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Metatarsalgia is a frequent foot disorder. The objective was to evaluate whether the length ratio between the second and the third metatarsals after Weil osteotomy influences clinical outcomes. This retrospective study included 37 patients (53 feet). Preoperative planning consisted of keeping the second metatarsal greater than or equal to the third metatarsal after Weil osteotomy of the second metatarsal or the second and third metatarsals. Based on postoperative weightbearing and digital AP radiographs after Weil osteotomy, we divided the patients into 2 groups: group 1, the second metatarsal was longer than or equal to the third metatarsal; and group 2, the second metatarsal was shorter than the third metatarsal. We investigated whether there were differences between the groups. In 35 (66%) feet, the second metatarsal was longer than or equal to the third metatarsal (group 1), and in 18 (34%) feet, the second metatarsal was shorter than the third metatarsal (group 2). Postoperative American Orthopaedic Foot and Ankle Society scores were 86.2 and 82.7, respectively (p =.32). Postoperative Visual Analog Scale scores were 1.26 and 1.67, respectively (p =.39). The sample showed 11.3% of transfer metatarsalgia to the third metatarsal. Group 1 had 9% of transfer metatarsalgia, whereas group 2 had 17% of transfer metatarsalgia (p =.40). The presence of a second metatarsal shorter than the third metatarsal, after Weil osteotomy of the second metatarsal or the second and third metatarsals, does not influence outcomes or incidence of transfer metatarsalgia to the third metatarsal. [ABSTRACT FROM AUTHOR]

Osteoma is a benign bone-forming tumor composed of compact or mature trabecular bone and is limited almost exclusively to craniofacial bones, especially in the paranasal sinuses and mandible. It is typically a slow growing lesion that is asymptomatic, unless its size significantly increases to cause symptoms such as pain or other neurological symptoms, that happens more often in cases involving craniofacial bones. Radiological appearance of these tumors depends on their location. In cases of juxtacortical osteoma, it is crucial to differentiate between this type of tumor and parosteal osteosarcoma, sessile osteochondroma, and matured juxtacortical focus of myositis ossificans. However, in some cases, it is difficult to differentiate juxtacortical osteoma from above mentioned lesions only with radiologic appearance. We describe a case of an osteoma that arose from the second metatarsal bone, a rare anatomical location for osteoma. [ABSTRACT FROM AUTHOR]

Summary: Utilization of the metatarsal bones and interosseous muscles in foot reconstruction should be based on the vascular anatomy of the metatarsal bones and interosseous muscles. We studied the vascular anatomy of the metatarsal bones and the interosseous muscles to design a split metacarpal musculoosseous flap and dorsal interosseous muscle flap. Twenty-two feet from eleven cadavers that had been embalmed in formalin were studied. Dissection was done using a dissection microscope (×3.5), delineating meticulously the arcuate artery, dorsal metatarsal arteries and the small branches arising from the metatarsal arteries. The dorsal metatarsal arteries do not course at the midline of the interosseous muscles. The first dorsal metatarsal artery proceeds close to the first metatarsal bone in the first metatarsal space. While proceeding to the distal, it shoots out a branch that individually feeds the lateral head of the first dorsal metatarsal muscle and medial face of the second metatarsus, thereby feeding muscle and bone. Except for this branch, the first dorsal metatarsal gives off segmental and periosteal branches that individually feed the medial heads of the first dorsal metatarsal muscle and first metatarsal bone. The second, third and fourth metatarsal arteries proceed close to the third, fourth and fifth metatarsal bones in the metatarsal spaces. In these courses, the arteries give out segmental branches to both faces of the interosseous muscles and periosteal branches to the medial face of metatarsal bones. For defects or disease of the ankle bones, the metatarsal bones can be split at the medial border distally, and a split metatarsal musculoosseous flap, based proximally on the dorsal metatarsal artery, can be done. Distal intermetatarsal anastomoses between the dorsal and plantar vascular networks enables a split metatarsal musculoosseous flap based distally, including the dorsal metatarsal artery for bony defects of the proximal phalanx. [Copyright &y& Elsevier]

Fracture dislocations/subluxations of the tarsometatarsal joint are complex injuries that are often misdiagnosed. Prompt recognition and treatment of Lisfranc injuries decrease the likelihood of long-term sequelae. The original (1909) classification system was modified in 1982 and again in 1986. The 1986 classification system, developed by Hardcastle et al, is used most widely in clinical practice and is cited most often in the biomedical literature. For this—or any—classification system to be beneficial, however, multiple observers must be able to use it in a consistent manner, and a high level of interrater agreement should exist. This study examined interrater reliability among clinicians using the modified Hardcastle classification system for Lisfranc fracture dislocations. Thirteen Lisfranc injury radiographs were evaluated by 21 independent observers consisting of surgeons and residents (podiatric and orthopedic) as well as musculoskeletal radiologists, who classified radiographs according to the modified Hardcastle classification system. We used κ statistics to evaluate the degree of interrater reliability for the entire group. A mean weighted κ value of 0.54 was found for the group. Moderate interrater agreement was observed among clinicians interpreting the modified Hardcastle classification system for Lisfranc fracture dislocations. [Copyright &y& Elsevier]

A 33 years old female patient presented with posttraumatic pain in the right foot for which radiographs of the right foot was advised. No fracture was detected on radiographs and patient was managed conservatively on medications and posterior splint immobilization. We found coincidentally a short fourth metatarsal and an accessory navicular bone in the right foot radiographs. After 3 weeks of immobilization, she underwent mobilization of the right foot, weight bearing and intensive physio- therapy for 6 weeks. After two months of injury she was still complaining of pain on the plantar aspect of right foot which was diagnosed as metatarsalgia and operated on by excision of the neuroma present in the 3rd web space of the right foot. After surgery she was completely relieved of pain and could do activities well related to the right foot. [ABSTRACT FROM AUTHOR]