Forefoot disorders and conservative treatment

Abstract

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

Keywords: Conservative treatment; Forefoot disorder; Insole; Orthosis; Shoes.

Fig. 1.

(A) Metatarsal shortening of first metatarsal on right foot due to hallux valgus recurrence after hallux valgus surgery. (B) Callosity under second and third metatarsal head due to altered metatarsal position after hallux valgus surgery.

Fig. 2.

Orthosis for treatment of hallux valgus. (A) Toe spreader, (B) Valgus splint, and (C) Bunion shield.

Fig. 3.

Hammer toe with a flexion deformity at the proximal interphalangeal joint of the toe accompanied by a slight metatarsophalangeal joint extension deformity.

Fig. 4.

Claw toe with a hyperextension deformity at the metatarsophalangeal joint and secondarily having flexion deformity in the proximal interphalangeal and distal interphalangeal joints.

Fig. 5.

Mallet toe with a flexion deformity at the distal interphalangeal joint.