#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Metatarsalgia in patients with rheumatoid arthritis


Authors: J. Klouda 1;  R. Hromádka 1,2;  S. Popelka ml. 1;  S. Popelka 1;  A. Sosna 1
Authors‘ workplace: Ortopedická klinika 1. LF UK a FN Motol, Praha 1;  Anatomický ústav 1. LF UK, Praha 2
Published in: Čes. Revmatol., 22, 2014, No. 2, p. 82-89.
Category: Review Article

Overview

Metatarsalgia (i.e. metatarsal pain) is one of the most common symptoms in patients with rheumatoid arthritis. It refers to painful difficulties localized in the forefoot region under the second through fifth metatarsal heads. The pain is often accompanied by deformity of the first and fifth rays as well as of the toes. There is a wide scale of possible causes of metatarsalgia but all of them seem to be related to foot anatomy, weight-bearing during walking and foot and ankle deformity. Most patients present with abnormalities of the metatarsophalangeal joints. In managing metatarsalgia, an individualized treatment protocol is required. Nonsurgical management is usually sufficient to achieve satisfactory results. Surgical intervention must be reasonably indicated, precise, and all pain-producing deformities must be corrected. Depending on the site of maximum impairment, we use either interventions leading to the restoration of the first ray function, metatarsal osteotomy or resection arthroplasty of first metatarsophalangeal joint. The aim of surgery is to make the patient able to use standard or custom made footwear and to ensure painless standing and walking.

Key words:
Metatarsalgia, rheumatoid arthritis, metatarsal osteotomy, treatment


Sources

1. Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br 2000; 82: 781–90.

2. Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg 2010; 18: 474–85.

3. Fadel GE, Rowley DI. (iv) Metatarsalgia. Current Orthopaedics 2002; 16: 193–204.

4. Perry J, Schoneberger B. Gait Analysis: Normal and Patho­logical Function. Thorofare, NJ, Slack Inc, 1992.

5. Espinosa N, Maceira E, Myerson MS. Current concept review: Metatarsalgia. Foot Ankle Int 2008; 29: 871–9.

6. Maestro M, Besse JL, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin 2003; 8: 695–710.

7. Jung HG, Zaret DI, Parks BG, Schon LC. Effect of first metatarsal shortening and dorsiflexion osteotomies on forefoot plantar pressure in a cadaver model. Foot Ankle Int 2005; 26: 748–53.

8. Popelka S, Vavřík P, Hromádka R, Barták V, Bek J, Sosna A. Hallux valgus in patients with rheumatoid arthritis - Current surgical treatment options. Čes Revmatol 2011; 19: 119–23.

9. Schneider W, Csepan R, Kasparek M, Pinggera O, Knahr K. Intra- and interobserver repeatability of radiographic measurements in hallux surgery: improvement and validation of a method. Acta Orthop Scand 2002; 73: 670–3.

10. Eulry F. [Static metatarsalgia]. Rev Prat 1997; 47: 37–42.

11. Thompson IM, Bohay DR, Anderson JG. Fusion rate of first tarsometatarsal arthrodesis in the modified Lapidus procedure and flatfoot reconstruction. Foot Ankle Int 2005; 26: 698–703.

12. Crosbie J, Burns J, Ouvrier RA. Pressure characteristics in painful pes cavus feet resulting from Charcot-Marie-Tooth disease. Gait Posture 2008; 28: 545–51.

13. Fuhrmann RA. [Lesser toe deformities]. Ther Umsch 2004; 61: 417–20.

14. Fuhrmann RA, Roth A, Venbrocks RA. [Metatarsalgia. Differential diagnosis and therapeutic algorithm]. Orthopade 2005; 34: 767–8,769–72,774–5.

15. Freiberg AH. Infraction of the second metatarsal bone – a typical injury. Surg Gynecol Obstet 1914; 19: 191–3.

16. Yu GV, Judge MS, Hudson JR, Seidelmann FE. Predislocation syndrome. Progressive subluxation/dislocation of the lesser metatarsophalangeal joint. J Am Podiatr Med Assoc 2002; 92: 182–99.

17. Wiener-Ogilvie S. The foot in rheumatoid arthritis. Foot 1999; 9: 169–74.

18. Mizel MS, Yodlowski ML. Disorders of the Lesser Metatarsophalangeal Joints. J Am Acad Orthop Surg 1995; 3: 166–73.

19. Grondal L, Tengstrand B, Nordmark B, Wretenberg P, Stark A. The foot: Still the most important reason for walking incapacity in rheumatoid arthritis - Distribution of symptomatic joints in 1,000 RA patients. Acta Orthop 2008; 79: 257–61.

20. Otter SJ, Lucas K, Springett K, Moore A, Davies K, Cheek L, et al. Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study. Clin Rheumatol 2010; 29: 255–71.

21. Matricali GA, Boonen A, Verduyckt J, Taelman V, Verschueren P, Sileghem A, et al. The presence of forefoot problems and the role of surgery in patients with rheumatoid arthritis. Ann Rheum Dis 2006; 65: 1254-5.

22. Gajdosik RL, Allred JD, Gabbert HL, Sonsteng BA. A stretching program increases the dynamic passive length and passive resistive properties of the calf muscle-tendon unit of unconditioned younger women. Eur J Appl Physiol 2007 99 449–54.

23. Brodsky JW, Kourosh S, Stills M, Mooney V. Objective evaluation of insert material for diabetic and athletic footwear. Foot Ankle 1988; 9: 111–6.

