for treatment of patient with failed arthrodesis or patients requiring the reversal of the arthrodesis due to other issues.

Plantar Pressure and Joint Motion After the Youngswick Procedure for Hallux Limitus

2004 ◽  
Vol 94 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Alan R. Bryant ◽  
Paul Tinley ◽  
Joan H. Cole
Keyword(s):  
Pressure Distribution ◽  
Peak Pressure ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Joint Motion ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Second Metatarsal

The effects of the Youngswick osteotomy on plantar peak pressure distribution in the forefoot are presented for 17 patients (23 feet) with mild-to-moderate hallux limitus deformity and 23 control subjects (23 feet). During 2 years of follow-up, the operation produced a significant increase in the range of dorsiflexion of the first metatarsophalangeal joint in these patients, reaching near-normal values. Preoperative and postoperative measurements, using a pressure-distribution measurement system, show that peak pressure beneath the hallux and the first metatarsal head remained unchanged. However, peak pressure was significantly increased beneath the second metatarsal head and decreased beneath the fifth metatarsal head. These findings suggest that the foot functioned in a less inverted manner postoperatively. Compared with normal feet, hallux limitus feet demonstrated significantly higher peak pressure beneath the fourth metatarsal head preoperatively and postoperatively. (J Am Podiatr Med Assoc 94(1): 22-30, 2004)

A Normal Variant Simulating Freiberg's Disease

1987 ◽  
Vol 28 (1) ◽  
pp. 85-86 ◽  
Author(s):  
E. Legarth Jensen ◽  
A. de Carvalho
Keyword(s):  
Metatarsal Head ◽  
Joint Space ◽  
Normal Variant ◽  
Anatomic Variant ◽  
Radiologic Examination ◽  
Second Metatarsal ◽  
Freiberg’S Disease

Radiologic examination of the feet was performed in 72 normal persons with no history or physical signs of disease of the feet. In about 10 per cent, bilateral flat configuration of the second metatarsal head accompanied by a joint space wider than in the neighbouring joints was found, and is therefore a normal anatomic variant that must not be confused with Freiberg's disease or its final stages.

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