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Forefoot & Toes

Forefoot/toe pathologies: turf toe, 5th metatarsal & navicular fractures, and management of acute/chronic conditions.

Overview

Lesser toe deformities in adults involve specific pathology and biomechanics that inform management algorithms based on current literature [1]. Ray amputation is a clinically effective and patient-acceptable option for foot macrodactyly when there is metatarsal involvement, a motionless toe, or involvement of multiple digits [2]. Ray resection yields the best cosmetic and functional outcomes for macrodactyly involving the lesser toes [3], whereas involvement of the great toe often yields only fair results and may require repeated soft-tissue debulking [3].

Surgical treatment for brachymetatarsia shows high rates of patient satisfaction and good functional results regardless of the technique used [4]. Two surgical methods are recommended for brachymetatarsia, with selection depending on the affected metatarsal and desired final length [4]. Distal metatarsal osteotomy by minimal invasive surgery is a safe and effective surgical procedure for the treatment of metatarsalgias of the lesser rays [29]. For hallux valgus, fourth-generation percutaneous transverse osteotomies demonstrate significant improvement in clinical and radiographic outcomes with a low rate of recurrence [28], while the syndesmosis procedure demonstrates satisfactory short-term results with good clinical and radiological outcomes two years post-operatively [10].

Toe phalanx harvest for congenital hand differences causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term [11]. Careful assessment of donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes in toe-to-finger vascularized joint transfers [15]. A maximum of 6 mm shortening length during first metatarsal osteotomy is considered within the safe range regarding forefoot loading patterns [12]. The plantar approach for Morton's neuroma excision is recommended if the patient needs better appearance, as it has less influence on quality of life regarding foot appearance compared to the dorsal approach [16].

Anatomy & Pathophysiology

Lesser toe deformities involve pathology of the normal anatomy and biomechanics of the lesser toes in adults [1], while assessing multi-joint interactions in progressive collapsing foot deformity aids in understanding the pathophysiology and surgical treatment planning [5]. Hallux valgus is a complex deformity influenced by extrinsic factors such as constricting footwear and intrinsic factors including heredity and foot mechanics [20]. This condition is associated with balance impairment, increased foot pain, and an increased risk of fall [47], with severity positively associated with the magnitude of anteroposterior postural sway [41].

Measurement & Geometry: Hallux valgus angles based on margo medialis pedis measurements are slightly but statistically significantly smaller than metatarsophalangeal angles, serving as conservative estimates [30]. Progressive Distance Mapping suggests subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus severity [31]. A theoretical geometric model illustrates the possibility of defining an instantaneous center of rotation common to the metatarso-phalangeal and metatarso-sesamoid joints while accounting for morphometric and spatial variability [36].

Biomechanics & Kinematics: Dysfunction of the windlass mechanism is associated with hallux rigidus, evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet [45]. A decrease in maximum force in the middle forefoot in patients with a previous stress fracture may result from gait alterations after the fracture [32]. During first metatarsal osteotomy, a shortening length of up to 6 mm is considered within the safe range [12].

Pathoanatomy & Specific Conditions: A high medial longitudinal arch may contribute to increased load on the lateral side of the foot in the pathoanatomy of Jones fracture [42]. A plantar approach for the reduction of dorsal dislocation of the metatarsophalangeal joint of the great toe provides the best visualization of pathological anatomy and the most direct means of reduction [27]. Treatment options for foot deformities in Apert syndrome include conservative means like insoles and orthopedic shoes or surgery to improve biomechanics and normalize plantar pressures [22]. Surgical options for hallux valgus are tailored to specific characteristics such as joint congruency and intermetatarsal angle [9].

Classification

Adult Deformities: Lesser toe deformities are commonly adult deformities with pathology and management strategies proposed based on current literature [1]. Forefoot disorders, including second MTP synovitis, Freiberg infraction, and lesser toe deformities, are multifactorial conditions often exacerbated by footwear and anatomical variations [7]. Hallux valgus is a common deformity with multiple surgical options tailored to specific deformity characteristics such as joint congruency and intermetatarsal angle [9].

