Search Results (42)

Introduction: Distal intracapsular minimally invasive osteotomies (DICMOs) for central metatarsals are described as intracapsular procedures; however, neither their intracapsular location throughout the entire cut nor the optimal anatomical position for their execution have been fully validated. The aim of this study was to assess the geometric position of the DICMO osteotomy in the central metatarsals (third and fourth) and quantify associated anatomical damage when performed under three different guidance modalities: anatomical palpation, fluoroscopic control, and ultrasound guidance. Material and methods: An experimental cadaveric study was conducted using 29 fresh specimens (11 males, 18 females), contributing a total of 58 central metatarsals (third and fourth). All specimens underwent a DICMO-type metatarsal osteotomy. Osteotomies were randomly allocated to three intervention groups: (1) ultrasound (n = 20), (2) fluoroscopy (n = 19), and (3) anatomical guidance (n = 19). Metatarsal length, the distance between the osteotomy line and the articular surface, and post-dissection soft-tissue damage were recorded. Results: After dissection, all osteotomies were confirmed to be intracapsular. A constant proportional relationship was identified between osteotomy location and metatarsal length: distance to the joint line = 0.239 × metatarsal length. This relationship was independent of the guidance technique used. Only one iatrogenic lesion was observed: an articular cartilage injury of a third metatarsal in the anatomical-guidance group. Conclusions: The optimal position for DICMO osteotomy placement is approximately 24% of the total distal metatarsal length. This ensures an intracapsular trajectory and may contribute to intrinsic osteotomy stability. Image guidance—either fluoroscopy or ultrasound—appears essential to optimize outcomes and prevent avoidable anatomical damage. Full article

Introduction and Objectives: The thickness of the plantar fat pad (PFP) beneath the metatarsal heads may play a protective role in preventing forefoot disorders such as metatarsalgia. However, reference values for plantar adipose tissue thickness in this region among healthy individuals are currently unavailable. Therefore, the aim of this study was to determine, by means of ultrasound imaging, the thickness of the PFP beneath the five metatarsal heads and to analyze its possible relationship with body mass index (BMI). Materials and Methods: Thirty-five young adults (17 males and 18 females) with neutral feet, free from deformities or pain, participated in the study. Using a VINNO E35 ultrasound device, the thickness of the PFP beneath each of the five metatarsal heads was quantified. A linear transducer was positioned longitudinally along the axis of each metatarsal. The distance between the dermis and the flexor tendon was measured from the second to the fifth metatarsal heads, and from the fibular sesamoid for the first metatarsal head. Results: The central forefoot showed the greatest PFP thickness (2nd metatarsal head, 7.1 ± 0.9 mm; 3rd metatarsal head, 6.9 ± 0.9 mm). No significant differences in PFP thickness were found between sexes. However, a positive correlation was observed between BMI and PFP thickness at the fourth metatarsal head (r = 0.358, p = 0.035). Conclusions: The study demonstrated greater PFP thickness beneath the second and third metatarsal heads, with no significant sex-related differences. These findings indicate a consistent anatomical pattern independent of sex in young, healthy individuals. Moreover, a moderate influence of BMI was identified at the fourth metatarsal head, which could represent a potential protective mechanism against forefoot overload. Full article

Background: Cavus foot, defined by an increased medial longitudinal arch and often forefoot plantarflexion, alters biomechanics and increases peak plantar pressures, raising the risk of musculoskeletal disorders such as metatarsalgia, Achilles tendinopathy, and gait instability. Custom foot orthoses are the preferred conservative treatment, offering plantar support, pressure redistribution, and reduction in compensatory muscle activity. This study evaluated the medium- and long-term effectiveness of custom orthoses in 71 patients with cavus feet using surface electromyography (sEMG) and the same shoes. Methods: Muscle activity of the peroneus longus, peroneus brevis, and gastrocnemius was recorded during treadmill gait after one and four months of orthotic use. Results: Significant reductions in muscles were observed, especially after four months, confirming greater long-term effectiveness. No residual benefits were found when participants walked without orthoses. Conclusions: These findings support the clinical value of insoles in reducing the compensatory muscle activity in cavus feet and emphasize the importance of investigating their long-term role in biomechanics and potential pathology risk reduction. Full article

