Flexible metatarsalgia

　　1, Etiology

　　The disease is caused by congenital shortening of the first metatarsal, which cannot effectively bear weight and needs to be replaced by the second or third metatarsal.

　　2, Pathogenesis

　　It often occurs on the basis of congenital metatarsal deformity, such as shortening, varus, or abnormal frequent activity of the first metatarsal. Because the first metatarsal cannot effectively bear weight, it needs to be replaced by the second or third metatarsal. Normally, the interosseous muscles contract to bring the metatarsal heads close together. If, due to factors such as weight gain, long-distance walking, intense exercise, or weak feet after illness, the interosseous muscles atrophy and weaken, the stability between the metatarsal heads decreases, leading to collapse of the transverse arch of the foot, relaxation of the transverse ligament between the metatarsal heads, and pain occurs.

　　It can be accompanied by claw toes, where the toes are claw-like, and this toe deformity affects three joints of the toes. It is caused by excessive extension of the metatarsophalangeal joint, and bending and deformation of the proximal and distal interphalangeal joints due to unbalanced tension of the muscles or nerves.

　　The toes are claw-like, which is a fixed deformity formed by the dorsiflexion of the metatarsophalangeal joint, and the plantar flexion of the proximal and distal interphalangeal joints. The toes are prone to develop thick calluses due to friction.

　　Pain is located on the transverse ligament of the metatarsal head plantar surface, presenting as persistent burning pain, which intensifies during walking and can affect the lower leg. There is tenderness on the plantar and dorsal sides of the metatarsal head, with calluses on the plantar surface, a wide forefoot, atrophy of the interosseous muscles, and claw toes.

　　1. Avoid eating dry and unrefined foods.

　　2. It is especially taboo to eat hormone drugs.

　　3. Pay attention to a nutritious and balanced diet, and appropriately supplement the intake of vitamin D and calcium.

　　4. During exercise, master the amount of exercise and the principles of exercise according to your physical condition, fully prepare for the warm-up; pay attention to the method of exercise, progress step by step; pay attention to rest in daily life, and avoid excessive activities and joint flexion.

　　5. It is best to receive sports medical consultation before engaging in high-intensity sports, learn some common sense of sports physiology and hygiene; prepare sports clothing and wear elastic sports shoes, and avoid running and jumping on hard ground.

　　X-ray film shows that the intervertebral spaces between the first and second tarsal bones and the two cuneiform bones are widened; the second and third tarsal bones are robust and large, with increased density; the first tarsal bone is shortened and inverted, etc., and it is generally not necessary to perform CT and MRI examinations.

　　In addition to conventional treatment, patients with rheumatoid plantar pain syndrome should also pay attention to light diet, stay away from spicy and刺激性 foods, and at the same time ensure nutrition during treatment to assist in the treatment of the disease.

　　I. Treatment

　　1. Treatment Objective:Correct the deformity, restore and maintain the transverse arch of the forefoot, and avoid the continued compression of the transverse ligament of the tarsal bone head.

　　2. Treatment Methods

　　(1) Conservative treatment: Wearing wide forefoot shoes with appropriate heels and hard soles can avoid or reduce the load on the tarsal bone head.

　　(2) Surgical treatment: Common methods include:

　　① Tarsal bone suspension surgery: Make a longitudinal incision centered on the neck of the tarsal bone, and drill a hole near the proximal neck of the tarsal bone. Cut the extensor digitorum longus tendon at its insertion point, thread the tendon through the hole, tighten and suture, and use this muscle force to lift the tarsal bone head.

　　② Tarsal osteotomy: The method is to expose the neck of the tarsal bone, make an oblique osteotomy from the lateral side to the distal tarsal side, and bite off the two ends of the bone tips, so that the head of the tarsal bone moves to the back side and shortens itself, raising the head of the tarsal bone to reduce pressure.

　　II. Prognosis

　　After treatment, the prognosis is still good.