Macrodactyly: Ray amputation is a clinically effective and patient-acceptable option for foot macrodactyly in children when there is metatarsal involvement, a motionless toe, or involvement of multiple digits [2]. Ray resection yields the best cosmetic and functional outcomes in feet with macrodactyly involving the lesser toes [3]. Involvement of the great toe in macrodactyly often yields only fair results requiring repeated soft-tissue debulking [3].

Brachymetatarsia: Two surgical methods are recommended for brachymetatarsia, with selection depending on the affected metatarsal and desired final length [4]. Surgical methods for brachymetatarsia show high rates of patient satisfaction and good functional results regardless of the technique [4].

Toe Morphology: Fifth triphalangeal toes present with a higher proportion of pathology compared to biphalangeal toes [8]. The risk of suffering from hammer toe is almost 4 times greater in triphalangeal toes compared to biphalangeal toes [8].

Other Considerations: Assessing multi-joint interactions in progressive collapsing foot deformity assists in understanding pathophysiology and surgical treatment planning [5]. Turf toe is a relatively rare and debilitating condition requiring a high index of suspicion for early, accurate diagnosis to prevent chronic problems [6]. During first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range [12]. Toe function and metatarsalgia are improved by toe exercises, suggesting they are closely related [21]. Hallux valgus could be an integral part of the causes of stress fractures of the proximal phalanx of the great toe [25]. Progressive Distance Mapping (PDM) suggests subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus severity [31]. Injuries in foot-launched flying sports should be considered sharply distinct due to different injury dynamics and patterns rather than being generically grouped together [24], though the medical literature on injuries in foot-launched flying sports is scarce and fragmented [24].

Clinical Presentation

Lesser toe deformities in adults involve specific pathology and biomechanics distinct from normal anatomy [1]. Forefoot disorders, including second MTP synovitis, Freiberg infraction, and lesser toe deformities, are multifactorial conditions often exacerbated by footwear and anatomical variations [7]. Hallux valgus is a common deformity with multiple surgical options tailored to specific deformity characteristics such as joint congruency and intermetatarsal angle [9]. Fifth triphalangeal toes present with a higher proportion of pathology compared to biphalangeal toes, and the risk of suffering from hammer toe is almost 4 times greater in triphalangeal toes compared to biphalangeal toes [8].

Acute Injury Patterns: Turf toe is a relatively rare and debilitating condition requiring a high index of suspicion for early, accurate diagnosis to prevent chronic problems [6]. Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment [18]. Foot injuries, particularly calcaneal, talar, and midfoot fractures, are common and can result in severe functional limitation or long-term disability if missed [35]. Imaging plays a role in the diagnosis of calcaneus secundarius in cases of acute pain of the foot [19]. Microgeodic disease should be considered in the presence of pain and swelling in the fingers and toes of young athletes exposed to cold environments [34].

Chronic Arthropathy and Deformity: Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis, though longitudinal follow-up is required to determine the mechanism and presentation of this pathology [13]. Hallux valgus could be an integral part of the causes of stress fractures of the proximal phalanx of the great toe [25]. Involvement of the great toe in macrodactyly often yields only fair results requiring repeated soft-tissue debulking [3]. Conversely, ray resection results in the best cosmetic and functional outcomes in feet with macrodactyly involving the lesser toes [3]. Ray amputation is a clinically effective option for patients with foot macrodactyly who have metatarsal involvement, a motionless toe, or involvement of multiple digits [2].

Functional Assessment and Outcomes: Assessing multi-joint interactions in progressive collapsing foot deformity aids in understanding pathophysiology and surgical treatment planning [5]. Toe function and metatarsalgia are improved by toe exercises, suggesting they are closely related [21]. Surgical methods for brachymetatarsia selection depend on the affected metatarsal and the desired final length [4]. Surgical methods for brachymetatarsia show high rates of patient satisfaction and good functional results regardless of the technique used [4]. Toe phalanx harvest causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term [11].

