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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2005 March;29(1):1
Metatarsalgia due to hyperpronation of the subtalar: a logical concept?
Pathological pronation of the subtalar is often indicated as a biomechanical moment in the pathogenesis of metatarsalgic conditions resulting from destabilisation of structures distal to the subtalar joint, particularly when its pathological attitude continues in the detachment stage. Involvement of cutis, subcutis, metatarsal heads, metatarso-phalangeal joints, toes, intermetatarsal vasculo-nervous sheathes. If, however, it is remembered that a contribution to the normal set up of the subtalar is made by the talus, ligamentous and myotendinous components, and the suprasegmental stability of the extremity, and also that the subtalar joint forms part with the talo-navicular of a single joint complex (coxa pedis) and again that the coxa pedis rather than the subtalar participates in the mechanism that opens and closes the kinetic chain of the foot (talus bone of the leg with closed kinetic chain and coxa pedis of enarthrosic constitution) it is evident that the subtalar joint, apart from any intrinsic pathology, acts secondarily to other mechanisms that we have to define from case to case. Nor is the terminology clear: while for some authors pronation is a complex movement acting in the three spatial planes, for the most part it is a simple movement that takes place in the frontal plane on the longitudinal axis of the foot. And in this case we have to speak, being a triplanar subtalar movement, of hypereversion.
To conclude (personal opinions and therefore debatable): it is difficult to speak of biomechanical metatarsalgias exclusively in terms of subtalar pronation; rather they should be classified in relation to their pathogenetic moment; if we wish to retain the reference to a syndrome it is more correct to talk about peritalar destabilisation.
With the definition of ''peritalar destabilisation syndrome'' we solve the terminological problem, the biomechanical moment that conditions the global disorder of the foot and forefoot is more understandable and, finally, the intrinsic pathogenetic moments of coxa pedis such as the recently acquired degenerative glenopathy as well as, obviously, the extrinsic causes that can intervene as destabilising moments (skeletal, ligamentous, neuro-muscular changes, suprasegmental disorders, etc.) are confirmed.