[The Primary Metatarsalgia: Pathogenesis, Biomechanics and Surgical Treatment]

Area of Science:

• Orthopedics
• Podiatry
• Surgical Innovation

Background:

• Metatarsalgia is forefoot pain stemming from various conditions.
• Central metatarsalgia involves excessive pressure under the metatarsal heads due to structural-functional changes.
• Current surgical treatments, primarily osteotomies, have complication rates ranging from 6% to 50%.

Purpose of the Study:

• To review the current concepts in diagnosing and treating central metatarsalgia.
• To analyze the efficacy and complication rates of different surgical interventions.
• To identify optimal surgical strategies for central metatarsalgia.

Main Methods:

• Comprehensive review of medical literature on central metatarsalgia diagnosis and treatment.
• Analysis of data on various osteotomy techniques and their associated complications.
• Evaluation of combined surgical approaches and their outcomes.

Main Results:

• Weil-osteotomy is a common surgical treatment for central metatarsalgia, but carries risks.
• The complication rate for Weil-osteotomy, especially when combined with intraphalangeal arthrodesis, can be as high as 50% (e.g., floating toe).
• Simultaneous procedures like Weil osteotomy, plantar plate repair, tendon lengthening, and triple Weil-osteotomy show a lower complication rate of approximately 15%.

Conclusions:

• Combined osteotomy techniques are more successful in treating central metatarsalgia.
• Considering structural-functional forefoot pathology and repairing metatarsophalangeal joint ligaments are crucial for successful surgical outcomes.
• Optimizing surgical techniques requires a holistic approach to forefoot biomechanics and joint stability.