Investigations

Plain radiography: Imaging is indicated for the diagnosis of calcaneus secundarius in cases of acute foot pain [19]. For hallux valgus assessment, angles based on margo medialis pedis measurements are slightly but statistically significantly smaller than the metatarsophalangeal angle, serving as conservative estimates [30].

MRI: In asymptomatic athletes, MRI findings of bone marrow edema should be interpreted with caution in the absence of foot pain or a corresponding diagnosis of metatarsal bone stress injury [40]. Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with rheumatoid arthritis [13].

Other Considerations: Ray amputation is a clinically effective and patient-acceptable option for foot macrodactyly in children with metatarsal involvement, a motionless toe, or involvement of multiple digits [2]. Ray resection results in the best cosmetic and functional outcomes in feet with macrodactyly involving the lesser toes [3], whereas involvement of the great toe often yields only fair results requiring repeated soft-tissue debulking [3]. Assessing multi-joint interactions in progressive collapsing foot deformity aids in understanding pathophysiology and surgical treatment planning [5]. Turf toe is a relatively rare and debilitating condition requiring a high index of suspicion for early diagnosis to prevent chronic problems [6]. Forefoot disorders, including second MTP synovitis, Freiberg infraction, and lesser toe deformities, are multifactorial conditions often exacerbated by footwear and anatomical variations [7]. Fifth triphalangeal toes present with a higher proportion of pathology, with the risk of suffering from hammer toe being almost 4 times greater in triphalangeal toes compared to biphalangeal toes [8]. Careful assessment of donor toe and recipient finger anatomy followed by systematic reconstruction may improve functional outcomes in toe-to-finger vascularized joint transfers for proximal interphalangeal joint reconstruction [15]. Hand and foot fractures frequently have accompanying injuries requiring attention during diagnosis and treatment [18]. The plantar approach provides the best visualization of pathological anatomy and the most direct reduction for dorsal dislocation of the metatarsophalangeal joint of the great toe [27]. Distal metatarsal osteotomy by minimal invasive surgery is a safe and effective procedure for metatarsalgias of the lesser rays [29]. There is no significant relationship between the width of the forefoot and the development of a Morton's neuroma [51].

Treatment

Non-Operative

Conservative management is a primary consideration for several forefoot pathologies. Fractures of the fifth metatarsal tuberosity heal well with conservative treatment, with almost all clinically united within three weeks [46]. Both nonsurgical management, including immobilization and nonweight bearing, and surgical management have demonstrated good results for navicular stress fractures [49]. Bunionette deformities often can be treated conservatively, but when shoe wear modification fails, surgical intervention is frequently successful [50]. Treatment options for foot deformities in Apert syndrome may include conservative means such as insoles and orthopedic shoes or surgery to improve biomechanics and normalize plantar pressures [22].

Operative

Indications: Surgical intervention is indicated for specific structural and functional deficits. Ray amputation is a clinically effective and patient-acceptable option for foot macrodactyly in children with metatarsal involvement, a motionless toe, or involvement of multiple digits [2]. Ray resection results in the best cosmetic and functional outcomes for feet with macrodactyly involving the lesser toes [3], whereas involvement of the great toe in macrodactyly often yields only fair results requiring repeated soft-tissue debulking [3]. Turf toe is a relatively rare and debilitating condition that requires a high index of suspicion for early, accurate diagnosis and initiation of treatment to prevent chronic problems [6]. Operative interventions for fifth metatarsal base fractures are recommended over non-operative interventions for reducing the rate of non-union, duration of union, duration of return to activity, duration of return to sport, and visual analog scale scores, while increasing the American orthopedic foot & ankle scale score [33]. Indications for arthrodesis of the first tarsometatarsal joint should be reconsidered based on the severity of degenerative changes [44].

