Journal of Yeungnam Medical Science

영남대 의대 학술지 편집위원회 (Yeungnam University College of Medicine, Yeungnam University Institute Medical Science)
권호 표지
DOI QR코드

DOI QR Code

Forefoot disorders and conservative treatment

  • Park, Chul Hyun (Department of Orthopedic Surgery, Yeungnam University College of Medicine) ;
  • Chang, Min Cheol (Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine)
  • 투고 : 2019.03.31
  • 심사 : 2019.05.10
  • 발행 : 2019.05.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

키워드

참고문헌

  1. Chang MC. Reduced foot pain after spasticity control with alcohol block in a patient with chronic hemiparetic stroke: a case report. J Phys Ther Sci 2017;29:767-70. https://doi.org/10.1589/jpts.29.767
  2. Chang MC. Metatarsalgia in a patient with chronic hemiparetic stroke managed with alcohol block of the tibial nerve: a case report. Neurol Asia 2017;22:267-70.
  3. Branthwaite H, Chockalingam N, Greenhalgh A. The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females. J Foot Ankle Res 2013;6:28. https://doi.org/10.1186/1757-1146-6-28
  4. Martorell JM. Hallux disorder and metatarsal alignment. Clin Orthop Relat Res 1981;(157):14-20.
  5. DiPreta JA. Metatarsalgia, lesser toe deformities, and associated disorders of the forefoot. Med Clin North Am 2014;98:233-51. https://doi.org/10.1016/j.mcna.2013.10.003
  6. Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg 2010;18:474-85. https://doi.org/10.5435/00124635-201008000-00004
  7. Bardelli M, Turelli L, Scoccianti G. Definition and classification of metatarsalgia. Foot and Ankle Surg 2003;9:79-85. https://doi.org/10.1016/S1268-7731(02)00002-4
  8. Charen DA, Markowitz JS, Cheung ZB, Matijakovich DJ, Chan JJ, Vulcano E. Overview of metatarsalgia. Orthopedics 2019;42:e138-43. https://doi.org/10.3928/01477447-20181206-06
  9. Maestro M, Besse JL, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin 2003;8:695-710. https://doi.org/10.1016/S1083-7515(03)00148-7
  10. Slullitel G, Lopez V, Calvi JP, Seletti M, Bartolucci C, Pinton G. Effect of first ray insufficiency and metatarsal index on metatarsalgia in hallux valgus. Foot Ankle Int 2016;37:300-6. https://doi.org/10.1177/1071100715615323
  11. Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int 2008;29:871-9. https://doi.org/10.3113/FAI.2008.0000X
  12. Gauthier G, Elbaz R. Freiberg's infraction: a subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res 1979;(142):93-5.
  13. Talusan PG, Diaz-Collado PJ, Reach JS Jr. Freiberg's infraction: diagnosis and treatment. Foot Ankle Spec 2014;7:52-6. https://doi.org/10.1177/1938640013510314
  14. Acevedo JI. Fixation of metatarsal osteotomies in the treatment of hallux valgus. Foot Ankle Clin 2000;5:451-68.
  15. Hofstaetter SG, Hofstaetter JG, Petroutsas JA, Gruber F, Ritschl P, Trnka HJ. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br 2005;87:1507-11.
  16. Reddy VB. Metatarsal osteotomies: complications. Foot Ankle Clin 2018;23:47-55. https://doi.org/10.1016/j.fcl.2017.10.001
  17. Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ. Multistep measurement of plantar pressure alterations using metatarsal pads. Foot Ankle Int 1994;15:654-60. https://doi.org/10.1177/107110079401501205
  18. Hsi WL, Kang JH, Lee XX. Optimum position of metatarsal pad in metatarsalgia for pressure relief. Am J Phys Med Rehabil 2005;84:514-20. https://doi.org/10.1097/01.phm.0000167680.70092.29
