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Metatarsalgie: Differentialdiagnose und Therapie

Metatarsalgia: Differential diagnosis and therapy

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Zusammenfassung

Der Begriff Metatarsalgie bezeichnet lokalisierte oder generalisierte Schmerzen im Bereich der Metatarsaleköpfchen. Die gezielte Anamnese und klinische Untersuchung vermag meist relativ einfach die Diagnose einer Metatarsalgie zu stellen, die zugrundeliegende Ursache ist aber häufig erst durch entsprechende Erfahrung und weiterführende Bildgebung nach gründlicher Abwägung möglicher Differentialdiagnosen zu identifizieren. Neben konservativen Therapiemöglichkeiten unter Einbeziehung der Orthopädietechnik und Physiotherapie können unterschiedlichste operative Maßnahmen in Abhängigkeit der zu Grunde liegenden Pathologie meist Abhilfe der Beschwerden erreichen. Auch hier gilt, wie für alle Fußpathologien, begleitende Deformitäten im kausalen Zusammenhang mit einer Metatarsalgie zu behandeln, um ein Rezidiv der Beschwerden und eine dauerhafte Ausheilung der Metatarsalgie zu erreichen. Die profunde Kenntnis relevanter Differentialdiagnosen und Begleitpathologien ist hierbei für eine erfolgreiche Behandlung ebenso notwendig wie eine differenzierte und individualisierte Behandlungsstrategie.

Summary

Metatarsalgia refers to localized or generalized forefoot pain in the region of the metatarsal heads. Symptoms can be isolated or in combination with accompanying deformities occurring in the forefoot and/or hindfoot. Anamnesis and clinical investigation usually yield to the diagnosis, the underlying cause on the other hand is not always easy to identify. In the foreground of the treatment is the exhaustion of conservative forms of therapy to minimize the symptoms of local pressure increase and callus under the metatarsal heads. In addition, various surgical methods are available, such as corrective osteotomy of the metatarsale bone, soft tissue interventions and the correction of associated deformities. The indications for surgical intervention should be made with caution in order to avoid failures and complaints persisting after surgery. The most common problems are an inadequate indication for surgery, technical problems and insufficient postoperative treatment.

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Abbreviations

IMTR:

Intermetatarsalraum

MFK:

Mittelfußknochen o. Mittelfußköpfchen

MRT:

Magnet Resonanz Tomographie

MT:

Metatarsale

PVNS: Pigmentierte villo:

noduläre Synovialitis

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Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    Andreas Toepfer, Rüdiger von Eisenhart-Rothe & Norbert Harrasser

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  1. Andreas Toepfer
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  2. Rüdiger von Eisenhart-Rothe
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  3. Norbert Harrasser
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Correspondence to Andreas Toepfer.

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A. Toepfer, R. von Eisenhart-Rothe und N. Harrasser geben an, dass kein Interessenkonflikt besteht.

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Toepfer, A., von Eisenhart-Rothe, R. & Harrasser, N. Metatarsalgie: Differentialdiagnose und Therapie. Wien Med Wochenschr 167, 285–292 (2017). https://doi.org/10.1007/s10354-016-0445-2

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  • DOI: https://doi.org/10.1007/s10354-016-0445-2

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