Metatarsalgia—third and fourth rays Case for small group discussion AOTrauma—Foot & Ankle Module 15: The lesser toes Les Grujic, AU

Case description 14-year-old boy Severe bilateral hand and foot deformities Severe metatarsalgia third and fourth rays Footwear fitting problems

Clinical pictures

Preoperative x-rays

Treatment planning What are the problems? What are the goals of treatment? Metatarsalgia 3–4 Nonfitting foot—forefoot is too large Syndactily 3–4—is it a problem? And mallet toes 3–4?

Postoperative x-rays Valgus first metatarsal osteotomy Shortening third and fourth metatarasals oteotomy What are the correct lengths? Discuss other options—first ray shortening, second ray resection in order to narrow the forefoot, third and fourth toes resection arthroplasty/arthrodesis to correct mallet deformity

Take-home messages In congenital deformities the treatment goal is a painless foot that fits into shoes The restoration of appropriate metatarsal length and height is effective in the control of metatarsalgia