Metatarsalgia

• Atrophy of the fat pad located just beneath the metatarsophalangeal joints
• Synovitis of the metatarsophalangeal joints, for example in rheumatoid arthritis
• Morton’s neuralgia
• Hammer and claw toes
• Damage to the plantar plate of a metatarsophalangeal joint with instability, usually of the second toe
• Subluxations of the metatarsophalangeal joints
• Dislocations of the metatarsophalangeal joints
• Hallux valgus with coexisting hypermobility of the first metatarsal bone
• Sesamoid disorders
• Stress fractures of the metatarsal bones
• Dermatological diseases, for example psoriatic arthritis
• Diabetes

Treatment depends on the cause. Unfortunately, structural changes are irreversible in most cases, and even successful treatment of the underlying disease, such as diabetes, does not eliminate the symptoms.

Treatment can be divided into non-surgical (conservative) methods, including:

• Individual orthopaedic insoles for transverse flatfoot that raise the transverse arch
• Individual stretching exercises for the posterior calf muscles
• Footwear modification
• Functional foot orthoses improving stabilisation of the first metatarsal bone
• Anti-inflammatory treatment of synovitis, including physical therapy and medication
• Treatment of the underlying disease – diabetes or rheumatoid arthritis

Surgical treatment includes:

• Minimally invasive surgery (MIS), currently used most often
• Metatarsal osteotomies relieving excessive joint loading, such as Weil, DuVries or Macera osteotomy
• Resection of metatarsal heads, used when symptoms are particularly severe
• Osteotomies of the proximal phalanx
• Total or hemiarthroplasty of a metatarsophalangeal joint (Cartiva)
• Correction of forefoot deformities causing lowering of the transverse arch, including surgery to correct hallux valgushammer and claw toes
• Surgical treatment of Morton’s neuralgia

Rehabilitation is an important element supporting rapid recovery after transverse-flatfoot surgery. To be effective, it should be based on the following principles:

• the patient’s condition should be assessed
• Individual recommendations should be prepared for postoperative treatment according to the type of procedure and cause of metatarsalgia
• therapy should be adapted to the patient’s abilities

Individual exercises with the patient aim to:

• improve the range of motion in the joints of the operated lower limb
• improve proprioception
• Work on improving neuromuscular coordination
• Reduction of swelling (soft-tissue work, lymphatic massage, kinesiotaping)
• correct gait and faulty movement habits
• physiotherapy

In foot surgery, ensuring a pain-free operation and minimising postoperative pain have always been major challenges.

It is commonly believed that recovery after foot surgery, especially hallux surgery, is very painful.

There are many options for anaesthesia during procedures on the foot.

Modern anaesthesiology aims, wherever possible, to use regional anaesthesia techniques – from central blocks such as spinal and epidural anaesthesia, commonly known as lumbar anaesthesia, to peripheral nerve blocks at various levels performed under ultrasound guidance, especially when operating on one foot.

The possibility of using a particular type of anaesthesia depends mainly on the extent of surgery and any coexisting conditions.

The final choice of anaesthesia is agreed with the patient during the preoperative assessment interview.

Using ultrasound in anaesthesiology to perform peripheral nerve blocks has enabled highly precise regional anaesthesia.

Our many years of experience have changed our perioperative approach, both to anaesthesia itself and to the postoperative period.

For foot surgery, peripheral nerve anaesthesia, known as an ankle block, means injecting a local anaesthetic around the nerves at the appropriate level.

These anaesthetics are highly precise because the nerves responsible for pain sensation are clearly visible on ultrasound and medication delivery is fully controlled.

This can substantially reduce or even eliminate the need for pain medication early after surgery.

For many patients, one of the most important advantages is that sensation above the knee is preserved in the operated leg and, most importantly, lumbar anaesthesia is avoided, which patients do not always accept.

Another important advantage is that walking can begin very soon after the procedure.

During the postoperative period, administering pain medication at regular intervals under ultrasound guidance around the nerves responsible for pain enables patients to pass through this period as comfortably and painlessly as possible.