Metatarsal Research Articles

Sex estimation using Magnetic Resonance Imaging measurements of hand and foot in Egyptian population

BackgroundThe identification of skeletal remains begins with a sex evaluation since other biological profile elements, such as size and age, are sex-specific. The pelvis is the favored element for sex assessment since it is very sexually dimorphic.Aim of the studyDelivering hand and foot bones sex estimate criteria for Egyptian population identification was the goal of this work.Subject and methodsEighty-two Egyptian adult subjects (41 males and 41 females) aged ≥ 21 years old were subjected to MRI scan on the right hand and foot to assess 9 measurements: hand length, hand width, four measurements of middle metacarpal bone (length, breadth, head breadth and base breadth), first metatarsal bone length, first metatarsal bone width and (first metatarsal bone length x first metatarsal bone width).ResultsAll the measured parameters in the right hand and foot were higher in males than females. First metatarsal bone length x first metatarsal bone width in the foot and middle metacarpal bone breadth in the hand were the most sexually dimorphic parameters, with accuracy of 86.6 percent and 84.1 percent, respectively. In stepwise discriminant analysis, three of nine measurements were selected: First metatarsal bone length x first metatarsal bone width, middle metacarpal bone breadth and hand width for the sex prediction equation in the Egyptian population, with a cross-validated sex classification accuracy of 90.2%.ConclusionSex can be assessed from hand and foot metric parameters measured by MRI with high accuracy.

Leukocyte-Rich Platelet-Rich Plasma for Osteonecrosis of Sesamoid in a Performing Artist: A Case Report.

Introduction: Sesamoid bones absorb and disperse weight from the metatarsal bones. Sesamoid injuries occur primarily in dancers and runners, with nonoperative management as the first line of treatment. Due to the lack of secondary blood supply, the sesamoids are at risk for osteonecrosis and nonunion fractures. The literature supporting orthobiologics for the treatment of sesamoid injuries is limited. Methods: In this case, a 28-year-old female dancer with sesamoid osteonecrosis underwent a leukocyte-rich platelet-rich plasma (LR-PRP) injection to the fibular sesamoid. Results: The patient reported significant improvement in pain at the 2-month follow-up and returned to regular auditions at the 3-month follow-up. At 2-year follow-up, the patient's symptoms returned to baseline. Conclusion: This is the first known case of sesamoid osteonecrosis treated with LR-PRP. LR-PRP should be considered in the treatment of sesamoid osteonecrosis in those who show limited improvement with standard conservative measures.

Astragalus Extract Mixture HT042 Alleviates Dexamethasone-Induced Bone Growth Retardation in Rat Metatarsal Bones.

The most widely used synthetic glucocorticoid, dexamethasone (DEX), causes stunted growth in children when used excessively or for long periods of time; however, there are still plenty of pediatric patients require long-term treatment with DEX. As an alternative, growth hormone is used in combination, but it has side effects, a high cost, and psychological factors, and it is not satisfactory in terms of effectiveness. It is necessary to develop a safe and affordable treatment that can replace it. The Korean Food and Drug Administration approved HT042, a standardized functional food ingredient, with the claim that it can help height growth of children. In this study, it was found that HT042 activated the Indian hedgehog/parathyroid hormone-related protein signaling pathway and enhanced the number of growth hormone receptors and insulin-like growth factor-1 receptors on the growth plate surface, which were reduced by DEX treatment, and restored growth retardation. In metatarsal bone and primary chondrocyte models, it was found that HT042 can promote the length of growth plate and recover DEX-induced growth retardation. It was also found that HT042 promotes cell proliferation using bromodeoxyuridine and terminal deoxynucleotidyl transferase dUTP nick end labeling assays; moreover, we verified increased expression of GHR/IGF-1R and Ihh/PTHrP pathway activity using qRT-PCR, western blotting, and siRNA analyses to verify its direct action on the growth plate. The anti-apoptotic effect of HT042 was identified by regulating the expression of apoptotic factors such as caspase-3, Bcl2, Bclx, and Bax. These results were identified using both ex vivo and in vitro models. Our study verified that co-administration of HT042 could recover the DEX induced growth retardation.

