The primary metatarsalgia: Pathogenesis, biomechanics and surgical treatment

Abstract

This paper presents a comprehensive review on the current concept of the diagnosis and treatment of central metatarsalgia on the basis of medical literature analyses. Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia is a kind of metatarsalgia which arises from structural-functional changes that lead to excessive pressure in the area of metatarsal heads. The data analysis demonstrated that presently various types of osteotomies of metatarsal bones are the main surgical treatment options with the chance of complication ranging from 6 to 50%. Weil-osteotomy is known to be the most popular type of osteotomy for treatment of central metatarsalgia. The most common complication of Weil-osteotomy is floating toe, the one that doesn't contact with the supporting surface. In case Weil-osteotomy and intraphalangeal arthrodesis with trans acticular fixation are both performed, the complication of floating toe increases up to 50%. When Weil osteotomy, plantar plate repair, extensor digitorum longum tendon lengthening and triple Weil-osteotomy are performed simultaneously, the complication rate is 15% approximately wh ich is much lower. Using combined osteotomy techniques as well as taking into account structural-functional pathologic changes of the forefoot and ligaments repair of metatarsalphalangeal joint will ensure the most successful development of surgical treatment techniques for central metatarsalgia.