PMID- 19796585
OWN - NLM
STAT- MEDLINE
DCOM- 20091203
LR  - 20140827
IS  - 1071-1007 (Print)
IS  - 1071-1007 (Linking)
VI  - 30
IP  - 10
DP  - 2009 Oct
TI  - Instability of the first metatarsal-cuneiform joint: diagnosis and discussion of 
      an independent pain generator in the foot.
PG  - 928-32
LID - 10.3113/FAI.2009.0928 [doi]
AB  - BACKGROUND: First metatarsocuneiform (MC) instability is recognized as a 
      pathologic contributor to hallux valgus. There are no studies identifying the 
      first MC joint as an independent pain generator in the foot that may require 
      surgical arthrodesis for its management. MATERIALS AND METHODS: The authors 
      reviewed the records of all patients with this newly described pathology in the 
      first MC joint. There were 61 patients with 85 feet who underwent a 
      fluoroscopically guided local anesthetic injection into the first 
      metatarsocuneiform joint to assess pain relief. Patient's complaints, physical 
      exam findings, treatment decisions, patient characteristics, and radiographic 
      findings were evaluated. RESULTS: Seventy-nine percent of patients (67/85) 
      injected had relief of their symptoms. Eight or these 67 patients were eventually 
      treated with first MC arthrodesis with complete relief of symptoms. The average 
      time from onset of symptoms to presentation was 21 (range, 1 to 72) months. 
      Eighty-five percent of feet (72/85) had multiple previous diagnoses. Radiographic 
      plantar widening of the first M-C joint on weightbearing views was inconsistent 
      with pathology. CONCLUSION: The first MC joint is an independent pain generator 
      in the foot that can have variable presentations. Radiographic data can often be 
      helpful, but clinical exam findings are paramount in the diagnosis. 
      Fluoroscopically-guided long acting local anesthetic injections of this joint are 
      helpful in the diagnosis, especially in the patient with multiple possible pain 
      generators in the foot and ankle. Failure to recognize the first MC joint as a 
      source of pain may lead to delay in treatment, misdiagnosis, and mistreatment of 
      foot pathology.
FAU - Cooper, Andrew J
AU  - Cooper AJ
FAU - Clifford, Paul D
AU  - Clifford PD
FAU - Parikh, Viraj K
AU  - Parikh VK
FAU - Steinmetz, Neil D
AU  - Steinmetz ND
FAU - Mizel, Mark S
AU  - Mizel MS
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Foot Ankle Int
JT  - Foot & ankle international
JID - 9433869
RN  - 0 (Anesthetics, Local)
RN  - 98PI200987 (Lidocaine)
RN  - Y8335394RO (Bupivacaine)
SB  - IM
CIN - Foot Ankle Int. 2010 Jun;31(6):560-1. PMID: 20557826
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anesthetics, Local/therapeutic use
MH  - Arthralgia/*drug therapy/*physiopathology
MH  - Arthrodesis
MH  - Bupivacaine/therapeutic use
MH  - Female
MH  - Fluoroscopy
MH  - Foot Joints/*physiopathology/surgery
MH  - Humans
MH  - Injections, Intra-Articular
MH  - Joint Instability/*diagnosis/physiopathology/surgery
MH  - Lidocaine/therapeutic use
MH  - Male
MH  - Metatarsal Bones/physiopathology/surgery
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Tarsal Bones/physiopathology/surgery
MH  - Young Adult
EDAT- 2009/10/03 06:00
MHDA- 2009/12/16 06:00
CRDT- 2009/10/03 06:00
PHST- 2009/10/03 06:00 [entrez]
PHST- 2009/10/03 06:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - 50029433 [pii]
AID - 10.3113/FAI.2009.0928 [doi]
PST - ppublish
SO  - Foot Ankle Int. 2009 Oct;30(10):928-32. doi: 10.3113/FAI.2009.0928.