Metatarsus Primus Elevatus in Hallux Rigidus

2005 ◽  
Vol 95 (3) ◽  
pp. 221-228 ◽  
Author(s):  
Thomas S. Roukis
Keyword(s):  
Hallux Valgus ◽  
Plantar Fasciitis ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Radiographic Measurement ◽  
Morton’S Neuroma ◽  
Significant Difference ◽  
History Of ◽  
Morton's Neuroma ◽  
Grade Ii

Two hundred seventy-five lateral weightbearing radiographs of isolated pathology were reviewed and stratified into hallux rigidus (n = 100), hallux valgus (n = 75), plantar fasciitis (n = 50), and Morton’s neuroma (n = 50) groups. The patient population consisted of healthy individuals with no history of foot trauma or surgery. The first to second metatarsal head elevation, Seiberg index, first to second sagittal intermetatarsal angle, first to fifth metatarsal head distance, and hallux equinus angle were measured in each population. Statistically significant differences were found between the hallux valgus, plantar fasciitis, and Morton’s neuroma populations and the hallux rigidus population, which showed greater elevation of the first metatarsal relative to the second for each radiographic measurement technique. In the hallux rigidus population, there was a statistically significant difference between grade II and grades I and III regarding the first to fifth metatarsal head distance (greater in grade II) and the hallux equinus angle (lower in grade II). A review of the literature and comparison with historical controls reveals that metatarsus primus elevatus exists in hallux rigidus and is greater than that found in hallux valgus, plantar fasciitis, and Morton’s neuroma groups. (J Am Podiatr Med Assoc 95(3): 221–228, 2005)

Sex Correlation to the Prevalence of Pedal Neuromas in Various Interspaces: A Retrospective Study

2020 ◽  
Vol 110 (5) ◽  
Author(s):  
Patrick A. DeHeer ◽  
Artinder P. Nanrhe ◽  
Shannon R. Michael ◽  
Sarah N. Standish ◽  
Christine D. Bhinder ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Statistical Significance ◽  
Special Focus ◽  
Morton’S Neuroma ◽  
Nerve Branch ◽  
Plantar Plate ◽  
Significant Difference ◽  
History Of ◽  
Morton's Neuroma ◽  
Male Patients

Background Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and in females. The principal investigator observed Morton's neuromas commonly in the second and third interspaces in both sexes. To our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each sex independently. The present study evaluates Morton's neuroma interspace location and whether there is a variation by sex. Methods In this retrospective study, 582 deidentified magnetic resonance imaging reports with a diagnosis code for Morton's neuroma were evaluated for patients scanned from January 2, 2015, through April 19, 2016. Incomplete records and those with radiologist findings inconsistent with Morton's neuroma were eliminated. For the remaining 379 patients, data were collected on sex, laterality, history of trauma, plantar plate tear, age, and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data were evaluated using the Pearson χ2 and independent-samples Mann-Whitney U tests, with P < .05 indicating statistical significance. Results No statistically significant distribution between sex and second and third interspace Morton's neuromas was noted. Right vs left foot, age, and history of trauma did not vary statistically significantly between sexes. There was a statistically significant difference between the presence of plantar plate tears between sexes. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (P = .01). Conclusions This study found that there were no statistically significant differences between sexes and Morton's neuromas location, laterality, or age.

scholarly journals Gender Correlation to the Prevalence of Pedal Neuromas in Various Interspaces - A Retrospective Study

2020 ◽  
Author(s):  
Patrick A DeHeer ◽  
Artinder P Nanrhe ◽  
Shannon R Michael ◽  
Sarah N Standish ◽  
Christine D Bhinder ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Statistical Significance ◽  
Special Focus ◽  
Morton’S Neuroma ◽  
Chi Square ◽  
Nerve Branch ◽  
Plantar Plate ◽  
Significant Difference ◽  
History Of ◽  
Morton's Neuroma

