METATARSALGIA

PAIN ABOUT DISTAL END OF FOOT AT THE METATARSOPHALANGEAL JOINTS

BIOMECHANICS
WALKING-Wt BORNE BY MAINLY 1st and SEC BY 5th MT AND TO LESSER EXTENT BY OTHER MTs ie;mt heads forms a fulcrum about which flexor tendons are angulated when heel is in takeoff position and wt is borne by mt heads with dorsiflexion of toes

BIOMECHANICS
Normally while standing axis of wt bearing is situated along 3rd mt but shifts medially as the heel is raised off the ground.now if the 1st mt is short/displaced more wt is borne by 2nd mt head. Transverse mt arch is present in the forefoot where it is less pronounced as in hind foot.the central mts lie higher to the 1st & 5th mts in tranverse arch.

BIOMECHANICS
The central three heads are elevated by the ligaments of the transverse arch and the intrinsic muscles of foot which also flex the toes at time of take off.:this relieves these central three mt heads of pressure.

ETIOLOGY
A)LIGAMENTOUS FACTORS: 1)CONGENITAL LAXITY ; SPLAY FOOT(widespread toes and phalanges)+flatfoot with everted heel& supinated forefoot and depressed long arch 2)Over Wt,prolonged standing,deg c/o old age

ETIOLOGY
B) MUSCULAR FACTORS:WEAKNESS OF INTRINSIC MUSCLES-DROP OF METATARSAL HEADS eg POLIO C) ARTHRITIC FACTORS AFFECTING METATARSO-PHALANGEAL JOINTS D)METABOLIC FACTORS-GOUT E)TRAUMATIC FACTORS: IMPROPER SHOES,Fall of heavy objects,prolonged walking

TREATMENT
TREAT THE ETIOLOGY

MORTON`S METATARSALGIA (NEUROMA)

DEVELOPMENT OF NEUROMA IN A DIGITAL NERVE JUST PROXIMAL TO IT`S BIFURCATION WITH SEVERE NEURALGIC PAIN

PATHOLOGY
PRIMARILY A VASCULAR LESION THAT CAUSES PERI -ARTERIAL FIBROSIS AND LATER ON PARTIAL RECANALISATION LEADING TO Sec ISCHAEMIC NERVE DAMAGE USUALLY THIRD DIGITAL NERVE IS AFFECTED AND SHOWS FUSIFORM SWELLING JUST BEFORE IT`S DIVISION

PATHOLOGY
COMPRESSION OF THE NERVE WITH ITS ARTERY BETWEEN TRANSVERSE METATARSAL LIG AND TENDONS

CLINICAL PICTURE
NEURALGIC PAIN/BURNING LIMITED TO SOLE BEYOND 3rd &4th MTs OCCURS SOON AFTER WALKING ON HARD SURFACES esp WITH HIGH HEELED SHOES MAY BE RELIEVED BY REST OR IN SEVERE CASES PERSISTS IN NIGHT

EXAMINATION
TENDERNESS BY FIRM UPWARD & BACKWARD PRESSURE IN THE SOLE esp AT 3rd & 4th MTP JOINTS RARELY PALPABLE TUMOR HYPERAESTHESIA ON OPPOSING SURFACES OF THIRD & FOURTH TOES IS Occ SEEN. RARELY PAINFULL RESISTANT ULCER ON INNER Surface of a toe.

TREATMENT
LOCAL INJ OF XYLOCAINE LOCAL INFILTRATION OF CORTICOSTEROID EXCISION OF NEUROMA(WHOLE NERVE WITH ITS VASCULAR BUNDLE REMOVED)