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The Journal of the American Academy of... Feb 2022A Jones fracture, located at the metaphyseal-diaphyseal junction of the fifth metatarsal, is at an increased risk for nonunion and continued pain. Even with excellent... (Review)
Review
A Jones fracture, located at the metaphyseal-diaphyseal junction of the fifth metatarsal, is at an increased risk for nonunion and continued pain. Even with excellent surgical technique and postoperative management, a delayed union and refracture can occur. These complications in athletes can have deleterious effects on performance and delay return to sport. This article reviews the classification, diagnosis, and treatment considerations for Jones fractures. Treatment options including nonsurgical management, intramedullary screw, and plate fixation will be covered. The authors preferred technique using intramedullary screw fixation will be discussed in depth. Emerging considerations including biologic augmentation, primary bone grafting, and refracture will be examined as well. Ideal rehabilitation protocols, orthoses, and shoe wear suggestions will be given to optimize patient outcomes.
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones
PubMed: 34932521
DOI: 10.5435/JAAOS-D-21-00542 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Congenital pathologies of the forefoot encompass two broad entities with vastly different treatments and prognosis: malformations, which occur during the embryonic... (Review)
Review
Congenital pathologies of the forefoot encompass two broad entities with vastly different treatments and prognosis: malformations, which occur during the embryonic period and cause anatomical defects, and deformations, which occur during the fetal period on a foot that is configured normally. These deformities are more easily cured when they occur later during the fetal period. When the anomaly is bilateral, a genetic origin must be considered. There are two main entities under the term "deformity": metatarsus adductus and skewfoot (aka "Z"-foot or serpentine foot). Within malformations are brachydactyly (transverse defects), longitudinal defects, syndactyly, polydactyly, clinodactyly and macrodactyly. Among other forefoot abnormalities are hallux valgus, which rarely presents in congenital form, and for which conservative treatment is sometimes sufficient. Also in this group are sequelae of amniotic band constriction, forefoot anomalies secondary to the treatment of congenital pathologies (talipes equinovarus and congenital vertical talus) and nail-related pathologies (ingrown toe nail and incorrect nail position).
Topics: Child; Foot Deformities, Congenital; Global Health; Humans; Incidence; Metatarsal Bones; Radiography
PubMed: 31648997
DOI: 10.1016/j.otsr.2019.03.021 -
Clinics in Podiatric Medicine and... Jul 2024Metatarsal fractures are some of the most common fractures reported in the human body. Recent advances in surgical techniques and fixation have helped facilitate healing... (Review)
Review
Metatarsal fractures are some of the most common fractures reported in the human body. Recent advances in surgical techniques and fixation have helped facilitate healing and improved outcomes for our patients. The treatment goals of metatarsal fractures are to maintain the metatarsal parabola, sagittal position of the metatarsal heads, and a congruent metatarsophalangeal joint. Most of these injuries can be treated nonoperatively, but displaced fractures require surgical intervention to preserve normal gait biomechanics.
Topics: Humans; Metatarsal Bones; Fractures, Bone; Fracture Fixation, Internal; Fracture Healing; Male
PubMed: 38789159
DOI: 10.1016/j.cpm.2024.01.001 -
Clinical Radiology Mar 2021Morton's neuroma is a commonly encountered cause of forefoot pain, which may limit weight-bearing activities and footwear choices. Although the aetiology and... (Review)
Review
Morton's neuroma is a commonly encountered cause of forefoot pain, which may limit weight-bearing activities and footwear choices. Although the aetiology and pathomechanism of this condition is controversial, the histological endpoint is well established as benign perineural fibrosis of a common plantar digital nerve, typically within the third intermetatarsal space. The diagnosis of Morton's neuroma is mainly based on characteristic symptoms and clinical findings, but may be confirmed by ultrasonography. Although ultrasound is a highly accurate diagnostic tool for Morton's neuroma, it is subject to interoperator variability due to differences in technique and level of experience. In this paper, the authors review the anatomy of the common plantar digital nerves and surrounding structures in the forefoot, which are deemed relevant to the understanding of Morton's neuroma, especially from a sonographic point of view. Several theories of the pathomechanism of Morton's neuroma are briefly discussed. The main purpose of this article is to illustrate the ultrasound techniques for evaluating Morton's neuroma and performing ultrasound-guided corticosteroid injections.
Topics: Diagnostic Imaging; Humans; Metatarsal Bones; Morton Neuroma
PubMed: 33168237
DOI: 10.1016/j.crad.2020.10.006 -
The Journal of Orthopaedic and Sports... Jul 2021Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using...
BACKGROUND
Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using noninvasive approaches that are designed to achieve a speedy but safe return to running.
CLINICAL QUESTION
What is the optimal load to manage low-risk tibial and metatarsal BSIs and safely return to running?
KEY RESULTS
Optimal load can be guided by knowledge of the BSI healing process and is symptom driven. At all stages, the optimal load does not produce symptoms during, after, or the day following loading.
CLINICAL APPLICATION
A period of initial load reduction, via partial or non-weight bearing, is typically needed to alleviate presenting symptoms. Analgesics or nonsteroidal anti-inflammatory drugs may be used in the short term (sooner than 7 days), but only for resting pain and night pain. Healing supplements (eg, low-intensity pulsed ultrasound and/or recombinant parathyroid hormone therapy) may be attempted to influence tissue healing. Athletes can maintain cardiopulmonary fitness via cross-training, while simultaneously addressing musculoskeletal fitness. A return-to-run program can be initiated once an athlete is pain free during daily activities for 5 consecutive days. Progress is directed by symptom provocation and initially focuses on increasing running volume before speed. Optimal loading should be continued following return to running and may include jump training and/or gait retraining to reduce subsequent BSI risk. The optimal loading approach to managing low-risk tibial and metatarsal BSIs is clinically successful, but requires further scientific validation. .