BACKGROUND: Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and predominantly identified in females. The principal investigator observed Morton's neuromas commonly in both the 2nd and 3rd interspaces in both genders. To the best of our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each gender independently. The present study evaluates Morton's neuroma interspace location and if there is a variation between males and females.METHODS: In this retrospective study, 582 de-identified ProScan magnetic resonance imaging reports, with a diagnosis code for Morton's neuroma (ICD Code 355.6), were obtained from their centralized database. These reports were evaluated for patients scanned from January 2015-April 2016. Incomplete records and those where the radiologist findings were not consistent with Morton's neuroma were eliminated. For the remaining 379 patients, data was collected on several factors such as gender, laterality, history of trauma, plantar plate tear, age and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data was then evaluated statistically utilizing the Pearson Chi-Square and Independent Samples Mann-Whitney U Test with statistical significance deemed p<0.05. RESULTS: No statistically significant distribution between gender and second and third interspace Morton's neuromas were noted. Additionally, right vs left foot, age and history of trauma did not vary between genders in a significant way. Lastly, there was a statistically significant difference between the presence of plantar plate tears between genders. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (34/92, p=0.01).CONCLUSION: Our study found that there was not a statistically significant difference between female and male and Morton's neuromas location, laterality or age.

scholarly journals Patient Related Outcome Measures (PROMs) in Morton’s Neuroma: Conservative vs. Surgical Management at One-Year Follow-Up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Alastair Faulkner ◽  
Alistair Mayne ◽  
Fraser Harrold
Keyword(s):  
Outcome Measures ◽  
Surgical Management ◽  
Conservative Management ◽  
Morton’S Neuroma ◽  
Significant Difference ◽  
Morton's Neuroma ◽  
One Year ◽  
Patient Related Outcome ◽  
Eq Vas

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

scholarly journals Assessment of First Metatarsal Head Bone Density for Optimal Screw Placement in Minimally-Invasive Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Katherine M. Dederer ◽  
Patrick J. Maloney ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Rebecca A. Cerrato
Keyword(s):  
Bone Density ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Metatarsal Head ◽  
Screw Placement ◽  
Cannulated Screws ◽  
First Metatarsal ◽  
History Of

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: Minimally-invasive surgery (MIS) for hallux valgus correction has become increasingly common. This technique involves an osteotomy of the first metatarsal, followed by fixation with two cannulated screws. Since screws are typically not bicortical, they rely upon bone quality within the metatarsal head for fixation strength. However, bone mineral density (BMD) within different regions of the metatarsal head is unknown. Measuring the BMD in the target region may predict the strength of the bone-screw fixation. Similar to previous work which determined the optimal position for lag screw placement in the femoral head during hip fracture fixation, this study aimed to determine average BMD within four quadrants of the metatarsal head using CT and thus predict the optimal trajectories for cannulated screws during the MIS bunion procedure. Methods: All patients between 18-75 years of age scheduled to undergo MIS hallux valgus correction by one of two surgeons experienced in the MIS technique were eligible to participate. Patients were excluded if they had a prior first metatarsal surgery, pre-existing hardware, previous first metatarsal fracture, or a history of osteoporosis treatment. Patients were enrolled prospectively, and a weight-bearing CT scan of the affected foot was obtained pre-operatively. Demographic factors including age, sex, laterality, body mass index (BMI), comorbidities, and smoking status as well as standard three-view weight-bearing radiographs were collected for all patients.Using the coronal CT slice at maximal metatarsal head diameter, each head was divided into equal quadrants. Hounsfield units (HU) within each quadrant were measured independently by three study investigators using our hospital’s radiology viewing software (Merge PACS; IBM Corporation, Armonk, NY), and these density measurements were averaged. Statistical analysis was conducted using ANOVA and Student’s t-test. Results: Fifteen patients were included for preliminary analysis. All patients were female. The average age was 45.7 years. 9 of the 15 included feet were right feet. Average BMI was 28.0. One patient reported active smoking prior to surgery. Comorbidities included obesity in three patients; none were diabetic. One had a history of diplegic cerebral palsy. The average HVA on a weight- bearing AP foot x-ray was 28.2°, and the average IMA was 12.6°. The BMD within the metatarsal head varied by quadrant, with the two combined dorsal quadrants having higher average BMD than the two combined plantar quadrants (122 vs 85 HU; p<0.001). The dorsal lateral quadrant had the highest average BMD of any quadrant (132 HU, p<0.001; Table 1). Conclusion: The density of the metatarsal head did vary by region within the head. The highest BMD was found in the dorsal lateral quadrant, and the lowest in the plantar lateral and plantar medial quadrants, which did not differ significantly from each other. Because strength of screw fixation is predicated upon screw design as well as bone density, these results suggest that surgeons may wish to direct screws toward the dorsolateral region of the metatarsal head in order to achieve optimal fixation. Further work is needed to determine whether this varies with patient age, gender, or hallux valgus angle. [Table: see text]

