metatarsalgia the inside story
Download
Skip this Video
Download Presentation
Metatarsalgia The inside story

Loading in 2 Seconds...

play fullscreen
1 / 53

Metatarsalgia The inside story - PowerPoint PPT Presentation


  • 133 Views
  • Uploaded on

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 .

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Metatarsalgia The inside story' - tal


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
metatarsalgia the inside story

MetatarsalgiaThe inside story

Greg Quinn FCPodS

Podiatric Surgeon

slide2

Pain has a message.

Once we get the pain\'s message,

and follow its advice,

the pain goes away.

slide4

“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

the surgical s ieve
The Surgical Sieve
  • Congenital
  • Infectious
  • Metabolic
  • Traumatic
  • Neoplastic
  • Iatrogenic
  • Idiopathic
  • Biomechanical

Can I Manage To Nap If I’m Busy?

congenital
Congenital
  • Metatarsus Adductus
  • TalipesEquinus Varus
  • Flexible Flat Foot
  • Vertical talus
  • Major malformations
infectious
Infectious
  • Bacterial
  • Viral
  • Fungal
metabolic
Metabolic
  • Inflammatory arthritis e.g. RA, Gout, psoriasis
  • Ischaemic Vascular disease
idiopathic
Idiopathic

I just don’t know why is this happening

biomechanical
Biomechanical
  • Capsulitis
  • Morton’s neuroma
  • Intractable plantar keratoses
  • Hallux valgus/rigidus
  • Lesser toe deformity
  • Muscle imbalance
slide15

Significant History

Pain:

onset/character/site/variation

Associated signs:

skin lesions/swelling/changing toe position/joint stiffness

slide16

X-Rays can help

soft tissue changes

joint space change/degeneration

fracture

MTPJ alignment & parabola

slide18

Metatarsal Abnormality

Dorsiflexed

Elongated

Plantarflexed

Shortened

Hypertrophic condyles

1st ray hypermobility

slide19

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

slide30

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)

slide31

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)

slide32

Potential confounding variables

Why didn’t we just evolve like this?

slide34

Phenotype does not follow genotype

(what we look like is governed by regulatory genes)

slide36

Question: What does this tell us?

Answer: Foot structure varies within and between populations.

slide37

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)

slide39

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
slide40

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!

slide41

High arch/inverted heel/hypomobile

Other symptoms include:

Lateral ankle sprain

Sesamoiditis

Genurecurvatum

slide42

Medium arch/inverted heel/hypomobile

Other symptoms include:

Retrocalcaneal bursitis

Pinch callus medial hallux

Lateral hip pain

slide43

Low arch/vertical heel/hypermobile

Other symptoms include:

Functional hallux limitus/HAV

Posterior tibial tendinitis

Plantar fasciitis

slide44

Medium arch/inverted heel/hypomobile/inverted forefoot

Other symptoms include:

Shin splints

Cuboid pain

Medial knee pain

slide45

Flat arch/everted heel/hypermobile/inverted forefoot

Other symptoms include:

Tarsal tunnel syndrome

Posterior tibial dysfunction

Plantar fasciitis

ad