Background and Objectives: The anesthetic nerve block test is a surgical technique that can assist in the differential diagnosis of forefoot pain. The MTP joint, enclosed by its capsule, may act as a sealed cavity with predictable contrast dispersion, whereas the IM space, lacking clear boundaries and containing bursae and the plantar digital nerve, favors diffuse spread. Due to the high rate of false positives in suspected cases of Morton’s neuroma with the anesthetic block current procedure in the intermetatarsal space, the aim of this study was to propose an alternative to the current procedure. Material and Methods: Six fresh cadaveric feet were used. Under ultrasound guidance, the 2nd–4th MTP joints received stepwise intra-articular injections of radiopaque contrast. The third common digital nerve was injected within the third intermetatarsal space. Standard radiographs were obtained to assess distribution and proximal spread. Results: A volume of 0.3 mL was sufficient to fully reach the intra-articular cavity and potentially induce effective localized anesthesia. When the third common digital plantar nerve was injected in an anatomically healthy region, the contrast medium showed a proximal diffusion pattern extending up to the mid-diaphyseal level of the third and fourth metatarsal bones. On radiographs, the intra-articular infiltration lines appear sharply demarcated, supporting the interpretation of the metatarsophalangeal joint as a sealed compartment. Conclusions: Low intra-articular anesthetic volumes may yield targeted effects, while Morton’s neuroma injections spread proximally, risking loss of diagnostic specificity; this technique may improve decision-making accuracy and reduce failures. Full article

Background: Foot pain often persists in patients with rheumatoid arthritis (RA), even during clinical remission. However, its causes are not fully understood. Identifying factors specifically associated with metatarsal pain, rather than generalized foot pain, may improve targeted management strategies. Objectives: The aim of this study was to compare the clinical, biomechanical, and radiological characteristics of RA patients in remission with isolated metatarsal pain versus those with pain in other foot regions, and to identify independent predictors of metatarsal pain. Methods: This cross-sectional study included 118 RA patients in remission, classified into two groups: isolated metatarsal pain (n = 61) and pain in other foot regions (n = 57). Clinical variables (demographics, disease duration, treatment, comorbidities), biomechanical measures (ankle, first metatarsophalangeal and subtalar joint mobility, hallux valgus severity, foot type), radiographic findings (erosions, subluxations), and ultrasound-detected synovitis in the 2nd–5th metatarsophalangeal (MTP) joints were recorded. Independent predictors were identified using binary logistic regression. Results: Patients with metatarsal pain had higher rates of severe hallux valgus, MTP synovitis, and dislocations ≥ 50%. Independent predictors were hallux valgus (OR = 5.428, 95% CI: 1.528–19.287, p = 0.009), MTP synovitis (OR = 2.093, 95% CI: 1.337–3.275, p = 0.001), and MTP dislocations (OR = 2.092, 95% CI: 1.275–3.432, p = 0.003). Conclusions: Persistent metatarsal pain in RA remission is associated with a distinct structural and biomechanical profile. Comparing foot pain by location may help identify clinically relevant patterns and support more individualized assessment and treatment strategies. Due to the cross-sectional design, causality cannot be established. Full article

Background and Objectives: Minimally invasive distal metatarsal osteotomy (DMMO) has established itself as an effective surgical technique for the treatment of metatarsalgia, notable for its reduced postoperative pain and faster recovery. However, doubts remain regarding the frequency and nature of postoperative complications. The objective of this systematic review and meta-analysis was to evaluate the incidence of the most frequent complications associated with the DMMO technique, including prolonged edema, delayed bone healing, transfer metatarsalgia, floating toe, and persistent pain. Materials and Methods: A systematic review was conducted following the PRISMA 2020 guidelines, with the protocol registered in the PROSPERO database (CRD420251067666). Searches were conducted in the PubMed, Scopus, and Web of Science databases, including clinical studies published between 2010 and 2025. The inclusion criteria covered studies in adults treated with DMMO and reporting postoperative complications. The methodological quality assessment was performed using Joanna Briggs Institute (JBI) tools according to the design of each study. Random-effects models were used for the meta-analyses, assessing heterogeneity using the I² statistic. Results: Fifteen studies with a total sample of more than 493 patients were included. Prolonged edema was the most common complication (30.91%), followed by delayed bone healing (14.9%), transfer metatarsalgia (12.73%), floating toe (10.45%), and persistent pain (8.5%). Less frequent complications included nonunion, infections, necrosis, and bone misalignments. The combined incidence of floating toe was 40% (I² = 0%), while prolonged edema showed considerable heterogeneity (I² = 88.3%). The overall quality of the evidence was considered moderate to low, mainly due to the predominance of observational studies. Conclusions: The DMMO technique represents a minimally invasive surgical option with generally favorable results. However, some complications, such as prolonged edema and floating toe, have a significant incidence. The methodological variability between studies highlights the need for standardized protocols and higher-quality prospective studies to establish the safety profile of this technique more accurately. Full article