Fatigue fracture of the second rib in a professional athlete

A fatigue fracture, also known as stress fracture or overuse fracture, is caused by the summation of micro-injuries resulting from a chronic state of bone overload. It affects 1.4 %- 4.4 % of professional athletes. The most common site of fatigue fractures are the lower limbs. This is related to the heavy load caused by body weight and performing dynamic activities like jumping, running. Typical fractures are fractures of the fifth metatarsal bone, fibula and tibia, and less common fractures of the femur. Fractures involving the bones of the upper limbs and thorax are less commonly reported in the literature. It affect athletes in strength sports and athletes who perform dynamic and repetitive movements with their upper limbs, most often boxers, weightlifters, wrestlers, judokas, swimmers, golfers, rowers. Fractures in the thorax most often involve the first rib. Fractures of ribs II through XII are extremely rarely described. We present an unusual case of a second rib fracture in a professional athlete. A 26-year-old athlete training in racewalking reported increasing pain in the left scapula area 7 days before competing in the European Championships. Immediately after the competition, the pain changed location to the anterior thorax area, making movement of the upper limb and breathing much more difficult. A chest tomography was performed and it revealed a fatigue fracture of the second rib on the left side. The case report presents an atypical fracture in a female racewalking athlete and presents the uncharacteristic symptoms accompanying this fracture. Incorrect initial diagnosis and application of physiotherapy procedures without performing basic diagnostic tests, delay the diagnosis and initiation of proper treatment, and thus the athlete's recovery.

A rare case report of Maffucci syndrome in a 16-year-old girl

Maffucci syndrome is an extremely rare, sporadic disorder that primarily affects bone and skin. It is characterized by multiple enchondromas, especially in the bones of hands and feet, with cutaneous hemangiomas. Treatment consists of orthopedic and surgical intervention to minimize deformities and for cosmetic purposes. Careful surveillance for both skeletal and non-skeletal malignancies is needed. We report here a case of Maffucci syndrome in a 16-year-old girl.

Joint replacement and peroneal nerve flap transfer repair surgery for deficiency in the fifth metatarsal bone of the right foot

Joint replacement and peroneal nerve flap transfer repair surgery for deficiency in the fifth metatarsal bone of the right foot

Effect of forefoot transverse arch stiffness on foot biomechanical response--based on finite element method.

The plantar vault, comprising the transverse and longitudinal arches of the human foot, is essential for impact absorption, elastic energy storage, and propulsion. Recent research underscores the importance of the transverse arch, contributing over 40% to midfoot stiffness. This study aimed to quantify biomechanical responses in the ankle-foot complex by varying the stiffness of the deep metatarsal transverse ligament (DTML). Using CT image reconstruction, we constructed a complex three-dimensional finite element model of the foot and ankle joint complex, accounting for geometric complexity and nonlinear characteristics. The focus of our study was to evaluate the effect of different forefoot transverse arch stiffness, that is, different Young's modulus values of DTML (from 135MPa to 405MPa), on different biomechanical aspects of the foot and ankle complex. Notably, we analyzed their effects on plantar pressure distribution, metatarsal stress patterns, navicular subsidence, and plantar fascial strain. Increasing the stiffness of the DTML has significant effects on foot biomechanics. Specifically, higher DTML stiffness leads to elevate von Mises stress in the 1st, 2nd, and 3rd metatarsals, while concurrently reducing plantar pressure by 14.2% when the Young's modulus is doubled. This stiffening also impedes navicular bone subsidence and foot lengthening. Notably, a 100% increase in the Young's modulus of DTML results in a 54.1% decrease in scaphoid subsidence and a 2.5% decrease in foot lengthening, which collectively contribute to a 33.1% enhancement in foot longitudinal stiffness. Additionally, doubling the Young's modulus of DTML can reduce the strain stretch of the plantar fascia by 38.5%. Preserving DTML integrity sustains the transverse arch, enhancing foot longitudinal stiffness and elastic responsiveness. These findings have implications for treating arch dysfunction and provide insights for shoe developers seeking to enhance propulsion.

Clubfoot: Congenital Talipes Equinovarus.