Surgical Approach / Technique: Two surgical methods are recommended for brachymetatarsia, with selection depending on the affected metatarsal and desired final length [4]. Surgical treatment for brachymetatarsia shows high rates of patient satisfaction and good functional results regardless of the technique used [4]. The short-term results of using a syndesmosis procedure for the treatment of hallux valgus are satisfactory, with good clinical and radiological results two years post-operatively [10]. Fourth-generation percutaneous transverse osteotomies for hallux valgus demonstrated significant improvement in clinical and radiographic outcomes with a low rate of recurrence [28]. Minimally invasive distal transverse metatarsal osteotomy–Akin osteotomy (MITA) provides effective correction of hallux valgus, achieving excellent radiographic alignment and favorable clinical outcomes [37]. During first metatarsal osteotomy, a maximum shortening length of 6 mm is considered to be within the safe range [12]. The plantar approach for Morton's neuroma excision is recommended if the patient needs better appearance, as it has less influence on quality of life regarding foot appearance compared to the dorsal approach [16]. Patients who received plantar plate repair for a grade 3 turf toe injury demonstrated significant improvement in patient-reported outcomes and achieved a nearly 91% return-to-sport rate within approximately 5 months after surgery [39]. Non-vascularized toe transfer can be an effective correction for severe clinodactyly of the thumb in Rubinstein–Taybi syndrome and may be more stable than osteotomy in the long-term [26]. Distally based peroneal artery perforator-plus fasciocutaneous flaps (DPAPF) can be effectively used to reconstruct soft tissue defects over the distal forefoot due to convenient harvest and reliability [43]. A toe amputated at the metatarsophalangeal level can heal by first intention with an uneventful recovery and discharge on the ninth postoperative day [14].

Complications

Wound complications: Ray amputation is a clinically effective option for patients with metatarsal involvement, a motionless toe, or involvement of multiple digits in foot macrodactyly [2]. A toe amputated at the metatarsophalangeal level can heal by first intention with an ununeventful recovery and discharge on the ninth postoperative day [14]. In feet with involvement of the lesser toes, ray resection results in the best cosmetic and functional outcomes [3], whereas involvement of the great toe in macrodactyly often yields only fair results requiring repeated soft-tissue debulking [3].

Deformity and functional sequelae: Hallux valgus is a complex deformity influenced by extrinsic factors, such as constricting footwear, and intrinsic factors, including heredity and foot mechanics [20]. Forefoot disorders, including second MTP synovitis, Freiberg infraction, and lesser toe deformities, are multifactorial conditions often exacerbated by footwear and anatomical variations [7]. Fifth triphalangeal toes present with a higher proportion of pathology, with the risk of suffering from hammer toe being almost 4 times greater in triphalangeal toes compared to biphalangeal toes [8]. Turf toe is a relatively rare and debilitating condition that requires a high index of suspicion for early, accurate diagnosis and initiation of treatment to prevent chronic problems [6].

Donor site morbidity: Toe phalanx harvest for congenital differences of the hand causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term [11]. Reconstruction using a non-vascularized fourth metatarsal for Type IIIB and IV hypoplastic thumb allows for the preservation of a 5-digit hand with reasonable function and appearance and minimal donor site morbidity [23].

Other Considerations: Surgical methods for brachymetatarsia show high rates of patient satisfaction and good functional results regardless of the technique selected [4]. Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis [13]. Parameters such as BMI, the shape of the first metatarsal head, or the amputation level could not be identified as risk factors for the development of hallux valgus deformity or ulcer occurrence after second toe amputation in diabetic patients [48].

Recovery

Light activity (weeks): Patients undergoing toe amputation at the metatarsophalangeal level may be discharged on the ninth postoperative day with an uneventful recovery [14]. For athletes with turf toe injury, the time to return to sport is significantly influenced by the severity of injury and the athlete's level of competition [53].

Full activity (months): Two surgical methods for brachymetatarsia demonstrate high rates of patient satisfaction and good functional results regardless of the technique selected [4]. Short-term results of a syndesmosis procedure for hallux valgus are satisfactory, with good clinical and radiological results two years post-operatively [10]. Reconstruction of Type IIIB and IV hypoplastic thumb with a non-vascularized fourth metatarsal allows for the preservation of a 5-digit hand with reasonable function and appearance [23].

