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Metatarsalgia The inside story

Metatarsalgia The inside story. Greg Quinn FCPodS Podiatric Surgeon. Pain has a message. Once we get the pain's message , and follow its advice , the pain goes away .

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Metatarsalgia The inside story

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  1. MetatarsalgiaThe inside story Greg Quinn FCPodS Podiatric Surgeon

  2. Pain has a message. Once we get the pain's message, and follow its advice, the pain goes away.

  3. “The postural erect attitude of man as a bipedal animal renders his species advantaged within his natural environment.” A N Forsythe Anthropologist; 1873 “I know exercise is good for me. I also need to work, eat and socialise; so that’s why I always make a point of walking to the car, the kitchen and the pub.” Mr E. White Podiatry patient; 2004

  4. “It is better to die on your feet than live on your knees!” • Emiliano Zapata

  5. The Surgical Sieve • Congenital • Infectious • Metabolic • Traumatic • Neoplastic • Iatrogenic • Idiopathic • Biomechanical Can I Manage To Nap If I’m Busy?

  6. Congenital • Metatarsus Adductus • TalipesEquinus Varus • Flexible Flat Foot • Vertical talus • Major malformations

  7. Infectious • Bacterial • Viral • Fungal

  8. Metabolic • Inflammatory arthritis e.g. RA, Gout, psoriasis • Ischaemic Vascular disease

  9. Traumatic

  10. Neoplastic

  11. Iatrogenic

  12. Idiopathic I just don’t know why is this happening

  13. Biomechanical • Capsulitis • Morton’s neuroma • Intractable plantar keratoses • Hallux valgus/rigidus • Lesser toe deformity • Muscle imbalance

  14. Significant History Pain: onset/character/site/variation Associated signs: skin lesions/swelling/changing toe position/joint stiffness

  15. X-Rays can help soft tissue changes joint space change/degeneration fracture MTPJ alignment & parabola

  16. Metatarsal Abnormality Dorsiflexed Elongated Plantarflexed Shortened Hypertrophic condyles 1st ray hypermobility

  17. Diagnosis Avascular necrosis Tumour Foreign body Infection Fracture Lesser MTPJ instability Capsulitis (+/- degeneration) Neuroma Immobilisation &/or Surgery Padding Orthotics Shoe mod’s Injection NSAID’s

  18. The Necker Cube

  19. Essentialism

  20. ‘Anyone who ignores history is living hand to mouth’ Goethe

  21. What the foot delivers via autosupport Medial loading with controlled arch deformation (pronation/1st ray elevation) Recovery to stabilise arch (even pressure distribution) Propulsion through 1st Ray with heel lift (hip, knee & spinal extension)

  22. Potential confounding variables Variable bone configuration (arch heights) Variable alignment (within body planes) Variable adaptability to early walking (plasticity in joint ROM) Variable neuromuscular control (movement pathway/strength/endurance)

  23. Potential confounding variables Why didn’t we just evolve like this?

  24. Evolution = genetics + time

  25. Phenotype does not follow genotype (what we look like is governed by regulatory genes)

  26. Question: What does this tell us? Answer: Foot structure varies within and between populations.

  27. What significant things vary? Variable bone configuration (arch heights) Variable alignment (within body planes) Variable adaptability to early walking (plasticity in joint ROM) Variable neuromuscular control (movement pathway/strength/endurance)

  28. How will all foot structures vary?

  29. All feet possess important common structures that: • Combine to deliver loading and propulsive motion • Show inherited variation in their proportions and alignments • Vary in their capacity to respond to weight-bearing • Accordingly demonstrate patterns of movement that can create symptoms

  30. Consider what we know High varus angles increase difficulty to load the medial column. The higher the arch the greater need for pronation At our disposal: pronation, flexibility & foot placement angle Collectively real patterns emerge!

  31. High arch/inverted heel/hypomobile Other symptoms include: Lateral ankle sprain Sesamoiditis Genurecurvatum

  32. Medium arch/inverted heel/hypomobile Other symptoms include: Retrocalcaneal bursitis Pinch callus medial hallux Lateral hip pain

  33. Low arch/vertical heel/hypermobile Other symptoms include: Functional hallux limitus/HAV Posterior tibial tendinitis Plantar fasciitis

  34. Medium arch/inverted heel/hypomobile/inverted forefoot Other symptoms include: Shin splints Cuboid pain Medial knee pain

  35. Flat arch/everted heel/hypermobile/inverted forefoot Other symptoms include: Tarsal tunnel syndrome Posterior tibial dysfunction Plantar fasciitis

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