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common musculoskeletal entity that affects one to two per 1000 live births worldwide. Imaging modalities including radiography, US, and MRI have emerged as valuable tools for the diagnosis, treatment, and monitoring of CTEV. The deformity is characterized by midfoot cavus, forefoot adductus, and hindfoot varus and equinus. The Ponseti method of manipulation and serial casting is the standard treatment of CTEV. Radiography shows the anatomy, position, and relationships of the different bones of the foot. US allows accurate assessment of cartilaginous and bony structures, in addition to its inherent advantages such as absence of ionizing radiation exposure. One of the indications for US is to monitor the response to Ponseti method treatment. MRI enables visualization of bones, cartilage, and soft tissues and allows multiplanar evaluation of deformities, providing a comprehensive imaging analysis of CTEV. An integrated approach that combines clinical examination and imaging findings is essential for effective management of CTEV. The authors provide a comprehensive overview of CTEV with a review of imaging modalities to help evaluate CTEV, focusing on radiography, US, and MRI. Using this article as a guide, radiologists involved in the assessment and treatment of CTEV can contribute to the management of the condition. ©RSNA, 2024 Supplemental material is available for this article.

Extended finite element analysis for the 2nd and 3rd metatarsals stress fracture during push-off

Metatarsal stress fractures (MSF), particularly the 2nd and 3rd MSF, are common injuries among athletes. Although there are several practices to reduce foot and ankle injuries, there is no injury prevention program specifically designed to minimize MSF. This is mainly due to the lack of information about the loadings/postures that cause MSF. Therefore, this study aimed to investigate dangerous loadings/postures potentially causing MSF during push-off (PO). The analysis was conducted with Finite Element Modelling (FEM), calibrated with the three-point bending test, and validated with peak plantar pressure (PPP) and fracture force measurement. Extended Finite Element Method was used for MSF simulation such that ten different foot and ankle configurations were designed, with five for each of the 2nd and 3rd MSF under pure vertical loadings. A more complex loading, ankle eversion/inversion during PO, was also examined for the MSF. The average error percentage for the calibration of the model with the three-point bending test was 3.05%. The average error percentages for the validation of the model with PPP and fracture force measurements were 18% and 30%, respectively. The outcomes of pure vertical loadings indicated the higher potential for the 2nd and 3rd MSF at 30% PO and 70% PO, respectively. The results of ankle eversion/inversion loadings represented that the most dangerous posture for MSF was 30° ankle eversion for the 3rd metatarsal at 70% PO. These results provide a guide, including what postures to avoid for the 2nd and 3rd MSF among people who are at high risk of MSF.

Navigating Beyond Neuromas: A Riveting Case Report Unveiling Intriguing Differential Diagnoses

The purpose of this research was to evaluate the pathophysiology, diagnosis, and differentialdiagnosis of metatarsalgia by describing a clinical case of a rare lower limb injury, fibrolipomatous hamartoma of the plantar nerve (HFL). Material and Method: We present thecase of a 47-year-old patient with a one-year history of pain in the anterior region of the right foot, associated with paresthesia of the lesser toes and no history of trauma. Physical examination revealed hyperkeratosis on the third rocker over the 2nd metatarsal (MTT), localpain, and neuritic symptoms, along with a doubtful Mulder sign. X-rays showed a negative index with narrowing of the space in the second toe. Magnetic resonance imaging described findings suggestive of a possible Morton's neuroma in the second space. Initial conservative management was chosen. After the lack of response to conservative treatment, surgical intervention was decided, during which the digital nerve was visualized and excised. Subsequently, a Triple Weil osteotomy was performed on the second and third MTT to prevent transfer metatarsalgia. The postoperative period was uncomplicated, and the patient showed complete relief of symptoms without recurrence after surgical excision. HFL presentsas a rare benign tumor with an atypical location in the foot, generating symptoms similar to Morton's neuroma. The imperative need for a differential diagnosis with this entity is emphasized.

Modern issues of surgical anatomy of the ligamentary apparatus and metatarsal bones of the human foot

The article presents an analysis of scientific literature devoted to the study of surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The literature covers the issues of macroanatomy and histology of the ligaments and metatarsal bones of the foot quite fully. At the same time, issues related to the same shape and size of bones, the relative position of ligaments, their histotopographic features are contradictory, which is associated with high variability, individual and age variability in combination with a number of social factors and features of the regions of residence. The work shows that at present, the data of domestic and foreign scientific literature on the anatomy and topography of the bones and ligaments of the metatarsal bones of the human foot are presented either by sectional studies or by the results of clinical observations using diagnostic equipment. The existing studies do not provide a comprehensive picture of the surgical anatomy of the ligamentous apparatus and metatarsal bones of the human foot. The article reflects the need for widespread use in fundamental anatomical studies of ligaments and metatarsal bones using the histotopographic method of research, quantitative and qualitative assessment of morphological parameters, which open up new possibilities for diagnosing pathological processes and developing new surgical techniques.