  19. Männikko K, Sahlman J. The effect of metatarsal padding on pain and functional ability in metatarsalgia. Scand J Surg 2017;106:332-7. https://doi.org/10.1177/1457496916683090
  20. Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br 2005;87:1038-45. https://doi.org/10.1302/0301-620X.87B8.16467
  21. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res 2010;3:21. https://doi.org/10.1186/1757-1146-3-21
  22. Hecht PJ, Lin TJ. Hallux valgus. Med Clin North Am 2014;98:227-32. https://doi.org/10.1016/j.mcna.2013.10.007
  23. McBride ED. A conservative operation for bunions. J Bone Joint Surg Am 1928;10:735-9.
  24. Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg Am 2011;93:1650-61. https://doi.org/10.2106/JBJS.H.01630
  25. Nery C, Coughlin MJ, Baumfeld D, Ballerini FJ, Kobata S. Hallux valgus in males--part 1: demographics, etiology, and comparative radiology. Foot Ankle Int 2013;34:629-35. https://doi.org/10.1177/1071100713475350
  26. Wilkerson RD, Mason MA. Differences in men's and women's mean ankle ligamentous laxity. Iowa Orthop J 2000;20:46-8.
  27. Tehraninasr A, Saeedi H, Forogh B, Bahramizadeh M, Keyhani MR. Effects of insole with toe-separator and night splint on patients with painful hallux valgus: a comparative study. Prosthet Orthot Int 2008;32:79-83. https://doi.org/10.1080/03093640701669074
  28. Cha YH, Kim SJ, Lee KH, Kwon JY, Kim DH, Seo A, et al. Designing personalized toe spreaders for hallux valgus with three-dimensional scanning and printing. J Biomed Eng Biosci 2018;5:1-6.
  29. Camasta CA. Hallux limitus and hallux rigidus. Clinical examination, radiographic findings, and natural history. Clin Podiatr Med Surg 1996;13:423-48.
  30. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2003;24:731-43. https://doi.org/10.1177/107110070302401002
  31. Shereff MJ, Baumhauer JF. Hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint. J Bone Joint Surg Am 1998;80:898-908. https://doi.org/10.2106/00004623-199806000-00015
  32. Beeson P, Phillips C, Corr S, Ribbans W. Classification systems for hallux rigidus: a review of the literature. Foot Ankle Int 2008;29:407-14. https://doi.org/10.3113/FAI.2008.0407
  33. Bingold AC, Collins DH. Hallux rigidus. J Bone Joint Surg Br 1950;32:214-22. https://doi.org/10.1302/0301-620X.32B2.214
  34. Zammit GV, Menz HB, Munteanu SE. Structural factors associated with hallux limitus/rigidus: a systematic review of case control studies. J Orthop Sports Phys Ther 2009;39:733-42. https://doi.org/10.2519/jospt.2009.3003
  35. Bartlett DH. Arthroscopic management of osteochondritis dissecans of the first metatarsal head. Arthroscopy 1988;4:51-4. https://doi.org/10.1016/S0749-8063(88)80014-8
  36. Bonney G, macnab I. Hallux valgus and hallux rigidus; a critical survey of operative results. J Bone Joint Surg Br 1952;34:366-85. https://doi.org/10.1302/0301-620X.34B3.366
  37. Shrader JA, Siegel KL. Nonoperative management of functional hallux limitus in a patient with rheumatoid arthritis. Phys Ther 2003;83:831-43. https://doi.org/10.1093/ptj/83.9.831
  38. Schuh R, Trnka HJ. First metatarsophalangeal arthrodesis for severe bone loss. Foot Ankle Clin 2011;16:13-20. https://doi.org/10.1016/j.fcl.2010.11.005
  39. Becerro de Bengoa Vallejo R, Sanchez Gomez R, Losa Iglesias ME. Clinical improvement in functional hallux limitus using a cut-out orthosis. Prosthet Orthot Int 2016;40:215-23. https://doi.org/10.1177/0309364614550262
