| 1BackgroundMetatarsalgia is a commom disease of foot surgery,which is a symptomatic diagnosis caused by many diseases.The common reasons are trauma,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.2ObjectiveTo evaluate the clinical result of metatarsal osteotomy in the treatment of metatarsalgia with metatarsophalangeal joint dislocation,and validation and evaluation scientific and practicability of the standard of classification about metatarsalgia.3Method From October2010to March2013,72feet of49patients(including men11casesl9feet,women38cases53feet)of metatarsalgia with metatarsophalangeal joint dislocation were treated by metatarsal osteotomy. Patients’ages range from51to70years,an average age62.3.There were124metatarsals.49metatarsals received with weil osteotomy surgery(including17second metatarsal,32third metatarsal),and75metatarsals received with metatarsal proximal oblique osteotomy and shortening surgery(including56second metatarsal,19third metatarsal).Postoperative follow-up time were12to36months, the average of follow-up time were22months. To measure a series of data,including the size of callosum,the activity of joints,the maximum pressuresand impluses on the area of pain.ACFAS and VAS were used to assessment clinical outcomebefore and after surgery.All patients were observed by shooting a X-ray before and after surgery,and Observe the relevant indicators.4Results4.1After the Weil osteotomy surgery,the disappearance and significantly reduce the rate of callosum is96%.The preoperative VAS score (6.35±3.42) and postoperative VAS score (1.13±0.57).The preoperative ACFAS score (57.27±9.28) and postoperative ACFAS score (84.12±8.20).The scores were statistically significant (P<0.05) before and after surgery.The maximum pressure of the pain area was decreased from (139.66±90.26) N to (79.52±52.29) N,the maximum pressure of the pain area was decreased from (18.31±8.86)P/cm2to (13.43±8.01)P/cm2,the impulse decreased from (51.44±38.32) Ns to (27.87±18.75) Ns,had statistical sigoigicaoce (P<0.05).The average shortening of metatarsal after osteotomy is3.41mm.The clearance of metatarsophalangeal joint and the angle were statistically significant before and after surgery(P<0.05).4.2After the metatarsal proximal oblique osteotomy and shortening surgery,the disappearance and significantly reduce the rate of callosum is94.7%.The preoperative VAS score (8.23±3.67) and postoperative VAS score (1.89±0.61).The preoperative ACFAS score (45.64±6.67) and postoperative ACFAS score (83.67±9.37).The scores were statistically significant (P<0.05) before and after surgery.The maximum pressure of the pain area was decreased from (125.32±67.21) N to (52.12±26.23) N,the maximum pressure of the pain area was decreased from ((6.34±8.31) P/cm2to (6.34±3.65) P/cm2,the impulse decreased from.(46.47±30.42) Ns to (19.34±1.89) Ns,had statistical sigoigicaoce (P<0.05).The average shortening of metatarsal after osteotomy is5.87mm.The clearance of metatarsophalangeal joint and the angle were statistically significant before and after surgery(P<0.05).4.3The activity of metatarsophalangeal joint was reduced Compared with preoperative,and there was Significantly different (P<0.05).After surgery,6feet had metastatic pain.12feet had numbness of the skin,and the symptoms was restored after6-12months.3feet appeard skin necrosis,and cured after dressing.3feet(5metatarsal)appeard nonunion,and cured after reducing activities and oral Chinese medicine.there was no shifting,recurrencing of the metatarsophalangeal joint,deep vein thrombosis,rejection,and so on.4.4All responsibility metatarsophalangeal joint space preoperative of weight-bearing was-4.34±6.14mm, and non-weight-bearing position was-0.01±3.72mm.There were statistically significant (P<0.05) before and after surgery.In the use of the Weil osteotomy surgery,the responsibility metatarsophalangeal joint space preoperative of weight-bearing was-4.27±2.85mm,and non-weight-bearing position was1.86±1.12mm.There were statistically significant (P<0.05) before and after surgery.In the use of the the metatarsal proximal oblique osteotomy and shortening surgery,the responsibility metatarsophalangeal joint space preoperative of weight-bearing was-7.44±6.30mm,and non-weight-bearing position was-1.49±4.35mm.There were statistically significant (P<0.05) before and after surgery.5Conclusion5.1Metatarsal osteotomy surgery based on the classification of metatarsalgia can improve the forefoot pain symptom,correct the deformity of metatarsophalangeal joint dislocation,and prove the effectiveness of the operation plan.5.2The methods of classification of metatarsalgia has certain scientific and practical,and has clinical guiding significance. |
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