Complete recovery / outcome plateau (months): Long-term growth of the metatarsals used in thumb reconstruction still needs to be monitored [23]. Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with rheumatoid arthritis [13]. Toe phalanx harvest causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term [11].

Rehabilitation protocol: Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes in toe-to-finger vascularized joint transfers [15]. Achilles tendon lengthening at the time of transmetatarsal amputation is associated with a reduction in the risk of later development of forefoot ulcers, especially in younger patients [52].

Functional milestones: Ray amputation is a clinically effective and patient-acceptable option for foot macrodactyly in children with metatarsal involvement, a motionless toe, or involvement of multiple digits [2]. Ray resection results in the best cosmetic and functional outcomes in feet with involvement of the lesser toes [3]. Involvement of the great toe in macrodactyly often yields only fair results requiring repeated soft-tissue debulking [3]. Non-vascularized toe transfer can be an effective correction of severe clinodactyly and may be more stable than osteotomy in the long-term [26].

Other Considerations: Assessing multi-joint interactions in progressive collapsing foot deformity assists in surgical treatment planning [5]. Forefoot disorders, including second MTP synovitis, Freiberg infraction, and lesser toe deformities, are multifactorial conditions often exacerbated by footwear and anatomical variations [7]. Fifth triphalangeal toes present with a higher proportion of pathology compared to biphalangeal toes [8]. The risk of suffering from hammer toe is almost 4 times greater in triphalangeal toes compared to biphalangeal toes [8].