  40. Rambarran KK, Lemaire E, Robertson GD. Effectiveness of the Kinetic Wedge foot orthosis modification to reduce relative plantar pressure. 25th Conference of the American Society of Biomechanics [Internet]. 2003 [cited 2019 March 28]. http://www.asbweb.org/conferences/2003/pdfs/163.pdf
  41. Menz HB, Levinger P, Tan JM, Auhl M, Roddy E, Munteanu SE. Rocker-sole footwear versus prefabricated foot orthoses for the treatment of pain associated with first metatarsophalangeal joint osteoarthritis: study protocol for a randomised trial. BMC Musculoskelet Disord 2014;15:86. https://doi.org/10.1186/1471-2474-15-86
  42. Smith DG, Barnes BC, Sands AK, Boyko EJ, Ahroni JH. Prevalence of radiographic foot abnormalities in patients with diabetes. Foot Ankle Int 1997;18:342-6. https://doi.org/10.1177/107110079701800606
  43. Malhotra K, Davda K, Singh D. The pathology and management of lesser toe deformities. EFORT Open Rev 2017;1:409-19. https://doi.org/10.1302/2058-5241.1.160017
  44. Stainsby GD. Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar. Ann R Coll Surg Engl 1997;79:58-68.
  45. Shirzad K, Kiesau CD, DeOrio JK, Parekh SG. Lesser toe deformities. J Am Acad Orthop Surg 2011;19:505-14. https://doi.org/10.5435/00124635-201108000-00006
  46. Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot Ankle Int 2000;21:94-104. https://doi.org/10.1177/107110070002100202
  47. Mizel MS, Michelson JD. Nonsurgical treatment of monarticular nontraumatic synovitis of the second metatarsophalangeal joint. Foot Ankle Int 1997;18:424-6. https://doi.org/10.1177/107110079701800709
  48. Di Caprio F, Meringolo R, Shehab Eddine M, Ponziani L. Morton's interdigital neuroma of the foot: a literature review. Foot Ankle Surg 2018;24:92-8. https://doi.org/10.1016/j.fas.2017.01.007
  49. Bradley N, Miller WA, Evans JP. Plantar neuroma: analysis of results following surgical excision in 145 patients. South Med J 1976;69:853-4. https://doi.org/10.1097/00007611-197607000-00014
  50. Kasparek M, Schneider W. Surgical treatment of Morton's neuroma: clinical results after open excision. Int Orthop 2013;37:1857-61. https://doi.org/10.1007/s00264-013-2002-6
  51. Sofka CM, Adler RS, Ciavarra GA, Pavlov H. Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results. HSS J 2007;3:44-9. https://doi.org/10.1007/s11420-006-9029-9
  52. Climent JM, Mondejar-Gomez F, Rodriguez-Ruiz C, Diaz-Llopis I, Gomez-Gallego D, Martin-Medina P. Treatment of Morton neuroma with botulinum toxin A: a pilot study. Clin Drug Investig 2013;33:497-503. https://doi.org/10.1007/s40261-013-0090-0
  53. Hinz A. Nerve disorders. In: DiGiovanni CW, Greisberg J, editors. Foot and ankle: core knowledge in orthopaedics. Philadelphia: Elsevier Mosby; 2007. p. 171-6.

피인용 문헌

  1. Reducción de las presiones plantares dinámicas en un calcetín experimental. Un estudio preliminar vol.32, 2019, https://doi.org/10.20986/revesppod.2021.1619/2021
  2. Effects of Balance Shoes on Balance and Postural Stability in the Elderly: A Crossover, Controlled, Randomized Single-Blind Study vol.9, pp.2, 2019, https://doi.org/10.3390/healthcare9020179
  3. Diagnosis and conservative management of great toe pathologies: a review vol.133, pp.4, 2019, https://doi.org/10.1080/00325481.2021.1895587
  4. Evaluating the Symmetry in Plantar Pressure Distribution under the Toes during Standing in a Postural Pedobarographic Examination vol.13, pp.8, 2021, https://doi.org/10.3390/sym13081476
  5. Seated Virtual Reality-Guided Exercise Improved Gait in a Postoperative Hallux Valgus Case vol.18, pp.24, 2021, https://doi.org/10.3390/ijerph182413267