Synchronous fibrous tarsal coalition of the posterior subtalar joint and between the medial cuneiform and navicular in the same foot: An unusual case report and literature review

Tarsal coalition (TC) is a well-known abnormality of the foot articulations due to failure of embryonic mesenchymal segmentation presenting with pain or deformity in orthopedic clinics. However, simultaneous TC affecting separate tarsal joints in the same foot is rare. We report a rare case of synchronous fibrous TC of the posterior subtalar joint and between the medial cuneiform and navicular bone of the right foot in a 25-year-old male and review the literature exploring such a combination. The clinical presentation and radiological findings leading to effective diagnosis and management are highlighted.

3D reconstruction of foot metatarsal bones of women using CT images

Bone morphology is a fundamental factor in human anatomy. However, foot and ankle bones have yet to be adequately evaluated in 3-dimensional. It is essential to present the biometric data of anatomical structures. This study formed 3D models of the metatarsal bones of the feet of young women using image processing techniques to examine biometric measurements and determine morphology on these 3D models. This study investigated bone lengths in the metatarsal bones of women feet in Türkiye. A total of ten young female subjects were included as the test group to measure the lengths of their foot metatarsal bones using CT (Computed Tomography) scans, and 20 feet (left/right) were examined. The parameters that were used for the analyses were detector collimation of 64x0.5 mm, section thickness of 0.5 mm, current of 100 mA, tube voltage of 120 kVp, and pixel spacing of 512x512 pixels with a monochrome resolution providing 16-bit gray levels. CT images were processed, and a 3D metatarsal reconstruction was gathered. Then, the biometric measurements were calculated on this 3D model. For the lengths of the volunteers' right/left foot metatarsal bones, statistically significant differences were calculated using a one-sample t-test. For the female metatarsal bones of the left and right feet, statistically significant differences in length were calculated on 3D models. The mean results of the metatarsal length measurements were MT1(metatarsal): 59.52±1.42 mm, MT2: 70.45±1.82 mm, MT3: 66.25±1.82 mm, MT4: 65.12±1.81 mm and MT5: 63.63±1.81 mm. The level of statistical significance was accepted as p <0.05 for the one-sample t-test conducted for each metatarsal bone. The lengths of the right foot metatarsal bones were different from those of the left foot metatarsal bones in the sample. However, this difference was approximately one-tenth of a millimeter. The shortest bone was MT1, and the longest bone was MT2. These measurements are consistent with the anatomical information in the literature. The 3D models from the CT images and the biometric measurements of the metatarsal bones were found to be reliable and accurate.

Curved carbon-plated shoe may further reduce forefoot loads compared to flat plate during running

Using a curved carbon-fiber plate (CFP) in running shoes may offer notable performance benefit over flat plates, yet there is a lack of research exploring the influence of CFP geometry on internal foot loading during running. The objective of this study was to investigate the effects of CFP mechanical characteristics on forefoot biomechanics in terms of plantar pressure, bone stress distribution, and contact force transmission during a simulated impact peak moment in forefoot strike running. We employed a finite element model of the foot-shoe system, wherein various CFP configurations, including three stiffnesses (stiff, stiffer, and stiffest) and two shapes (flat plate (FCFP) and curved plate (CCFP)), were integrated into the shoe sole. Comparing the shoes with no CFP (NCFP) to those with CFP, we consistently observed a reduction in peak forefoot plantar pressure with increasing CFP stiffness. This decrease in pressure was even more notable in a CCFP demonstrating a further reduction in peak pressure ranging from 5.51 to 12.62%, compared to FCFP models. Both FCFP and CCFP designs had a negligible impact on reducing the maximum stress experienced by the 2nd and 3rd metatarsals. However, they greatly influenced the stress distribution in other metatarsal bones. These CFP designs seem to optimize the load transfer pathway, enabling a more uniform force transmission by mainly reducing contact force on the medial columns (the first three rays, measuring 0.333 times body weight for FCFP and 0.335 for CCFP in stiffest condition, compared to 0.373 in NCFP). We concluded that employing a curved CFP in running shoes could be more beneficial from an injury prevention perspective by inducing less peak pressure under the metatarsal heads while not worsening their stress state compared to flat plates.

