Experience of treatment of forefoot pain syndrome of various genesis

Aim. Defining the causes of metatarsalgia and methods of its elimination. Methods. With the use of clinical and radiologic methods the results of conventional and surgical treatment were studied in 132 patients treated at Foot surgery center of the international clinic «MEDEM» from September 2014 to September 2016 with initial diagnosis of metatarsalgia of unknown origin. Females comprised 74.2%, males - 25.8%. Results. Physical examination, Х-ray, CT- and MRI-scan, and ultrasound of soft tissues of feet were performed. In all cases, the exact cause of metatarsalgia was established: transverse platypodia - 20.4%, longitudinal platypodia - 11.3%, anterior tibialis tendinitis - 10.6%, plantar fasciitis - 9.1%, tailor’s bunion - 7.6%, peroneal tendinitis - 6.8%, Haglund’s deformity - 6.8%, achilotendinitis - 6.1%, hallucis extensor tendinitis - 6.1%, Morton’s neuroma (neurofibroma) - 5.3%, congenital long second toes - 3%, Keller’s disease II - 2.3%, Ledderhose disease - 2.3%, stress metatarsal fractures - 1.5%, Mueller-Weiss disease - 0.8%. Conservative treatment was conducted in 55.3% of cases, surgical treatment - in 44.7%. Follow-up period was 6 to 30 months. No complications were registered. Evaluation of the results was carried out with the use of visual analogue scale - the average score was 6 (73 before treatment); American Orthopaedic Foot and Ankle Society (AOFAS) scale - the average score was 97 (64 before surgery); scale of Nizhny Novgorod Research Institute of Traumatology and Orthopedics - the average score was 40 (27 before surgery). Conclusion. Metatarsalgia is a manifestation of multiple foot diseases; robust diagnosis, a combination of conventional and surgical methods of treatment, early activation and dynamic follow-up provide an accurate identification of etiology and rapid relief of pain syndrome.

metatarsalgia, conventional and surgical treatment, subcutaneous osteotomy