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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

MetatarsalgiaThe 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.


“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


  • “It renders his species advantaged within his natural environment.” is better to die on your feet than live on your knees!”

  • Emiliano Zapata


  • The surgical s ieve
    The Surgical renders his species advantaged within his natural environment.” Sieve

    • Congenital

    • Infectious

    • Metabolic

    • Traumatic

    • Neoplastic

    • Iatrogenic

    • Idiopathic

    • Biomechanical

    Can I Manage To Nap If I’m Busy?


    Congenital
    Congenital renders his species advantaged within his natural environment.”

    • Metatarsus Adductus

    • TalipesEquinus Varus

    • Flexible Flat Foot

    • Vertical talus

    • Major malformations


    Infectious
    Infectious renders his species advantaged within his natural environment.”

    • Bacterial

    • Viral

    • Fungal


    Metabolic
    Metabolic renders his species advantaged within his natural environment.”

    • Inflammatory arthritis e.g. RA, Gout, psoriasis

    • Ischaemic Vascular disease


    Traumatic
    Traumatic renders his species advantaged within his natural environment.”


    Neoplastic
    Neoplastic renders his species advantaged within his natural environment.”


    Iatrogenic
    Iatrogenic renders his species advantaged within his natural environment.”


    Idiopathic
    Idiopathic renders his species advantaged within his natural environment.”

    I just don’t know why is this happening


    Biomechanical
    Biomechanical renders his species advantaged within his natural environment.”

    • Capsulitis

    • Morton’s neuroma

    • Intractable plantar keratoses

    • Hallux valgus/rigidus

    • Lesser toe deformity

    • Muscle imbalance


    Significant History renders his species advantaged within his natural environment.”

    Pain:

    onset/character/site/variation

    Associated signs:

    skin lesions/swelling/changing toe position/joint stiffness


    X-Rays can help renders his species advantaged within his natural environment.”

    soft tissue changes

    joint space change/degeneration

    fracture

    MTPJ alignment & parabola


    Metatarsal Abnormality renders his species advantaged within his natural environment.”

    Dorsiflexed

    Elongated

    Plantarflexed

    Shortened

    Hypertrophic condyles

    1st ray hypermobility


    Diagnosis renders his species advantaged within his natural environment.”

    Avascular necrosis

    Tumour

    Foreign body

    Infection

    Fracture

    Lesser MTPJ instability

    Capsulitis (+/- degeneration)

    Neuroma

    Immobilisation

    &/or

    Surgery

    Padding

    Orthotics

    Shoe mod’s

    Injection

    NSAID’s


    The necker cube
    The Necker Cube renders his species advantaged within his natural environment.”


    Essentialism
    Essentialism renders his species advantaged within his natural environment.”


    ‘Anyone who ignores history is living hand to mouth’ renders his species advantaged within his natural environment.”

    Goethe


    What the foot delivers via autosupport renders his species advantaged within his natural environment.”

    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)


    Potential confounding variables renders his species advantaged within his natural environment.”

    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)


    Potential confounding variables renders his species advantaged within his natural environment.”

    Why didn’t we just evolve like this?


    Evolution = genetics + time renders his species advantaged within his natural environment.”


    Phenotype does not follow genotype renders his species advantaged within his natural environment.”

    (what we look like is governed by regulatory genes)


    Question renders his species advantaged within his natural environment.” : What does this tell us?

    Answer: Foot structure varies within and between populations.


    What significant things vary? renders his species advantaged within his natural environment.”

    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)


    How will all foot structures vary? renders his species advantaged within his natural environment.”


    All feet possess important common structures that: renders his species advantaged within his natural environment.”

    • 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


    Consider what we know renders his species advantaged within his natural environment.”

    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!


    High arch/inverted heel/ renders his species advantaged within his natural environment.” hypomobile

    Other symptoms include:

    Lateral ankle sprain

    Sesamoiditis

    Genurecurvatum


    Medium arch/inverted heel/ renders his species advantaged within his natural environment.” hypomobile

    Other symptoms include:

    Retrocalcaneal bursitis

    Pinch callus medial hallux

    Lateral hip pain


    Low arch/vertical heel/ renders his species advantaged within his natural environment.” hypermobile

    Other symptoms include:

    Functional hallux limitus/HAV

    Posterior tibial tendinitis

    Plantar fasciitis


    Medium arch/inverted heel/ renders his species advantaged within his natural environment.” hypomobile/inverted forefoot

    Other symptoms include:

    Shin splints

    Cuboid pain

    Medial knee pain


    Flat arch/ renders his species advantaged within his natural environment.” everted heel/hypermobile/inverted forefoot

    Other symptoms include:

    Tarsal tunnel syndrome

    Posterior tibial dysfunction

    Plantar fasciitis


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