Disorders of the forefoot

2011 ◽  
Author(s):  
Andrew H.N. Robinson ◽  
Maneesh Bhatia
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Early Mobilization ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Indications For Surgery ◽  
Forefoot Surgery ◽  
First Ray

♦ The aim of modern forefoot surgery is to refunction the first ray, and balance the lesser rays around it♦ The indications for surgery in hallux valgus are of pain over the bunion, or of pain with subluxation or dislocation of the lesser rays as a result of first ray insufficiency♦ Hallux valgus surgery aims to reposition the metatarsal head over the sesamoids whilst maintaining length. The osteotomy should be stable to allow early mobilization♦ The mainstays of the surgical treatment of hallux rigidus are dorsal cheilectomy and fusion of the first MTPJ♦ 96% excellent and good results in reconstruction of the rheumatoid forefoot have been reported with fusion of the first MTPJ and resection of the lesser metatarsal heads.

scholarly journals Comparative Analysis of Dorsal Nerve Transfer vs Dorsal Neurectomy in Morton’s Neuroma

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0025
Author(s):  
Manjunath Koti ◽  
Zaid Marhoon ◽  
Mirant Parikh ◽  
Max Edwards ◽  
Jack McAllister
Keyword(s):  
Comparative Analysis ◽  
Nerve Transfer ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Morton’S Neuroma ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Morton's Neuroma ◽  
Dorsal Nerve ◽  
Transfer Group

Category: Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Comparative analysis of Dorsal Nerve Transfer and Dorsal Neurectomy in Surgical management of Morton’s Neuroma Methods: This clinical audit was conducted on patients who had undergone surgery for Morton’s neuroma (MN) between 2002 and 2014. Data was collected using an in-depth review of patients’ case-notes. During the period studied, there were a total of 77 patients, 4 the DNT and 40 in the DN groups. The key indication for surgery in all cases reviewed was failure of the condition to improve using conservative methods. A telephonic survey with Primary outcome measure being Coughlin’s Overall patient’s satisfaction criteria and secondary outcome measures were resolution of sensory symptoms and any footwear restrictions. Results: The results of this clinical study shows excellent to good results with the Dorsal nerve transfer group (84%) and Dorsal neurectomy (80%). There were poor results in 11% in the DNT group and 15% in the DN group. Key advantages of Dorsal nerve transfer are better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). 7% reported Nov change and 11% were worse after surgery. 20% had no change and 15% were worse following surgery in DN group. Around 83% had no restriction wearing any footwear in the DNT group when compared to 80%. 17% in the DNT group and 20% were in the DN group wore modified or shoes with no heels. Conclusion: In general there is no significant difference in the outcome of the two surgery all procedures. Key advantages of Dorsal nerve transfer is better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). Around 83% in DNT group and 80% in DN group had no restriction wearing any footwear gain is almost similar in both groups in the DNT group. Whilst Dorsal nerve transfer is a slightly longer procedure than Dorsal neurectomy as some problems were encountered relating to mobilising the nerve due to overlying prominent blood vessels or nerve anomalies.

First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus

2016 ◽  
Vol 106 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Robin C. Lenz ◽  
Darshan Nagesh ◽  
Hannah K. Park ◽  
John Grady
Keyword(s):  
Hallux Valgus ◽  
Frontal Plane ◽  
Metatarsal Head ◽  
Head Width ◽  
Plane Rotation ◽  
First Metatarsal ◽  
Significant Difference ◽  
Medial Eminence ◽  
And Control

Background: Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. Methods: We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Results: Medial eminence width was 1.12 mm larger in patients with hallux valgus (P &lt; .0001). Metatarsal head width was 2.81 mm larger in patients with hallux valgus (P &lt; .001). Metatarsal shaft width showed no significant difference (P = .63). Conclusions: Metatarsal head width and medial eminence width are significantly larger on anteroposterior weightbearing radiographs in patients with hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

scholarly journals Interdigital Perineural Fibroma And A Care Pathway.

