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Is 2nd MPJ synovitis the most common forefoot problem?

Discussion in 'General Issues and Discussion Forum' started by Craig Payne, Jun 1, 2015.

  1. Craig Payne

    Craig Payne Moderator

    Articles:
    6

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    2nd MPJ synovitis or plantar plate dysfunction?
    See video: https://vimeo.com/94092927


    Facebook comment:
    What say you?
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Watched the vid twice now ... pretty much everything he says applies to plantar plate dysfunction .... confused
     
  3. ok cool so I don´t have to watch then :D

    was about to say No that would be Plantar Plate issues as the most common forefoot problem
     
  4. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hmm, thanks Craig, I agree with Mike, saves me watching too!?! Can't say that
    Second MTP joint synovitis
    OR
    plantar plate dysfunction
    are the most
    common forefoot problem
    I have encountered or our team encounter? I will check in with my term to confirm this.
    Cheers
     
  5. Mart

    Mart Well-Known Member

    Quite a bit of confusion seems to be being expressed in this video.

    Main problem is that he seems to be confusing synovitis with other effects of mechanical overload.

    We see a lot of persistent metatarsalgia at our clinic and 2nd MTP synovitis would be diagnosed ONLY if joint effusion is visible with B mode and signal with power Doppler imaging was detected at MTP .......... this is quite rare in isolation and usually associated with inflammatory disease rather than mechanical overload. An exception is neovacularised plantar plate defect which unusual in our experience.

    I think this video is largely confusing terminology using synovitis inappropriately in place of much more common findings of plantar plate injury, pre-dislocation syndrome, plantar fibro-fatty pad overload and plantar digital neuritis (which may or not be associated with so called “Morton’s neuroma”.

    that my cents worth

    Cheers

    Martin

    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  6. Craig Payne

    Craig Payne Moderator

    Articles:
    6
  7. Mart

    Mart Well-Known Member

    Wow that is interesting style ........... I kind of like seeing the work of someone who rants with less inhibition than I do. I don't doubt that there are many questionable diagnosis and surgeries being done for metatarsalgia but using the "where's the evidence" card does beg the "where's the plausible alternative" question. Some times apparent wackos can be right on the money ....... Cant wait for part 2.

    :dizzy:

    Cheers

    Martin

    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
  9. Mart

    Mart Well-Known Member

    I am quite curious about this so posted the paragraph below on Dr Angry's blog. I will point him towards this podarena thread if I can engage him.

    I agree that increasing forefoot ground reaction forces are common as normal part of aging, sedentary lifestyle and disease process such as DM and that this is likely largely a function of increase ankle joint complex stiffness attributed to loss of triceps surae flexibility. I agree that in most of population forefoot pressures are highest at 2nd metatarsal head during walking and running gait. I agree that there is a tenancy for surgeons to look in their ?surgical options? tool box and that there is concern that the toolbox is largely filled with manufacturers product. All worthy Stuff. I disagree with your premise that metatarsalgia is most commonly explained by synovitis. In our clinic we use sonography as an extension to our physical exam in recalcitrant metatarsalgia and finding of synovitis is extremely rare based on lack of finding signal with power Doppler imaging within synovial envelope. If you are unfamiliar with this metric look at the abundant rheumatology medical literature which shows sonography as a highly sensitive and specific for detecting inflammatory joint disease. I applaud your rant against mindless use of surgical procedures, common concern regarding poor diagnosis of cause of metatarsalgia and would enjoy discussing the empirical findings of our clinical approach around metatarsalgia further if you email me.


    Cheers

    Martin

    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  10. cpoc103

    cpoc103 Active Member

    He lost me straight away with the "tight calf the only cause of PF".
     
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