Challenges and Recent Trends in the Management of Forefoot Disorders

Jitendra Mangwani

Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, United Kingdom

Corresponding Author: Jitendra Mangwani, Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, United Kingdom, Phone: +441162584217, e-mail: jitendra.mangwani@uhl-tr.nhs.uk

How to cite this article: Mangwani J. Challenges and Recent Trends in the Management of Forefoot Disorders. J Foot Ankle Surg (Asia-Pacific) 2023;10(4):161–161.

Source of support: Nil

Conflict of interest: None

Forefoot disorders are common, and pain arising from them can lead to a significant impact on the quality of life of patients. Pain in the forefoot must be carefully analyzed to establish a correct diagnosis.

Some of the common causes of forefoot pain are hallux rigidus, lesser toe metatarsophalangeal (MTP) joint instability, and Morton’s neuroma. Although these conditions are not new, there have been significant developments in the understanding and management of these disorders in the past couple of decades. In this issue, there are high-quality peer-reviewed articles focusing on some new concepts and recent trends in the treatment of these disorders.

In the recently published literature, there has been a lot of emphasis on the patient-reported outcome measures (PROMs) in foot and ankle surgery. In their original research work, Adukia et al. investigated the effect of baseline scores and comorbidities on the outcome of patients undergoing the first MTP joint fusion. This adds a completely new dimension to the understanding of the use of PROMs and how they can be used in informed consent.

Whilst MTP fusion remains the gold standard treatment in the management of hallux rigidus, the role of arthroplasty remains somewhat unclear. The review article by Poutoglidou et al. looks back at the fascinating history of implant designs and materials used for hallux arthroplasty and reports the outcomes, survivorship, and complication profile of these implants.

Lesser toe instability diagnosis and management remains a challenging area in foot and ankle surgery. Ahmed et al. performed a comprehensive review and described how best to diagnose and treat lesser MTP joint instability.

In 1876, Morton published a report of 12 cases of a “neuralgic affection of the foot.” He described the severe pain in the forefoot, aggravated usually by tight shoes, that we today associate with the term Morton’s neuroma. The management of these symptoms, according to Morton, called for resection of the fourth MTP joint. Although there has been a lot published on Morton’s neuroma, which has improved our understanding of this condition, there remains controversy with regard to the best form of treatment. In their original research paper in this issue, Lam et al. described their early clinical and radiological results using cryoablation.

This issue provides readers with an improved understanding and evidence-based approach to the management of these common forefoot conditions. It is hoped, thereby, we may be able to achieve the goal of Horace, who said, “If it is well with your belly, chest, and feet, the wealth of kings can give you nothing more.”¹^,²

REFERENCES

1. Bartlett J. Familiar Quotations. 14th eds: Boston, Toronto, Little, Brown Co., 1968; p. 123.

2. Akermark C. Mannen bakom syndromet: Thomas G Morton. Botade patienterna—men fann inte förklaringen till smärtan [The man behind the syndrome: Thomas G Morton. He cured the patients—but failed to find an explanation for the pain].Lakartidningen 1986;83(25):2315–2316. PMID: 3526056.

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