Cameron Bulluss

Forefoot - defined
From the digits to the mid part of the metatarsals

Basic Biomechanics
50% of body weight is taken through the forefoot in

standing In walking factors that can increase forefoot stress are

Overpronation Instability Toe pain or deformity Equinus Loss of range through the ankle, subtalar joints or

midfoot High heels Tight shoes

Metatarsalgia
The term metatarsalgia is often used to describe pain

in the distal forefoot, but does not define a specific diagnosis or indicate a particular mode of treatment.

Assessment

Clinical Examination Radiology MRI, CT, Radionucleide studies X -Rays

intra-articular problems such as degenerative arthritis,

Freibergs infraction, stress fracture of the metatarsal and inflammatory arthritis, Weight bearing x-rays often useful

Laboratory Studies FBC, ESR, Rheumatoid factor, Uric Acid

Types of Toe Deformities

Hammer toe is flexion

contracture of the PIP Claw toe is hyperextension of the MTP and flexion of the PIP Mallet toe is flexion contracture at the DIP

Treatment Options for IPK (intractable plantar kerotoses)

Distinguish from plantar wart 2. This involves trimming the callus to relieve pressure. Initially, debulking the callus and then on a weekly basis the patient may use a rasp or pumice stone to reduce the keratosis further. A dome placed on the insole just proximal to the symptomatic metatarsal headhelps to redistribute pressure to the metatarsal diaphysis or use of an metatsal head accomodation 3. If successful incorporate the dome or accomodation into an orthotic 4. If unsuccessful surgery
1.

Metatarsal Dome

Callosities

A Diagnostic Algorithm for the Treatment of Forefoot Pain

Evidence for met pad/dome

Significant reduction in plantar foot pressure (15 -40%)

Where to place
10 25 mm distal to metatarsal heads

Will orthotic help more

Yes probably through more even weight distribution

Alternative to a metatarsal dome

Submetatarsal accomodation