Evaluation of Conservative Treatment or Osteosynthesis in the Treatment of Cats with Metacarpal and/or Metatarsal Fractures: A Retrospective Study

Aim: This study aims to assess the merits, drawbacks, and postoperative outcomes associated with conservative treatment and osteosynthesis methods employed in managing metacarpal (MC) and/or metatarsal (MT) bone fractures resulting from trauma in cats. Materials and Methods: The research encompassed a sample of fifty-two cats of varying breeds, genders, and ages, all presenting with metacarpal and/or metatarsal bone fractures between 2022 and 2023. Conservative treatment was administered in 46 cases, while osteosynthesis was applied in the remaining 6 cases. Results: In the group treated conservatively, 29 cases (63.04%) exhibited no signs of lameness at the 6-week examination, indicating a successful recovery with unimpeded mobility. In contrast, mild lameness was observed in the remaining cases (36.96%) at the 6-week check-up. Upon reassessment at the 12-month examination, 43 cases (93.47%) demonstrated unimpeded walking, with only 3 cases (6.53%) experiencing occasional mild lameness. Conversely, 2 cases (33.3%) showed a complication-free recovery among the cats undergoing osteosynthesis, while postoperative issues emerged in 4 cases (66.6%). In one complication-free case (50%), mild lameness was noted at the 6-week examination, and in the other case (50%), occasional mild lameness was observed. Importantly, all cases exhibited uneventful walking during the 12-month assessment. Conclusion: Conservative treatment proves to yield favorable outcomes in cats, both independently and when osteosynthesis applications fall short. However, the limited number of surgical cases examined in the study constrains the findings' generalizability

Skeletal malformation in growing milk sheep.

Two six-month old female Lacaune lambs with severe skeletal malformations of both front limbs were presented to the Department of Farm Animals, University of Zurich. The clinical examination showed alert animals with a high body weight and body condition score as well as a valgus deformation without pain or swelling. Radiographic examination showed severe irregularities in the epiphysial plate of the metacarpal bones in both lambs. Delayed growth in the lateral aspects of the physis was evident and resulted in valgus deformation. Nutritional causes were considered as the main reason for this presentation and a nutritional consultation was performed by the Institute of Animal Nutrition and Dietetics, University of Zurich. The estimated energy intake of these lambs was 65 % higher than the recommended maximum for growing sheep and the estimated vitamin D content of the diet was 71 % below the recommended allowance. Both animals were euthanized, and peripheral quantitative computed tomography (pQCT) was performed postmortem to measure total bone mineral density (BMD), trabecular bone mineral density (tBMD) and cortical bone mineral density (cBMD) of the left and right metatarsal bone of both animals. The BMD and the tBMD at 10 % of bone length were below the reference values and the BMD at 50 % was above the reference values. In addition, postmortem examination revealed a Salter-Harris-Typ-1 facture in the right caput humeri of one lamb. Histological evaluation showed defects in the articular cartilage with an eburnation in the metacarpal region and a disrupted area of columnar cartilage. This case report supports the fact that a high dietary energy intake leads to damage to the cartilage and the epiphyseal zone in sheep. In addition, insufficient dietary vitamin D intake contributed to the incomplete bone mineralization, as well as delayed growth and skeletal malformation.

Effects of functional treatment of V metatarsal bone fracture in athletes – an evaluation of cases

