Yu GV, Judge MS, Hudson JR, et al: Predislocation syndrome: progressive subluxation/dislocation of the lesser metatarsophalangeal joint. .JAPMA 92::182. ,2002. .
Mann RA, Mizel MS: Monarticular nontraumatic synovitis of the metatarsophalangeal joint: a new diagnosis?. Foot Ankle 16::18. ,1985. .
Vandeputte G, Dereymaeker G, Steenwerckx A, et al: The Weil osteotomy of the lesser metatarsals: a clinical and pedobarographic follow-up study. .Foot Ankle Int 21::370. ,2000. .
Mendicino RW, Statler TK, Saltrick KR, et al: Predislocation syndrome: a review and retrospective analysis of eight patients. .J Foot Ankle Surg 40::212. ,2001. .
Ford LA, Collins KB, Christensen JC: Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. .J Foot Ankle Surg 37::217. ,1998. .
Ashman CJ, Klecker RJ, Yu JS: Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. .Radiographics 21::1425. ,2001. .
Yao L, Cracchiolo A, Farahani K, et al: Magnetic resonance imaging of plantar plate rupture. .Foot Ankle Int 17::33. ,1996. .
Lui TH, Chow HT: Role of toe flexor tendoscopy in management of an unusual cause of metatarsalgia. .Knee Surg Sports Traumatol Arthrosc 14::654. ,2006. .
Sarrafian SK: Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional, 2nd Ed, p 556, Lippincott, Philadelphia. ,1993. .
Dreeben SM, Noble PC, Hammerman S, et al: Metatarsal osteotomy for primary metatarsalgia: radiographic and pedobarographic study. .Foot Ankle 9::214. ,1989. .
Fishco WD: How to address predislocation syndrome of lesser MPJs. .Podiatry Today 20::76. ,2007. .
Fortin PT, Myerson MS: Second metatarsophalangeal joint instability. .Foot Ankle 16::306. ,1995. .
Coughlin MJ: Crossover second toe deformity. .Foot Ankle Int 8::29. ,1987. .
Coughlin MJ: Subluxation and dislocation of the second metatarsophalangeal joint. .Orthop Clin North Am 20::535. ,1989. .
Johnston RB, Smith J, Daniels T: The plantar plate of the lesser toes: an anatomic study in human cadavers. .Foot Ankle 15::276. ,1994. .
Thorndike J, Deland JT, Sung H: Medial crossover toe: a cadaveric dissection. .Foot Ankle Int 21::375. ,2000. .
Background: Lesser metatarsal overload may lead to pathologic conditions ranging from plantar metatarsophalangeal joint pain to dislocation. The flexor tendon sheath lies directly plantar to the joint. The increased pressure associated with lesser metatarsal overload may lead to synovitis and pain of the flexor tendon sheath.
Methods: Fifteen consecutive patients with lesser metatarsal overload had visual analog scale scores determined at three metatarsophalangeal joint areas to determine the source of pain. The patients underwent seven maneuvers to determine the pain scale score: single-leg heel raise and palpation of the second and third metatarsophalangeal joints on the plantar proximal, plantar distal, and dorsal aspects. The patients were then injected with 0.5 mL of lidocaine, 2%, into the second and third flexor tendon sheaths, and the maneuvers were repeated.
Results: Before the injection, the second metatarsophalangeal joint had a significantly greater visual analog scale score plantar than dorsal (6.9 and 2.6, P ≤ .01). The flexor tendon sheath injection significantly improved all seven pain scale scores.
Conclusions: Patients with lesser metatarsal overload experienced significantly greater visual analog scale pain scores on the plantar than the dorsal aspect of the second metatarsophalangeal joint. The scores significantly improved after diagnostic injection in the flexor tendon sheaths. The flexor tendon sheaths are probably involved in patients with primarily plantar pain. (J Am Podiatr Med Assoc 99(2): 129–134, 2009)