2020 ◽  
Author(s):  
Mark Price ◽  
Andrew Bridgen
Keyword(s):  
Surgical Approach ◽  
Care Pathway ◽  
Treatment Options ◽  
Surgical Excision ◽  
Outcome Data ◽  
Mixed Methods Design ◽  
Morton’S Neuroma ◽  
Audit Data ◽  
Significant Difference ◽  
Morton's Neuroma

Abstract BackgroundInterdigital perineural fibroma (IPF) is a complex condition affecting the plantar nerve of the foot and the care pathway for its management is based upon a consensus of clinical opinions. AimThe aim of the study was to investigate the treatment outcomes within a podiatric surgical practice and produce a validated care pathway over a three-year period.MethodsA retrospective mixed methods design was used to allow combination of quantitative and qualitative data. 89 patients between 1/4/2014 and 1/4/2017 had completed PASCOM-10 audit data. The treatment options were investigated and the MOXFQ domains and PSQ10 outcome scores were subject to analysis with SPSS.FindingsThe mean age of patients in the study was 56 (range 36-86, SD 10.85) and 89% were female, 11% male. 749 patients out of the total caseload had local anaesthetic/steroid injections over the three-year period, of which 49% of the known injections were for Morton’s Neuroma. No outcome data was recorded for injections.89 patients went forward for surgical excision of the IPF. The surgical approach for excision was either dorsal (60.7%) or plantar (39.3%). All plantar incisions (transverse and linear) were analysed as a group for comparison against the dorsal approach. Using an independent t-test, there was no significant difference for dorsal or plantar approach or location of IPF across the three MOxFQ domains and PSQ10.Using a Pearson product moment correlation coefficient there was a moderately strong correlation between the PSQ10 and the MOxFQ domains (n=89, Walking and Standing: r=0.48, p<0.01; Pain: r=0.42, p<0.01; Social Interaction: r=0.40, p<0.01). Where increases in MOxFQ outcome score (amount of improvement) produces higher PSQ10 scores (greater patient satisfaction).ConclusionsMore audit data is required to assess the effectiveness of steroid and / or alcohol injections. Recommendation for practice is based on literature review. The surgical outcomes would suggest that the excision of IPF is an appropriate and effective technique and the surgical approach or location of pathology will not affect the clinical outcomes. A new care pathway for the management of IPF (Morton’s Neuroma) will be employed in practice and

scholarly journals The Shape of the First Metatarsal Head and its Association with its Pronation Angle and the Presence of Sesamoid-Metatarsal Joint Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0037
Author(s):  
Yoshimasa Ono ◽  
Satoshi Yamaguchi ◽  
Seiji Kimura
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Qualitative Evaluation ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Lateral Edge ◽  
Ankle Surgery ◽  
History Of ◽  
Joint Deformation ◽  
The Mean

Category: Bunion Introduction/Purpose: The rounded shape of the first metatarsal head’s lateral edge on the dorsoplantar radiograph of the foot is used as a qualitative evaluation of the first metatarsal pronation in hallux valgus feet. However, the relationship between the rounded shape and the metatarsal pronation angle of the first metatarsal has not been examined in detail. Furthermore, hallux valgus often accompanies osteoarthritis in the sesamoid-metatarsal joint. Deformation of the metatarsal head by osteophytes on the lateral edge of the lateral sesamoid facet may affect the rounded shape. The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head. Methods: Patients were prospectively recruited between December 2016 and March 2017. Patients with a history of previous foot and ankle surgery or destruction of the head due to rheumatoid arthritis were excluded. A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head’s lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations of the rounded shape of the first metatarsal with the pronation angle and sesamoid-metatarsal joint osteoarthritis. Results: Of 121 feet, 31, 41, and 49 feet had rounded, intermediate, and angular metatarsal heads, respectively. Sesamoid- metatarsal joint osteoarthritis was evident in 49 (40%) feet. The mean hallux valgus and first metatarsal pronation angle was 23° and 9°, respectively. The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (24 (77%), 11 (27%), and 14 (29%) for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. Furthermore, the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001). These associations were also significant in the multiple regression analysis. Conclusion: A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.

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