Key Evidence

  • [L5] The paper describes the normal anatomy and biomechanics of the lesser toes, the pathology of commonly adult deformities, and discusses the rationale behind various treatment strategies, proposing management algorithms based on current literature. (10.1302/2058-5241.1.160017)
  • [L4] For patients with metatarsal involvement, a motionless toe, or involvement of multiple digits, ray amputation is a clinically effective option which is acceptable to patients. (10.1302/0301-620x.97b10.35660)
  • [L4] Ray resection results in the best cosmetic and functional outcomes in feet with involvement of the lesser toes, while involvement of the great toe often yields only fair results requiring repeated soft-tissue debulking. (10.2106/00004623-200207000-00015)
  • [L5] Two surgical methods are recommended with selection depending on the affected metatarsal and desired final length, showing high rates of patient satisfaction and good functional results regardless of the technique. (10.1530/eor-23-0011)
  • [L4] Assessing multi-joint interactions in progressive collapsing foot deformity will lead to a better understanding of the pathophysiology and assist in surgical treatment planning. (10.1186/s13018-026-06670-1)
  • [L5] Turf toe is a relatively rare and debilitating condition that requires a high index of suspicion for early, accurate diagnosis and initiation of treatment to prevent chronic problems. (10.1302/2058-5241.3.180012)
  • [L3] Fifth triphalangeal toes seem to present with a higher proportion of pathology, with the risk of suffering from hammer toe being almost 4 times greater in triphalangeal toes compared to biphalangeal toes. (10.1186/1471-2474-15-295)
  • [L4] The short-term results of this surgical procedure for the treatment of hallux valgus are satisfactory, with good clinical and radiological results two years post-operatively. (10.1302/0301-620x.96b4.32193)
  • [L4] This study demonstrates that toe phalanx harvest causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term. (10.1016/j.jhsa.2019.04.005)
  • [L5] During the first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range. (10.1186/s12891-019-2973-6)
  • [L3] Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with RA. (10.1186/s12891-017-1668-0)
  • [L4] The toe was amputated at the metatarsophalangeal level and the wound healed by first intention; the patient was discharged on the ninth postoperative day with an uneventful recovery. (10.2106/00004623-195032020-00031)
  • [L4] Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes. (10.1177/1558944720988081)
  • [L3] The plantar approach is recommended if the patient needs a better appearance, as it had less influence on quality of life regarding foot appearance compared to the dorsal approach. (10.1186/s12891-022-05858-w)
  • [L4] Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment. (10.1186/s12891-024-07407-z)
  • [Case_report] This case illustrates the role of imaging for the diagnosis of CS in cases of acute pain of the foot. (10.1186/s12891-021-04246-0)
  • [L5] Hallux valgus is a complex deformity influenced by both extrinsic factors, such as constricting footwear, and intrinsic factors, including heredity and foot mechanics. (10.2106/00004623-199606000-00018)
  • [L4] Toe function and metatarsalgia are improved by toe exercises, suggesting that they are closely related. (10.1186/s13018-020-02113-7)
  • [L5] Treatment options may include conservative means (i.e. insoles, orthopedic shoes) or surgery to improve biomechanics and normalize plantar pressures. (10.1186/s12891-020-03812-2)
  • [L4] The reconstruction allows for the preservation of a 5-digit hand with reasonable function and appearance and minimal donor site morbidity, although long-term growth of the metatarsals still need to be monitored. (10.1177/1753193420937547)
  • [L4] The hallux valgus could be an integral part of the causes of stress fractures of the proximal phalanx of the great toe. (10.1177/0363546503258780)
  • [L4] Non-vascularized toe transfer can be an effective correction of severe clinodactyly and may be more stable than osteotomy in the long-term. (10.1177/1753193420909784)
  • [L4] The best visualization of the pathological anatomy and most direct means of reduction of the dislocation is provided through a plantar approach. (10.2106/00004623-197456050-00022)
  • [L5] This study, which was the largest consecutive series of any percutaneous osteotomy technique used to correct hallux valgus deformity, demonstrated significant improvement in clinical and radiographic outcomes with a low rate of recurrence. (10.2106/jbjs.24.01326)
  • [L4] These results suggest that this could be a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays. (10.1186/s13018-019-1159-0)
  • [L4] Because the hallux valgus angles based on margo medialis pedis measurements were slightly but statistically significantly smaller, these measurements should be considered conservative estimates of the metatarsophalangeal angle. (10.1186/1471-2474-15-133)
  • [L4] Progressive Distance Mapping (PDM) suggests subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus severity. (10.1186/s13018-025-06587-1)
  • [L3] The decrease in maximum force in the middle forefoot in patients with a previous stress fracture could have resulted from gait alterations after the fracture. (10.1177/0363546508324967)
  • [L1] The systematic review and meta-analysis recommend the use of operative interventions for managing the fifth metatarsal's base fracture, demonstrating beneficial effects compared to non-operative interventions for reducing the rate of non-union, duration of union, duration of return to activity, duration of return to sport, and visual analog scale scores, while increasing the American orthopedic foot & ankle scale score. (10.1371/journal.pone.0237151)
  • [L4] The possibility of this disease should be considered in the presence of pain and swelling in the fingers and toes of young athletes exposed to cold environments. (10.1177/0363546508314405)
  • [L5] This theoretical geometric model illustrates how it is possible to define an instantaneous center of rotation common to all three joints while simultaneously accounting for morphometric and spatial variability. (10.1186/s13018-019-1110-4)
  • [L4] MITA provides effective correction of hallux valgus, achieving excellent radiographic alignment and favorable clinical outcomes. (10.1186/s13018-025-06361-3)
  • [L4] Patients who received plantar plate repair for a grade 3 turf toe injury demonstrated significant improvement in patient-reported outcomes and achieved a nearly 91% return-to-sport rate within approximately 5 months after surgery. (10.1177/03635465251344313)
  • [L3] The absence of foot pain or a corresponding diagnosis of a metatarsal bone stress injury suggests that MRI findings of bone marrow edema in asymptomatic athletes should be interpreted with caution. (10.1177/23259671211063505)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L3] In addition, high medial longitudinal arch may contribute to increased load on the lateral side of the foot. (10.1177/0363546519893365)
  • [L4] The DPAPF flaps can be effectively used to reconstruct the defects over the distal forefoot because of convenient harvest and reliability. (10.1186/s13018-020-02019-4)
  • [L3] These findings suggest that the indications for arthrodesis of the first tarsometatarsal joint should be reconsidered based on the severity of the degenerative changes. (10.1186/s12891-022-05523-2)
  • [L3] Dysfunction of the windlass mechanism is associated with hallux rigidus, as evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet. (10.2106/jbjs.24.00437)
  • [L4] Fractures of the tuberosity of the fifth metatarsal heal well with conservative treatment, with almost all clinically united within three weeks. (10.2106/00004623-197557060-00010)
  • [L4] In addition to balance impairment, hallux valgus is also associated with increased foot pain. (10.1186/s12891-025-09357-6)
  • [L3] This study could not identify parameters such as the BMI, the shape of the first metatarsal head or the amputation level as risk factors for the development of either hallux valgus deformity or ulcer occurrence after second toe amputation. (10.1186/s13018-023-03577-z)
  • [L5] Both nonsurgical management (immobilization and nonweight bearing) and surgical management (open reduction and internal fixation) have demonstrated good results. (10.5435/jaaos-d-20-00869)
  • [L5] Bunionette deformities often can be treated conservatively; however, when shoe wear modification fails, surgical intervention is frequently successful. (10.5435/00124635-200705000-00008)
  • [L3] We conclude that there is no significant relationship between the width of the forefoot and the development of a Morton's neuroma. (10.1302/0301-620x.99b3.bjj-2016-0661.r1)
  • [L3] ATL at the time of TMA is associated with a reduction in the risk of later development of forefoot ulcers, especially in younger patients. (10.2106/jbjs.21.00888)
  • [L4] The time to return to sport for an athlete who suffers from a turf toe injury is significantly influenced by the severity of injury and the athlete's level of competition. (10.1177/2325967119875133)