Hallux valgus is one of the common causes of forefoot pain in the field of foot and ankle surgery. This condition is characterized by valgus and pronation deformities of the first ray, leading to bunion pain, metatarsalgia, callus formation, and gait disturbances. Conventional open osteotomy of the first metatarsal and proximal phalanx of the first toe has been widely performed. Recently, with increasing reports of favorable radiologic and clinical outcomes of minimally invasive surgery, this technique has been performed by many surgeons. Despite the various surgical methods available, there is still no consensus on the optimal treatment of hallux valgus, and the advantages and disadvantages of open versus minimally invasive techniques remain a topic of debate. This narrative review aims to provide a comprehensive overview of the latest radiographic evaluation and surgical treatment for hallux valgus. Full article

Nonunion of the second metatarsal presents a significant clinical challenge, often leading to pain, functional impairment, and deformity. Various treatment strategies have been described in the literature, tailored to the patient’s specific characteristics. To provide a comprehensive overview of the available therapeutic options, a literature review was conducted. In this context, this article aims to present an innovative and personalized surgical technique for patients with nonunion and an altered metatarsal formula following a proximal shaft fracture of the second metatarsal. This technique enables the simultaneous consolidation of the nonunion and restoration of metatarsal alignment, with favorable clinical, functional, and radiological outcomes observed over a three-year follow-up period. Full article

Background: Plantar fat plays a crucial role in protecting and cushioning the metatarsals. Its degeneration is a risk factor for the development of metatarsalgia and, consequently, predislocation syndrome. Objectives: To evaluate the relationship between plantar fat thickness and predislocation syndrome in an adult population, and to determine a possible association between a decrease in forefoot plantar fat and the presence of symptoms. Material and Methods: A retrospective observational study was conducted, including records of patients who visited the podiatry clinic between December 2022 and December 2023. Fifty complete records were selected, divided into two groups, one healthy and one pathological, aged between 18 and 70 years. An ultrasound examination of the plantar area of the second metatarsophalangeal joint was performed to assess the thickness of the fat and plantar plate. Results: The analysis of the 50 records, divided into healthy and pathological groups, reveals significant differences in the thickness of plantar fat and the plantar plate between the two groups. Subjects with predislocation syndrome have a significantly lower plantar fat thickness (0.566 cm) compared to the healthy group (0.941 cm) and also show a greater thickness of the plantar plate (0.359 cm vs. 0.244 cm). Statistical tests confirm these differences with high significance (p < 0.001). The ROC curve shows that plantar fat thickness is a good predictor of predislocation syndrome, with an area under the curve (AUC) of 0.923, emphasizing the utility of this measure in identifying the condition. Conclusions: Preliminary studies suggest that a reduction in plantar fat increases the predisposition to develop predislocation syndrome at the level of the second metatarsophalangeal joint. Full article

Brachymetatarsia is a rare congenital anomaly characterized by the shortening of one or more metatarsals, which can lead to functional impairment, pain, and aesthetic concerns. This case report describes a 17-year-old female patient with brachymetatarsia affecting the third and fourth metatarsals of the right foot, which was unresponsive to conservative treatment and caused persistent pain while standing. To address this condition, a single-stage surgical approach was performed using an autologous calcaneal bone graft to lengthen the affected metatarsals. Additionally, the second and fifth metatarsals were shortened to restore a physiological metatarsal parabola and resolve chronic metatarsalgia. The procedure resulted in complete correction of the metatarsal parabola, full resolution of metatarsal pain, and satisfactory functional recovery. The use of an autologous calcaneal graft proved to be an effective and reliable surgical option due to its cortico-cancellous composition, high osteogenic potential, and low antigenicity. This case highlights the advantages of autologous bone grafting as a valuable technique in the surgical management of brachymetatarsia. Full article

Introduction: Metatarsalgia is a very common pathology in podiatric consultations, whose main aetiological factor is biomechanical alterations. Given the failure of conservative treatments, minimally invasive osteotomies of the distal metatarsal are becoming more popular, providing comparable results to open surgical techniques and with a lower rate of complications. Objectives: To determine clinical improvement and patient satisfaction after minimally invasive distal metatarsal osteotomy (DMMO) as a surgical treatment for central metatarsalgia at present. Methodology: The databases used for this systematic review were PubMed, Scielo, Cochrane Library, WOS and Scopus. We included articles that studied the efficacy of DMMO for primary metatarsalgia and excluded studies whose patients had more than one pathology or used other surgical techniques. Results: We identified 10 articles, 5 prospective studies, 4 retrospective studies and 1 cross-sectional, non-randomized, analytical study published between 2015 and 2021. The total number of subjects was 366, with a mean age of 61 years. The majority of subjects were women. They presented with symptomatology compatible with primary metatarsalgia for a minimum of 6 months and had failed conservative treatment. Conclusions: DMMO osteotomies for central metatarsals offer excellent post-surgical results for the treatment of central metatarsalgia in the assessment scales (AOFAS, MOXFQ etc.) of the articles analyzed and therefore an evident clinical improvement with benefits in terms of MTF mobility and reduction of surgical time, as well as a high degree of satisfaction in the patients who received this intervention that can be considered as excellent. Full article