Topics: Athletic Injuries; Clinical Reasoning; Fractures, Stress; Humans; Metatarsal Bones; Return to Sport; Running; Tibia
PubMed: 33962529
DOI: 10.2519/jospt.2021.9982 -
Deutsches Arzteblatt International Sep 2021Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons. Approximately 30% of metatarsal fractures...
BACKGROUND
Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons. Approximately 30% of metatarsal fractures affect the base of the fifth metatarsal bone. Nevertheless, no evidence-based treatment recommendations are available to date.
METHODS
The three fracture localizations according to Lawrence and Botte (zone I, proximal to the intermetatarsal joint between the fourth and fifth metatarsal bones; zone II, in the area of the joint; zone III, at the distal end of the joint) are analyzed on the basis of a systematic literature search. Studies were included that compared the treatment of two types of fracture in the same manner, or that compared two different treatments for a single type of fracture.
RESULTS
Nine studies compared different treatments of zone I fractures. Two of these were randomized controlled trials (RCTs); in one RCT, patients given functional therapy returned to work much sooner than those treated with immobilization (11 vs. 28 days; p = 0.001), with otherwise similar outcomes. The non-randomized studies revealed a faster return to full function (33 vs. 46 days; p<0.05) with early functional therapy, and similar outcomes for immobilization and surgery. One RCT that compared functional therapy with immobilization for zone II fractures revealed no statistically significant difference. Five studies compared fractures in zones I and II that were treated in the same manner, revealing similar outcomes. One RCT compared surgery and immobilization for zone III fractures: surgery led to statistically significant improvement of the outcome in all of the measured parameters.
CONCLUSION
Fractures in zones I and II should be treated with early functional therapy. There seems to be no reason to consider zone I and II fractures as two separate entities, as the outcomes in the two groups are similar. In contrast, fractures in zone III should primarily be treated surgically.
Topics: Ankle Injuries; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Randomized Controlled Trials as Topic
PubMed: 34789369
DOI: 10.3238/arztebl.m2021.0231 -
Clinics in Podiatric Medicine and... Jul 2024Fifth metatarsal features are the most common fractures in the foot. They have a long history that has resulted in many classification systems and little consensus on... (Review)
Review
Fifth metatarsal features are the most common fractures in the foot. They have a long history that has resulted in many classification systems and little consensus on appropriate treatment. Although there is some agreement among experts, there are also many questions yet to be answered. There is a general consensus that dancer's fractures and zone 1 fractures can generally be treated nonoperatively. There is much more debate about zone 2 and 3 fractures and appropriate treatment guidelines. The authors review the current literature and give the recommendation for treatment based on their experience in a community-based private practice.
Topics: Humans; Metatarsal Bones; Fractures, Bone; Fracture Fixation, Internal; Foot Injuries
PubMed: 38789160
DOI: 10.1016/j.cpm.2024.01.002 -
Foot and Ankle Clinics Mar 2020Hallux valgus is an extremely common and often disabling deformity. In addition to valgus deformity of the hallux, varying degrees of varus and supination of the first... (Review)
Review
Hallux valgus is an extremely common and often disabling deformity. In addition to valgus deformity of the hallux, varying degrees of varus and supination of the first metatarsal and instability in the metatarsophalangeal and metatarsocuneiform joints are frequently present. Because of the complexity and multiplicity of deformities, surgical techniques and fixation methods continue to be developed to obtain better results. Recent studies have focused on correcting pronation of the first metatarsal as a way of correcting and equalizing the metatarsal sesamoid bones in a more horizontal and stable position, possibly minimizing the chance of recurrence of the deformity.
Topics: Fracture Fixation, Internal; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy
PubMed: 31997750
DOI: 10.1016/j.fcl.2019.10.006 -
Foot and Ankle Clinics Dec 2019Freiberg's infraction is an uncommon condition of the lesser metatarsophalangeal joints. Onset is usually between the 11th and 17th year of age. It is the only... (Review)
Review
Freiberg's infraction is an uncommon condition of the lesser metatarsophalangeal joints. Onset is usually between the 11th and 17th year of age. It is the only osteochondrosis that dominantly affects females with a reported female-to-male ratio of 5.1. The second metatarsal is most frequently involved (68%) followed by the third metatarsal (27%), and the fourth (3%). Surgical treatment options can be categorized in joint destructive and joint preserving procedures. Studies reveal complete resolution of pain and full return to activities in 70% after joint destructive procedure and more than 90% after joint preserving procedures.
Topics: Arthroplasty; Bone Transplantation; Debridement; Decompression, Surgical; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Metatarsus; Osteochondritis; Osteotomy
PubMed: 31653371
DOI: 10.1016/j.fcl.2019.08.004 -
The New England Journal of Medicine Jan 2022
Topics: Adult; Foot Joints; Fracture Dislocation; Humans; Ligaments, Articular; Male; Metatarsal Bones; Radiography; Tarsal Bones
PubMed: 35029849
DOI: 10.1056/NEJMicm2034535