Chapter 18 Metatarsal Injuries

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Chapter 18 Metatarsal Injuries
2013-10-07 00:05:13
Chapter 18 Metatarsal Injuries

Chapter 18 Metatarsal Injuries
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  1. Etiology
    · Excessive Pronation
    · Forefoot varus
    · Wearing tight shoes (weakening supporting structures)
    · Being overweight
    · excessive exercise placing undo stress on the arch

    · Pain, weakness, fatigue in medial longitudinal arch

    · calcaneal eversion
    · bulging navicular
    · flattening of medial longitudinal arch
    · dorsiflexion w/ lateral splaying of 1st metatarsal

    · if no pain- dont correct

    · if pain- orthodics with medial wedge, and possible taping
    Pes Planus Foot
  2. Etiology
    · higher arch than normal- associated w/ excessive supination, high medial longitudinal arch

    · Poor shock absorption resulting in metarsalgia, foot pain, clawed or hammer toes

    · Associeted with forefoot valgus, shortening of Achilles and plantar fascia
    · Heavy callus on ball and heel of foot

    · If asymptomatic- dont correct

    · If problem- orthodics with lateral wedge
    · Stretch Achilles and plantar fascia
    Pes Cavus
  3. Etiology
    · abnormally short 1st metatarsal, making 2nd look longer
    · More weight bearing on 2nd toe-  impact gait Stress fracture can develop

    · Stress fracture S/S w/ pain during and after activity; point tenderness
    · Bones scan postive
    · **** Callus development under 2nd metatarsal head

    · no pain- do nothing
    · if associated with structural forefoot varus- orthodics with medial wedge
    Morton's Toe
  4. Etiology
    · Caused by increased stress on arch
    · Flattening of foot during midsupport phase causing strain on arch (appear suddenly or slowly)

    · Pain w/ running and jumping, pain/swelling below posterior tibialis tendon
    · or sprained calcaneonavicular ligament and flexor hallucis longus strain

    · immediate care, RICE and reduction of weight bearing
    · arch taping to allow pain free walking
    Longitudinal Arch Strain
  5. Etiology
    · increased tension and stress on fascia (especially when pushing off a run)
    · change from rigid to flexible footwear
    · poor running technique
    · leg length dicrepancy, excessive pronation, inflexible longitudinal arch, tight gastroc-soleus complex
    · running on soft surface with poor support

    · pain in anterior medial heel along medial longitudinal arch

    · increased pain in morning w/ first steps
    · increased pain w/ forefoot dorsiflexion

    · extended treatment (8-12 w)
    · soft orthodic w/ deep heel cup helpful
    · arch taping, night splint for stretching
    · vigorous heel cord stretching and great toe dorsiflexion exercises
    · Massage of plantar surface using tennis ball
    · NSAIDs and occasional steroidal inject
    Plantar Fasciitis
  6. · attributed to heel spurs, plantar fascia irritation and bursitis
    · plantar fascia- dense connective tissue attaching proximal and medially on calcaneus and plantar aspect of the foot
    · works in maintaining stability of the foot and bracing the longitudinal arch
    Plantar Fasciitis info
  7. Etiology
    · Fracture of metatarsal caused by inversion and plantar flexion, direct force (stepped on) or repetitive trauma
    · most common- 5th metatarsal

    · immediate swelling, pain over 5th metatarsal
    · *** high nonunion rate and course of healing is unpredictable

    · controversial treatment
    · crutches, gradually progression to weight bear  (may return to activity in 6 weeks)
    · if nonunion occurs internal fixation required
    · bone stimulator suggeted
    Jones Fracture
  8. Etiology
    · *** 2nd metatarsal fracture (March fracture)
    · change in running pattern, millage, hills, or hard surfaces
    · forefoot varus, hallux valgus, flatfoot or short 1st metatarsal
    · Occasional 5th metatarsal fracture at base and insertion of peroneus brevis (bc of high arch)

    · over 2-3 dull ache during exercise, progressing to pain at rest
    · progresses from diffuse to localized pain

    · Bone scan may be necessary
    · 3-4 days of partial weight bearing followed by 2 weeks rest
    · return to running should be gradual w/ orthodics for excessive pronation
    Metatarsal Stress Fracture
  9. Etiology
    · exostosis of 1st metatarsal head- associated w/ forefoot varus, narrow, pointed or short shoes
    · Bursa becomes inflamed and thickens, enlarging joints, and causing lateral malalignment of great toe
    · Bunionette (talior's bunion) impacts 5th causing displacement of toe

    · Tenderness, swelling, enlargement of joint,  angulation, ambulation
    · tendinitis in great toe flexors may develop

    · early reconigtion and care critical
    · *** wear correct fitting shoes, appropiate orthodics, pad over 1st metatarsal head, tape splint beftween 1st and 2nd toes
    · exercises for flexor and extensor muscles
    · bunionectomy may be necessary
    Bunion (Hallux Valgus Deformity)
  10. Etiology
    · caused by repetitive hyperextension of the great toes resulting in inflammtion

    · Pain under great toe, especially during push off
    · Tenderness under first metatarsal head

    · Treat w/ metatarsal pads, metatarsal bars arch supports
    · decrease activity to allow inflammation to subside
  11. Etiology
    · Pain in ball of foot (2nd, 3rd metatarsal heads)
    · restricted extensibility of gastroc-soleus complex
    · Typically emphasizes toe off phase during gait
    · Fallen metatarsal arch

    · Transverse arch flattened, depressed 2nd, 3rd, 4th metatarsal bones resulting in pain
    · Cavus foot may also cause problem

    · elevate depressed metatarsal heads or medial aspect of calcaneus
    · Remove excessive callus build up
    · Stretches heel cord and strengthening intrinsic foot muscles
    · Padding on ball or heel
  12. Etiology
    · Fallen metatarsals or pes cavus foot
    · Excessive pronation may compromise metatarsal head positioning and weight distribution

    · Pain or cramping in metatarsal region
    · Point tenderness, weakness, positive Morton's test

    · Pad to elevate metatarsals just behind ball of foot
    Metatarsal Arch Strain
  13. Etiology
    · Thickening of nerve sheath where nerve divides into digital branches
    · usually plantar nerve or between 3rd, 4th met heads
    · irritated by collapse of transverse arch- stressing transverse metatarsal ligaments compressing digital nerves and vessels
    ·Excessive pronation- predisposing factor

    · burning parethesia and severe intermittent pain in forefoot
    · pain relieved when non-weight bearing
    · toe hyperextension increases symptoms

    · must rule out stress fx
    · teardrop pad can be placed between met heads to increase space, decreasing pressure on neuroma
    · shoes w/ wider toe box
    · surgery may be required
    Morton's Neuroma