See Also

References

[1] The pathology and management of lesser toe deformities. EFORT Open Reviews. 2016. DOI: 10.1302/2058-5241.1.160017

[2] Ray amputation for the treatment of foot macrodactyly in children. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b10.35660

[3] Macrodactyly of the Foot. The Journal of Bone & Joint Surgery. 2002. DOI: 10.2106/00004623-200207000-00015

[4] Brachymetatarsia. EFORT Open Reviews. 2024. DOI: 10.1530/eor-23-0011

[5] A multiple joint morphometric analysis of female patients with progressive collapsing foot deformity: a cross-sectional study. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06670-1

[6] Turf toe. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.180012

[7] Chapter 111 Forefoot Disorders. 2019.

[8] Biphalangeal/triphalangeal fifth toe and impact in the pathology of the fifth ray. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-295

[9] Chapter 110 Disorders of the First Ray. 2019.

[10] The use of a syndesmosis procedure for the treatment of hallux valgus. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b4.32193

[11] Long-Term Donor-Site Morbidity After Free, Nonvascularized Toe Phalanx Transfer for Congenital Differences of the Hand. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.04.005

[12] Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2973-6

[13] Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1668-0

[14] A CAST SPREADER. The Journal of Bone & Joint Surgery. 1950. DOI: 10.2106/00004623-195032020-00031

[15] Toe-to-Finger Vascularized Joint Transfers for Proximal Interphalangeal Joint Reconstruction: A Systematic Review. HAND. 2021. DOI: 10.1177/1558944720988081

[16] Plantar and dorsal approaches for excision of morton’s neuroma: a comparison study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05858-w

[18] Clinical analysis of 1301 children with hand and foot fractures and growth plate injuries. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07407-z

[19] A case of an injured calcaneus secundarius in a professional soccer player. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04246-0

[20] Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Hallux Valgus†. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199606000-00018

[21] Effect of toe exercises and toe grip strength on the treatment of primary metatarsalgia. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-02113-7

[22] Is the Apert foot an overlooked aspect of this rare genetic disease? Clinical findings and treatment options for foot deformities in Apert syndrome. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03812-2

[23] Type IIIB and IV hypoplastic thumb reconstruction with non-vascularized fourth metatarsal. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420937547

[24] 17. Foot-Launched Flying Injuries. n.d..

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