Abstract
PurposeNo prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses.MethodsTwenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton’s neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes.ResultsMedian VAS and FFI before treatment were 8[5–8.5] and 45.85[32.4–59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0–5] and 0 [0–2.75], respectively) and median FFI (7.9 [3.95–20] and 0 [0–3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton’s neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters.ConclusionUltrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
Highlights
Metatarsalgia is one of the most frequent painful conditions of the forefoot [1]
Our main finding was that some ultrasound features seem to be associated with the response of metatarsalgia to custommade foot orthoses, the decrease of intermetatarsal bursitis
The use of orthotics in patients affected by forefoot pain has a proven beneficial effect on pain relief. This is probably related to the reduction in pressure on the metatarsal heads, which invariably increases with age
Summary
Metatarsalgia is one of the most frequent painful conditions of the forefoot [1]. Patients usually present with forefoot plantar pain during weight-bearing activities, typically in the area across the second through the fourth metatarsal heads. Metatarsalgia may be treated either conservatively (use of metatarsal pads or bars, physical therapy, steroid or alcohol injection, radiofrequency ablation) [4, 5] or surgically [6, 7], according to its main cause. La radiologia medica (2021) 126:963–970 or prefabricated insoles to reduce plantar pressure and subsequent pain in the metatarsal head region [7, 8]. The aim of this study was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses
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