In medical terms, "metatarsophalangeal ossification" is a common foot deformity that includes bulging of the ankle joint, tendon sheath cyst, gouty arthritis, eversion, and bone hyperplasia secondary to first metatarsophalangeal joint disease. It is a static subluxation of the first metatarsophalangeal joint characterized by outward displacement of the ankle joint and inward displacement of the first metatarsal bone. The "big foot bone" is also related to the mechanical mechanisms of the foot, such as Achilles tendon contraction, severe flat foot deformities, extensive neuromuscular disorders, or various inflammatory joint diseases, such as rheumatoid arthritis. 46% of patients develop the disease before the age of 20, with the highest incidence occurring between the ages of 20 and 30. Females are more common than males, and most cases occur simultaneously in both toes and feet.
1、 Causes of the disease
1. External factors
(1) Shoe wearing foot bone disease basically only occurs in people who wear shoes, and is less common in people who are barefoot. Placing wide or fan-shaped feet in tight shoes can cause symptoms in the medial bony processes.
(2) A small proportion of cases of Bigfoot Disease are caused by trauma to the forefoot, which can lead to the rupture of the medial joint capsule or instability of the first toe wedge joint, resulting in Bigfoot Disease.
2. Internal factors
(1) Genetic research has found that the metatarsal bone has a high maternal inheritance rate and a genetic tendency in the female population.
(2) Some scholars believe that Bigfoot Osteopathy is related to Flatfoot, which is a triggering factor for Bigfoot Osteopathy and can accelerate its progression.
(3) Many reports on the correction of large foot bones consider excessive movement of the first metatarsal column as a contributing factor.
(4) In some cases, Achilles tendon contracture is associated with the progression of Bigfoot disease. Mild external rotation of the foot increases the weight on the inner edge of the foot, causing excessive stress on the toes and leading to Bigfoot disease.
2、 The main purpose of classifying Bigfoot Bone Disease is to facilitate the development of treatment methods, which can be classified as mild, moderate, and severe. Surgical strategies are usually selected based on clinical experience.
(1) Mild eversion angle is less than 20 degrees, the metatarsophalangeal joint is usually matched, and the metatarsal angle is usually less than or equal to 11 degrees.
(2) The moderate eversion angle is between 20 and 40 degrees, the metatarsophalangeal joint is usually subluxated, and the metatarsal angle is between 11 and 16 degrees.
(3) The eversion angle is greater than 40 degrees, with the toes often overlapping above or below the second toe, and the metatarsal angle is usually between 16 and 18 degrees.
3、 Treatment
1. Conservative treatment
(1) Prefabricated orthotics can be customized for the treatment of mild symptoms of large foot bones. A silicone toe pad can be placed between the big toe and the second toe to reduce the outward rotation of the toes and relieve pain. Night correction braces can also be used to fix the big toe in the inversion position.
(2) Functional exercises include exercises such as hooking (back extension) of the big toe, grabbing towels with both feet, and hooking (back extension) of the ankle joint.
(3) Physical therapy involves local application of hot compress, infrared radiation, etc.
(4) Wear loose shoes with heels that are not too high, toe tips that are not too pointed, and shoe bodies that are not too tight. There should be some space for the toes to move inside, so that they do not feel any pressure. Especially, avoid wearing pointed and thin high heels to avoid squeezing the toes.
2. Surgical treatment
(1) Plan development includes occupation, sports interests, and degree of eversion.
(2) Soft tissue surgery includes joint capsule compression, adductor muscle release, and transverse plantar ligament release.
(3) Osteotomy includes distal metatarsal osteotomy, metatarsal shaft osteotomy, and proximal metatarsal osteotomy.
(4) Joint surgery includes both soft tissue surgery and osteotomy.
(5) Fusion surgery includes metatarsophalangeal joint fusion or metatarsophalangeal joint fusion.
The already formed large foot bones can only be treated through surgery to correct deformities and relieve pain. The correction of large foot bones has a certain degree of complexity. Different pathological stages and manifestations require different correction methods, which require detailed examination at the hospital.