| 1 BackgroundMetatarsalgia is a commom disease of foot surgery,which is a symptomatic diagnosis caused by many diseases. The common reasons are ma, inflammation, foot deformity,skin lesions and endocrine metabolic disease. The metatarsalgia of this study is painful callosum,which is caused by excessive weight under the partial broken metatarsal bones. The main clinical manifestations are pain under metatarsal bones,and pain worse to walk, run and jump. When developing to a certain stage, it will manifest as metatarsophalangeal joint dislocation,mallet fingers or claw toe. For the treatment of metatarsalgia, substantiating diagnosis is the first step, and then choose the suitable treatment method. Conservative treatment is effective for people without deformity,but the effect is poor for people with metatarsophalangeal joint dislocation.These people need operative treatment,and there are many methods. The focus of the treatment is to remove broken metatarsal bones excess weight and restore the function of joints.Now the classification of metatarsalgia and treatment based on the classification have not formed a unified opinion. So It is necessary to study the classification and treatment of metatarsalgia, and it will be helpful for the diagnosis and treatment of metatarsalgia. Summarizing research results and experience of the treatment,my tutor,Professor Wen Jianrnin put forward the methods of classification and treatment based on the classification. The major research of this subject is about metatarsalgia with metatarsophalangeal joint dislocation.By before-and-after study method,to assess the indicators of the patientsbefore and after surgery.2 ObjectiveTo evaluate the clinical efficacy of the minimally invasive treatment of metatarsal head and neck osteotomy raise no dislocation of metatarsalgia.3 MethodFrom June 2013 to March 2015, at Wangjing Hospital of China Academy of Traditional bone and joint two families accepted minimally invasive surgical treatment of metatarsal head and neck osteotomy raise no dislocation metatarsalgia patients after long-term follow-up of 24 patients with complete data 26 feet a total of 55 metatarsal, left foot 17, right foot 9 (included 28 cases of 32 feet,6 feet off four cases, patients were lost to follow-induced loss), including 3 males and 3 feet,23 feet and 21 females; age 47 years-78 years, mean 56.3 years. Minimally invasive treatment of metatarsal head and neck osteotomy and elevation, second metatarsal 21, the third metatarsa] 21, the fourth metatarsal 13, June-18 month follow-up period, an average of 13 months. Subjects were in the pre-operative and post-operative 3 months,6 months,12 months, measuring and recording time responsibility toe metatarsophalangeal joint motion, tenderness index visual analog scale (VAS) score, liability under the metatarsal heads using former American Physicians foot ankle scoring system (ACFAS) subjects were assessed using both Footscan plantar pressure analyzer to measure and record the normal gait cycle under the metatarsal heads corresponding to withstand the maximum pressure, maximum pressure and impulse before and after the change in the patient’s feet and shoot X-ray, including weight-bearing and non-weight-bearing radiographs, and clinical studies in which indicators tell the patient before surgery details, signed informed consent, in line with the conditions were included, no surgical contraindications patients included in this study. In order to establish the quality of the cases included, consisting of three or more high title and ankle surgery in the cases included in the expert assessment, take a simple majority for the controversial tripartite consultation, in line with the X-ray division last 0-1 degrees The cases included in this study.4 ResultsOsteotomy of the metatarsal head and neck in front of minimally invasive surgical treatment without raising dislocation surgery for plantar pain VAS scores (4.23+0.96) points, postoperative (1.55±1.05) minutes before the ACFAS preoperative score was (56.47 ± 8.16) points, postoperative (84.51± 4.39) minutes before surgery was tenderness index (2.09±0.67) points, postoperative (0.38 ± 0.49) differences were statistically significant (P <0.05); former responsibilities metatarsophalangeal joint activity surgery was (57.42+8.41) degrees, postoperative (31.07 ± 6.34), under the responsibility of the metatarsal head maximum pressure before surgery was (136.25 ± 19.42) N, postoperative (75.13±13.87) N, the maximum pressure before surgery was (15.15±2.34) cm2, postoperative (9.25 ± 2.63) cm2, impulse before surgery was (49.70 ± 12.09) Ns, postoperative (23.95 ± 6.59) Ns, the differences were statistically significant (P<0.05). Under the metatarsal head pain after two cases of metastatic, accounting for 3.63%, after metatarsal no nonunion; 4 cases of delayed healing osteotomy metatarsal 7.27%, where the second metatarsal two cases, one case of the third metatarsal, the fourth metatarsal one case, Nursing and reduce weight, after oral Bushenzhuanggu medicine granules are within 7-11 months after surgery to heal. Plantar skin numb after 3 feet, accounting for 11.53%, without special treatment, restoration of normal skin sensation within 3-5 months after surgery. The group study toe incision skin necrosis, foot soft tissue infections, the corpus callosum recurrence of deep vein thrombosis and other complications occurred.5 ConclusionBased on X-ray metatarsalgia indexing criteria to determine the minimally invasive treatment of metatarsal head and neck osteotomy raise no dislocation metatarsalgia (X line indexing 0-1 degrees), can significantly improve symptoms of pain under the metatarsal heads, for clinical treatment instructive.
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