Plantar vein thrombosis (PVT) is an underdiagnosed condition affecting the deep plantar veins, with challenging clinical diagnosis, often presenting with non-specific symptoms that mimic other foot pathologies. This study assessed the magnetic resonance imaging (MRI) features of patients diagnosed with PVT to contribute to the understanding of this condition. We performed the comprehensive analysis of a substantial dataset, including 112 patients, with a total of 130 positive MRI scans (86 of the forefoot and 44 of the ankle) presenting with PVT. Upon evaluating all the veins of the feet, we observed a higher frequency of involvement of the lateral plantar veins (53.1%) when compared to the medial veins (3.8%). The most affected vascular segments in the forefeet were the plantar metatarsal veins (45.4%), the plantar venous arch (38.5%), and the plantar communicating veins (25.4%). The characteristic findings on MRI were perivascular edema (100%), muscular edema (86.2%), venous ectasia (100%), perivascular enhancement (100%), and intravenous filling defects (97.7%). Our study provides valuable insights into the imaging evaluation of PVT and shows that MRI is a reliable resource for such diagnosis. Full article

Background: Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature has reported the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA). Methods: A prospective cohort of 31 feet from 25 patients with moderate-to-severe symptomatic HV but without metatarsalgia underwent MICA and was evaluated using radiographic parameters and pedographic measurements (Footscan^®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery. Results: The radiographic parameters of the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary’s angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area. Conclusion: MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia. Full article

Objectives: Metatarsalgia continues to be a problem in patients with rheumatoid arthritis (RA) in remission (remRA), as well as in the non-rheumatic population, with a mechanical origin. Identify and compare clinical, morphological, disability, synovitis (ultrasound), and radiological osteoarticular damage characteristics in two groups of patients with lesser-ray metar-tarsalgia, with remRA, and without RA. Methods: Cross-sectional study with 84 patients with remRA (mRA) and 60 patients without RA (nmRA). The study evaluated five clinical variables (pain, Foot Function Index (FFI), joint mobility, digital deformities, and foot type), a radiological variable (osteoarticular damage), and an ultrasound variable (metatarsal synovitis). The data were analysed using descriptive and correlational techniques. Results: There were no significant differences in sex, age, body mass index (BMI), or degree of pain. Both groups showed a high prevalence of limited joint mobility for the ankle and first metatarsal phalanx (DF1st MTPJ) and digital deformities, with no statistically significant differences. Similarly, there were no differences in lesser-ray synovitis. On the other hand, there were differences in mRA with greater disability and activity limitation (FFI), LDD (lesser-ray digital deformities) stiffness, first-ray deformities, radiological damage, synovitis in 1st MTPJ, and positive Doppler (five patients). Conclusions: Metatarsalgia presents similarities in both populations. Biomechanical factors may influence the symptoms and presence of synovitis in patients with RA in remission. Other characteristics are more frequent in mRA, which could be related to the disease; thus, future research should include both biomechanical and ultrasound exploration of the foot in the valuation of patients in remission. Full article

Background: Metatarsalgia is a common pathology that is initially treated conservatively, but failure to do so requires surgery, such as the minimally invasive distal metatarsal osteotomy (DICMO). Methods: In this prospective study of 65 patients with primary metatarsalgia who underwent DICMO, plantar pressures, American Orthopaedic Foot and Ankle Society MetaTarsoPhalangeal-InterPhalangeal scale (AOFAS-MTP-IP) and Visual Analog Scale (VAS) were evaluated pre-operatively and post-operatively and there was a subgroup in which an inclinometer was used to observe the importance of the inclination of the osteotomy. Results: The results show a significant reduction in plantar pressures after DICMO surgery without overloading the adjacent radii, especially in the subgroup with an inclinometer to guide the osteotomy. The AOFAS-MTP-IP scale evidenced a marked improvement in metatarsal function and alignment with scores close to normal. The VAS scale showed a substantial decrease in pain after DICMO osteotomy. Conclusions: DICMO, with an inclinometer for a 45° osteotomy, proved to be a safe and effective procedure for primary metatarsalgia, although further comparative studies are needed to confirm its superiority. Full article