This study presents the rehabilitation process for the management of six cases of fractures of the fifth metatarsal bone in players of various sports playing at high levels of competition in Poland. The course of treatment was based on an intensive rehabilitation protocol with the need for orthopaedic shoe inserts, with full weight bearing on the limb and under close supervision of a physiotherapist. The effectiveness of rehabilitation was assessed by physical examination, X-ray examination and the numerical pain rating scale - NRS. This study focuses on the rehabilitation process for managing fractures of the fifth metatarsal bone in high-level athletes in Poland. The treatment involved an intensive rehabilitation protocol with orthopaedic shoe inserts, full weight bearing, and physiotherapist supervision. The effectiveness of rehabilitation was evaluated through physical exams, X-rays, and the numerical pain rating scale. Introduction Fractures of the fifth metatarsal bone are common in athletes aged 10-29, especially in football, basketball, and dance. Complications include delayed bone fusion and repeat fractures, emphasizing the importance of quick return to fitness. The involvement of physiotherapists and patient positivity is crucial. The debate among clinicians stems from classification variations and interpretations of 'Jones fractures'. Diagnostic and Classification Methods The Lawrence and Bottle classification distinguishes three types of metatarsal fractures: avulsion, Jones, and fatigue fractures. The study presents six cases of conservative treatment for these fractures, showing positive outcomes in returning athletes to competition. Rehabilitation Procedure Patients underwent functional treatment with orthopaedic insoles, immediate weight-bearing, and various therapies like Orthokine®, Exogen, hyperbaric chamber sessions, ESWT, and EPTA. Post-workout treatments included Game Ready®, flossing, manual therapy, dry needling, and lymphatic drainage. Patients also engaged in self-managed rehabilitation exercises. Treatment Results Radiographic examinations showed progressive healing in all cases, with reduced pain and no edema after two weeks. Patients returned to sports within three weeks, with no complaints after 13 months. The study highlights the success of functional treatment in achieving full recovery without complications. Conclusion The study challenges the need for surgical intervention and immobilization in treating fifth metatarsal fractures. Functional treatment led to excellent outcomes and quick return to sports. Literature review supports early mobilization and functional therapy for optimal results. Further research is needed to establish a standard treatment protocol based on evidence-based medicine.

Internal Brace Fixation Technique for Lisfranc Injury: A Retrospective Study.

BACKGROUND The Lisfranc ligament is crucial for maintaining the transverse and longitudinal arch of the foot. Owing to the disruption between the medial cuneiform bone and the base of the second metatarsal bone, the currently preferred fixation method remains controversial. Our fixation technique involves screwing one anchor to the medial and intermediate cuneiform bones and using the anchor to carry the ligament to bind the Lisfranc joint and first and second metatarsal joints altogether for elastic fixation. This study evaluated the clinical and functional outcomes of InternalBrace fixation for Lisfranc injury. MATERIAL AND METHODS This retrospective study included 58 patients who underwent InternalBrace fixation for Lisfranc injury between January 2019 and September 2022 by an experienced surgeon. One-way analysis of variance or t test was used. Preoperative classification was performed according to the Myerson classification with imaging data. Postoperative follow-up was performed based on intraoperative blood loss, fracture healing time, visual analog scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Tegner score, and complications. RESULTS Surgery was completed in all patients, and follow-up was performed. The patients' ages ranged from 19 to 62 years (average: 34.6±9.4 years). The postoperative follow-up time was 12-24 months (average: 16.9±3.0 months). The average time for fracture healing was 12.8±3.0 (10-24) weeks. The VAS, AOFAS, and Tegner scores significantly improved postoperatively (from 5.33±1.0 (3-7) to 1.24±0.57 (0-2); 28.02±6.70 (18-51) to 91.59±4.76 (82-96); and 2.40±0.67 (1-4) to 6.53±0.54 (6-7), respectively), which was statistically significant (P<0.01), and the good rate of AOFAS was 91.4%. The postoperative complications were traumatic arthritis, incision infection, and temporary dorsal foot numbness, which gradually recovered. No other rejection reactions or Lisfranc fracture/dislocations recurrence occurred during the follow-up period. CONCLUSIONS InternalBrace fixation for Lisfranc injury is beneficial for restoring Lisfranc joint stability and function and allows for early and more aggressive rehabilitation for patients, with fewer surgical complications.

Comparison of in-shoe plantar pressure between Korean combat boots and running shoes

IntroductionCombat boots are special shoes designed for soldiers to wear during activities in rough terrain, such as long marches or military training. Combat boots have been known to cause high...

Morton's Metatarsalgia: The Current State of the Issue

A typical complaint with Morton's neuroma is a burning paroxysmal pain in the area of the plantar surface of the metatarsal bones with irradiation into the III interdigital space, which forces the patient to take off his shoes and massage the foot in the most inappropriate situations. Given that women are mostly ill, clinical manifestations reduce the quality of life of patients, limit their daily professional and work activities. The paper presents the etiology, pathogenesis and clinical picture of this disease, diagnostic features. A radical method of treatment is surgery, which is relatively simple in technique and consists in dissecting the tissues that compress the nerve and creating optimal conditions for the nerve trunk, preventing its subsequent traumatization.