• Journal of Korean Foot and Ankle Society
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• v.21 no.3
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• pp.83-87
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• 2017

Metatarsalgia means the pain under the lesser metatarsal heads. The many causes of metatarsalgia can be categorized into three groups: local disease in the region, altered forefoot biomechanics, and systemic disease affecting the region. Surgical options need to be considered if nonsurgical treatment fails. The metatarsal osteotomies are designed primarily to reduce the weightbearing forces on the metatarsal head by elevating or shortening the metatarsal. Many lesser metatarsal osteotomies have been described, and their success depends on many factors. Regardless of the method employed, it is important to maintain or restore the metatarsal cascade to maintain an even pressure under the lesser metatarsal heads and prevent transfer lesions. The surgeon must understand the effects of the metatarsal osteotomy on the forefoot patho-biomechanics and decide, using a combination of clinical examinations and imaging, whether the desired effect of the osteotomy is to shorten or elevate the metatarsal head or both.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.134-139
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• 2008

Purpose: The purpose of this study was to evaluate the radiological and clinical results of modified scarf osteotomy for hallux valgus with lesser metatarsalgia. Materials and Methods: Total 19 patients (24 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 46.4 years. The mean follow-up time was 14.8 months. We modified original scarf osteotomy by adding the procedure of closing wedge osteotomy at the medial side of distal fragment for achieving of the supination of the first metatarsal head. Additionally, Akin osteotomy of the first proximal phalanx was done in 16 patients (20 feet) and no lesser metatarsal operation was done. First-second intermetatarsal, hallux valgus and distal metatarsal articular angles were analyzed radiologically before and after the operation. And 3-dimensional CT was used to evaluate the supination of the first metatarsal head. Clinical results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score and persistence of lesser metatarsalgia. Results: First-second intermetatarsal and hallux valgus angles were reduced from the mean pre-operative values of $14.2^{\circ}$ and $32.5^{\circ}$ to $8^{\circ}$ and $12.5^{\circ}$, respectively, 12 months after the operation. And the supination of the first metatarsal head was confirmed by 3-dimensional CT. The mean AOFAS score improved from 41.4 points pre-operatively to 87.2 points at follow-up. Lesser metatarsalgia still remained in 2 patients (2 feet). Conclusion: Modified scarf osteotomy would be an effective surgical procedure, especially, for achieving downward displacement and supination of the first metatarsal head in hallux valgus with lesser metatarsalgia.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.47-54
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• 2003

Introduction: Painful plantar callosities under the second and third metatarsal heads are not uncommonly associated with hallux valgus and there have been controversies concerning its treatment modalities. We performed the Weil osteotomy in patients with painful callosities under the second and third metatarsal head associated with hallux valgus, and evaluated the outcome clinically & radiologically. Materials and Methods: From November 2000 through November 2001, out of 51 patients diagnosed with hallux valgus, the Weil osteotomy was performed in 5 women associated with painful callosities under the second and third metatarsal heads. The mean age was 53.4 years (range, 31-66) with a minimum follow-up period of 12 months(range, 12-16). Results: The mean AOFAS lessor metatarso-phalangeal-interphalngeal Scale(LMIS) improved from 61.2 points preoperatively to 88.8 points postopertively. Mean decreases in length of the second and third metatarsal after surgery were 3.2mm and 3mm. Conclusion: We experienced improvement of metatarsalgia in 80% of patients by Weil osteotomy and all patients were symptom-free at last follow-up, suggesting that the Weil osteotomy is an effective procedure in treating painful plantar callosities under the second and third metatarsal heads associated with hallux valgus.

• Journal of Yeungnam Medical Science
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• v.36 no.2
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• pp.92-98
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• 2019

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.

• Journal of Korean Foot and Ankle Society
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• v.25 no.4
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• pp.165-170
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• 2021

Purpose: This study sought to evaluate the clinical effectiveness of the shortening effect of the modified Weil osteotomy for the treatment of Freiberg's disease. Materials and Methods: We reviewed 21 cases treated with the modified Weil osteotomy for Freiberg's disease from November 2005 to June 2019. The average follow-up period was 32.5 months and the mean age of the patients was 38.3 years. The clinical results were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the visual analogue scale (VAS), and the range of motion (ROM) of the metatarsophalangeal joint. In the radiologic evaluation, the length of preoperative and postoperative metatarsal shortening was compared. Results: The average AOFAS lesser metatarsophalangeal-interphalangeal scale showed an improvement from 60.5 preoperatively to 90.9 at the latest follow-up. VAS showed a decrease from 5.4 preoperatively to 0.9 at the latest follow-up. ROM of the affected metatarsophalangeal joint increased from 40.2 degrees preoperatively to 58.6 degrees at the latest follow-up. The mean length of metatarsal shortening was 6.7 mm. There was no transfer metatarsalgia, osteonecrosis, and definite joint space narrowing. Conclusion: Modified Weil osteotomy with second layer cutting is an effective treatment option to restore the joint surface and painless joint motion for patients with Freiberg's disease.