Intermetatarsal Space Research Articles

The supra-transverse intermetatarsocapital bursa: a description and its relation to painful syndromes of the forefoot

Very many painful syndromes of the forefoot remain without a satisfactory explanation; although this region contains quite specific structures, it has suffered from the application of analogies with disorders of the hand. Among these specific components, the presence of the supra-transverse intermetatarsocapital bursa provides an explanation of such clinical entities as the acute syndrome of the second intermetatarsal space and gives fresh impetus to the debate on the etiopathogenesis of Morton's metatarsalgia. On the basis of 25 dissections, the authors studied the region between the metatarsal heads, confirming the presence of these bursae and specifying their site and size and particularly their relations with the common plantar digital nerve at its bifurcation into collateral nerves.

Monarticular Nontraumatic Synovitis of the Metatarsophalangeal Joint: A New Diagnosis?

Seven patients presented with forefoot pain in the metatarsal head region, with an average age of 57 years, and no history of trauma. Six had pain in the second metatarsophalangeal joint, while one patient had pain in the third. Physical examination demonstrated generalized thickening of the involved metatarsophalangeal joint along with warmth and tenderness to compression. Range of motion was decreased in flexion and two patients had a subluxed metatarsophalangeal joint. All patients demonstrated some instability of the joint with dorsoplantar stress. Palpation of the intermetatarsal space demonstrated some evidence of irritation of the common digital nerve. The toe demonstrated some thickening. Roentgenograms demonstrated some widening of the metatarsophalangeal joint in four of these patients. One patient responded to conservative treatment, and the remaining six patients underwent synovectomy. In three cases the common digital nerve was resected. Follow-up was 16 months, and four of the six patients operated on felt their symptoms were completely relieved, one patient felt that the symptoms were improved, and one patient believed her surgery was of no benefit. Synovial tissue in all cases revealed pathologic changes of chronic synovitis. The etiology of this synovitis is unknown. The excessive synovium resulted in the joint thickening, which probably accounts for the neuritic symptoms, the generalized thickening of the toe, and the instability of the joint. Because of the poor response to conservative treatment, perhaps earlier synovectomy is the treatment of choice for this entity.

The intermetatarsal nerve: a microscopic evaluation.

Microscopic evaluation of the interdigital neuroma is difficult because the appearance of the normal nerve has not been described precisely. In an effort to characterize the normal interdigital nerve, 104 nerves were removed at autopsy from the intermetatarsal spaces of 14 women who were more than 48 years old. A positive relationship between perineurial width and internal diameter of the nerve fascicle in web spaces 2, 3, and 4 was defined. In addition, the number and the diameter of blood vessels had a positive correlation in all web spaces. These measurements should be of help in the objective differentiation of the common interdigital neuroma from the normal interdigital nerve.

Therapy of Osteoarthritis Of the Great Toe and Hallux Rigidus

To the Editor.— Please permit me to add to the already excellent answer given to the question on the Treatment of Osteoarthritis of the Great Toe and Hallux Rigidus (216: 1207, 1971). Whereas x-ray film and clinical findings may indicate a severe degree of bony ankylosis and loss of motion, the injection of 2 cc of 2% lidocaine (Xylocaine) dorsally and into the first intermetatarsal space at the level of the metatarsal heads often results in a gratifying increase in the range of motion. A 24-gauge five-eighths inch needle is used and intraarticular injection is avoided. Apparently a great deal of the limited motion is caused by muscle splinting around the painful joint. If moderately forced dorsiflexion and plantar flexion are induced after the injection and repeated at weekly intervals, progressive and lasting improvement often occurs. In a series of 100 consecutive cases of hallux rigidus without complicating factors such

On the position and course of the deep plantar arteries, with special reference to the so-called plantar metatarsal arteries.

The arterial system of the deep planta was studied in forty feet of Japanese adult cadavers. Results obtained are as follows.I. Besides the deep plantar arch lying on the p lantar surfaces of the interosseous muscles, another deeper arch formation, which corresponds to a part of Pars profundus of Arcus plantaris profundus of Koch (1939) and Catella plantaris proximalis of Nishi (1943) in the foot of the monkey, was found, though only in two feet, on the plantar surface of the fourth metatarsal bone or in the fourth intermetatarsal space deep to the plantar surfaces of the interosseous muscles.II. The so-called plantar metatarsal arteries can be classified, as in the so-called palmar metacarpal arteries (Murakami,1969), into four arteries different in position and course (sM arteries descending along the lateral four metatarsal bones on the plantar surfaces of the interosseous muscles, dM arteries descending along these bones deep to the plantar surfaces of the muscles, sI arteries descending in the lateral intermetatarsal spaces on the plantar surfaces of the muscles and dI arteries descending in these spaces deep to the plantar surfaces of the muscles), although they often take abnormal oblique courses in proportion to the increment of the contribution of the dorsalis pedis artery to the deep plantar 'arch. Out of them, the sM arteries are the most fundamental in occurrence and also in contribution to the arte rial supply of the toes.III. Deep to the first dorsal interosseous muscle there occasionally occur three descending arteries. We arbitrarily call the artery descending close to the plantar surface of the muscle sI1, the artery descending along the medial side of the first metatarsal bone dI1 and the artery descending on the plantar aspect of the bone dM1. The dM1 is usually well developed to supply the toes. A rare faint artery lying dorsal to the long flexor tendon of the first toe is referred to as sM1.IV. We show ideal distributions of arteries near the meta t arsophalangeal joints. Various patterns of arteries to the toes can be considered as the results of the alterations whereby some of the normally existing small arteries or their branches are unusually well developed while others are reduced or wanting in turn.