24. Brodsky JW, Pollo FE, Cheleuitte D, Baum BS. Physical properties, durability, and energy-dissipation function of dual-density orthotic materials used in insoles for diabetic patients. Foot Ankle Int 2007; 28: 880–9.

25. Hodge MC, Bach TM, Carter GM. novel Award First Prize Paper. Orthotic management of plantar pressure and pain in rheumatoid arthritis. Clin Biomech (Bristol, Avon). 1999; 14: 567–75.

26. Ivanic GM, Trnka HJ, Homann NC. [Post-traumatic metatarsalgia. Early results of treatment with a new insole]. Unfallchirurg 2000; 103: 507–10.

27. Kelly A, Winson I. Use of ready-made insoles in the treatment of lesser metatarsalgia: a prospective randomized controlled trial. Foot Ankle Int 1998; 19: 217–20.

28. Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 4th Ed. Lippincott Williams and Wilkins, 2006.

29. Dye R. Dye technique for foot correction. Personal publication, 1941.

30. O'Sullivan K, Kennedy N, O'Neill E, Ni Mhainin U. The effect of low-dye taping on rearfoot motion and plantar pressure during the stance phase of gait. BMC Musculoskelet Disord 2008; 9: 111.

31. Russo SJ, Chipchase LS. The effect of low-Dye taping on peak plantar pressures of normal feet during gait. Aust J Physiother 2001; 47: 239–44.

32. Lange B, Chipchase L, Evans A. The effect of low-Dye taping on plantar pressures, during gait, in subjects with navicular drop exceeding 10 mm. J Orthop Sports Phys Ther 2004; 34: 201–9.

33. Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the ankle and foot. Am Fam Physician 2003; 68: 1356–62.

34. Hassouna H, Singh D, Taylor H, Johnson S. Ultrasound guided steroid injection in the treatment of interdigital neuralgia. Acta Orthop Belg 2007; 73: 224–9.

35. Popelka S, Hromádka R, Vavřík P, Barták V, Popelka S, Sosna A. Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure. BMC Musculoskelet Disord 2012; 13: 148.

36. Barouk LS. [Weil's metatarsal osteotomy in the treatment of metatarsalgia]. Orthopade 1996; 25: 338–44.

37. Maceira E, Farinas F, Tena J, Escobar R, Baltes J. Analisis de la rigidez metatarso-falangica en las osteotomias de Weil. Revista de Medicina y Cirugia del Pie 1998; 12: 35–40.

38. Beech I, Rees S, Tagoe M. A retrospective review of the Weil metatarsal osteotomy for lesser metatarsal deformities: An intermediate follow-up analysis. J Foot Ankle Surg 2005; 44: 358–64.

39. Jarde O, Hussenot D, Vimont E, Barouk LS, Ferre B, Raad GA. [Weil's cervicocapital osteotomy for median metatarsalgia. Report of 70 cases]. Acta Orthop Belg 2001; 67: 139–48.

40. Popelka S, Vavřík P. Revmatochirurgie nohy a hlezna. Praha: StudiaGeo: 2005.

41. Wolf MD. Metatarsal osteotomy for the relief of painful metatarsal callosities. J Bone Joint Surg Am 1973; 55: 1760–2.

42. Trnka HJ, Muhlbauer M, Zettl R, Myerson MS, Ritschl P. Comparison of the results of the Weil and Helal osteotomies for the treatment of metatarsalgia secondary to dislocation of the lesser metatarsophalangeal joints. Foot Ankle Int 1999; 20: 72–9.

43. Turan I, Lindgren U. Metatarsal osteotomy using internal fixation with compression screws. J Foot Surg 1989; 28: 116–9.

44. Mau C, Lauber H. The surgical treatment of hallux valgus. Deutsche Zeit Orthop 1926; 197: 361–77.

45. Giannestras NJ. Shortening of the metatarsal shaft in the treatment of plantar keratosis: an end-result study 1958. Foot Ankle Int 1995; 16: 529–34.

46. Gerbert J, Sgarlato TE, Subotnick SI. Preliminary study of a closing wedge osteotomy of the fifth metatarsal for correction of a tailor's bunion deformity. J Am Podiatry Assoc 1972; 62: 212–8.

47. Barouk LS, Rippstein P, Toullec E. New proximal oblique meatarsal osteotomy for the treatment of pes cavus (BRT osteotomy). J Bone Joint Surg Br 2002; 84-B(Suppl 1): 32-d-3.

48. Baruffaldi O, Bignardi A, Boero G. [Resection of the metatarsal heads. Clinical study of metatarsalgia]. Minerva Ortop 1970; 21: 298–305.

49. Kestler OC. Resection of metatarsal heads for metatarsalgia. Bull Hosp Joint Dis 1969; 30: 89–100.

50. Hulse N, Thomas AM. Metatarsal head resection in the rheumatoid foot: 5-year follow-up with and without resection of the first metatarsal head. J Foot Ankle Surg 2006; 45: 107–12.

51. Molloy AP, Myerson MS. Surgery of the lesser toes in rheumatoid arthritis: metatarsal head resection. Foot Ankle Clin 2007; 12: 417–33.

52. Thomas S, Kinninmonth AW, Kumar CS. Long-term results of the modified Hoffman procedure in the rheumatoid forefoot. J Bone Joint Surg Am 2005; 87: 748–52.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#