Strunsky's test - metatarsalgia를 판단하는 검사.

[문형철]

환자 앙와위, 검사자는 환자의 발가락을 잡고 빠르게 아래로 굴곡시킴

metatasalgia가 없는 환자는 불편이 없고, 아래와 같은 metatarsalgia가 있는 환자는  통증이 악화됨

동영상 추가

참고

Metatarsalgia is a very common condition that usually affects only the bottom of the ball of the foot. Occasionally, there will be some symptoms at the top of the forefoot near where the toes join the foot, but only after or concurrent with symptoms on the bottom of the ball of the foot. Metatarsalgia typically affects the bottom of the second metatarsophalangeal joint (where the second toe joins the foot).  However, any of the other metatarsals can be affected.   In more unusual cases, more than one metatarsal can be affected on one foot.   When metatarsalgia affects the second metatarsophalangeal joint, it also sometimes called “second metatarsophalangeal stress syndrome”.

The primary cause for metatarsalgia is repetitive application of excessive force to one metatarsal area more than

the others.  The second metatarsal is most commonly affected typically because there are a number of factors

that can lead to excess force on that bone/joint area.

Factors that can lead to metatarsalgia

Metatarsal bone longer than the others  

Metatarsal bone lower than the others

Adjacent unstable first metatarsal   

Adjacent bone higher than the others (transfer loading)

Associated hammertoe    

Tight calf muscle

High heeled shoes     

Shoes with inadequate cushioning

Overweight      

Overuse

The pain typically feels like a deep bruise.  Sometimes, it will feel like there is a rock under the ball of the foot.

These symptoms are usually worse when walking or standing barefoot on a hard surface or poorly cushioned

shoe, and better when in well-cushioned shoes.   At the end of a day with substantial standing and/or walking,

the area can throb a bit.  It is not uncommon to have a callus located under the affected metatarsal.

Pain usually is first noticed at the bottom of the ball of the foot and there is no swelling.  With progression,

swelling can appear, along with tenderness at the top side of the joint.  In some cases, bursitis will form adjacent

to the metatarsal.  In even more advanced cases, the joint capsule and ligaments on the bottom of the joint can

wear out and rupture, leading to the progressive development of a hammertoe.

The diagnosis of metatarsalgia is usually easily made with a careful history and physical exam.  X-rays are

usually not helpful in making the diagnosis.  Special tests, such as bone scans, MRI, and laboratory tests are

usually not required.

Mimickers of metatarsalgia include intermetatarsal neuroma (also called Morton’s neuroma), stress fractures,

and arthritis.   Neuromas can be differentiated fairly well by the examination.  Stress fractures can be

differentiated by pain and swelling more on the top of the foot, as well as with a bone scan.  Arthritis usually

has more pain and swelling on the top of the joints, and usually more than one joint is involved.

Non-surgical treatment of metatarsalgia can be quite effective.  This form of treatment should be comprehensive

and continuous until the pain has been resolved at least 2 months.  If cases fail to respond to non-surgical

treatment, either permanent alteration of footwear, lifestyle, and activities or surgical correction might be

necessary

[한지혜]

metatarsalgia(중족골통)
개념: 발의 앞 쪽, 특히 발의 제일 넓은 부위인 중족골의 발바닥 부위에 생기는 족부 질환
진단: Strunsky's test (환자 앙와위, 검사자는 환자의 발가락을 잡고 빠르게 아래로 굴곡)
위험요인:
-중족골이 다른 것 보다 longer
-중족골이 다른 것 보다 lower
-첫째 중족골의 인접한 불안정성
-인접한 뼈가 다른 것 보다 higher
-하이힐
-신발의 부적합한 쿠션
-과체중
-과사용 등
치료:
-발을 30~50cm정도 높은 곳에 올리고 잠
-얼음찜질 30분 후 휴식
-맞춤 깔창 사용 -> 발바닥 전체로 압력이 분산되도록