Term
| Definition of Metatarsalgia |
|
Definition
| Forefoot pain under met heads |
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Term
| Bony causes of Metatarsalgia |
|
Definition
Long metatarsal
Plantarflexed metatarsal
hammertoe
enlarged met head
arthritis
Freiberg's infarction
Stress fracture |
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|
Term
| Soft tissue causes of Metatarsalgia |
|
Definition
Calluses
Neuroma
Capsulitis
Plantar plate pathology
Hypermobile 1st ray
Equinus |
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|
Term
| Rays that have their own axis and usually have the most motion |
|
Definition
|
|
Term
|
Definition
Usually the 2nd or 3rd met
May get hammering of the digit
May get plantar callus
Chronic overloading can lead to capsulitis/plantar plate tears
Excess length can indirectly cause it to be plantarflexed |
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|
Term
|
Definition
hammering of the digit
causes plantar pressures |
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|
Term
| Conservative treatment - long met |
|
Definition
Metatarsal pad
Callus debridement
Budin slint |
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|
Term
| Metatarsal Osteotomy - indications |
|
Definition
Long met
plantarflexed met
hammertoe that cannot be reduced without decreasing met length
angular deformity of met |
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|
Term
| Metatarsal osteotomy - contraindications |
|
Definition
Pain of unknown etiology
parabola correction without underlying pain or symptoms
Severe osteopenia |
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|
Term
|
Definition
Shortening osteotomy
fixated with 1.5 or 2.0 screw
parallel to WB surface
will shorten to its own level |
|
|
Term
|
Definition
Older patients
can lead to arthritis
can lead to floating |
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|
Term
|
Definition
Dorsiflexory osteotomy with little shortening
can be allowed to float |
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|
Term
| Dorsiflexory wedge osteotomy |
|
Definition
can do proximal or distal
need less wedge if proximal
leave plantar cortex intact |
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|
Term
| Met osteotomy post-op (distal procedures) |
|
Definition
WB in post-op shoe for 6 weeks if fixated
if not fixated may consider NWB |
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|
Term
| Met osteotomy post-op (proximal procedures) |
|
Definition
|
|
Term
| Met osteotomy complications |
|
Definition
floating toe
transfer lesion (callus under adjacent toe)
delayed or nonunions without fixation |
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|
Term
|
Definition
Avascular necrosis of bone
usually involves 2nd met head
tenderness and edema with activity
nothing shows up on radiographs early on in disease |
|
|
Term
| Freiberg's Infarction - conservative treatment |
|
Definition
Steroid injection
Rocker bottom shoes
carbon plate |
|
|
Term
| Freiberg's Infarction - surgical treatment |
|
Definition
Met head resection
Graft
Implant |
|
|
Term
| Graft used in Tx of Freiberg's infarction |
|
Definition
Orthobiologics or fresh frozen graft
orthobiologics prvoide a scaffold for fibrocartilage
fresh frozen replaces cartilage |
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|
Term
|
Definition
pain with palpation dorsally
pain with tuning fork application
may have edema
x-rays initially negative
bone scan will see uptake in 3rd phase |
|
|
Term
| Stress fracture - conservative treatment |
|
Definition
| immobilize in boot or post-op shoe 4-6 weeks |
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|
Term
| Stress fracture - surgical treatment |
|
Definition
| done only if full fracture or excessive callus formation |
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|
Term
|
Definition
burning pain with tingling/numbness
"wrinkled sock" sensation
symptoms worse with shoes |
|
|
Term
| most common area affected by a neuroma |
|
Definition
3rd interspace
medial plantar and lateral plantar nerve combine at this point |
|
|
Term
|
Definition
squeeze forefoot while applying plantar and dorsal pressure
will feel a palpable click if positive
indicative of a neuroma |
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|
Term
|
Definition
pain with just squeezing the foot
indicative of a neuroma |
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|
Term
| Neuroma - conservative treatment |
|
Definition
Wider shoes
Metatarsal pad
Steroid injection
Sclerosing injection
B12 injection
Phenol |
|
|
Term
| 4% Alcohol Sclerosing injections |
|
Definition
inject just proximal to the "bulb" (painful spot)
repeat every 5-10 days (up to 7-9 injections) |
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