Musculo-skeletal   [back to the Category]

Osteoarthropathy of the instep   [read the french version]

Author :   Docteur Anne Thiescé

Osteoarthropathy of the instep Fig. 1

The forced plantar flexion of the instep by stretching the articular capsules of the tarsus and the medio-tarsus as well as the stress from compression exercised in the "pointe" position cause conflicting osteophytic reactions and sometimes the early onset of arthrosis.

Arthrosis of the tarsus is often well tolerated. Surgical cleaning is sometimes required when there is a cyst, or a conflict with the tendons of the toe extensors.

Arthropathies of the tarso-metatarsal joints
(Lisfranc) are sources of pain, swelling and instability. The differential diagnosis with stress fractures of the base of the first and second metatarsal can be difficult and often requires numerous additional examinations such as scintigraphy, Fig 2, MRI. This also shows a genuine arthrosis, with sub-chondral bone condensation, articular joint pinching and osteophytosis. These injuries are sometimes responsible for conflicts with adjacent soft parts, such as the extensor common to the toes and the musculocutaneus nerve. Treatment is generally medical, but infiltrations can be useful, Fig. 3. If all else fails, a partial surgical arthrodesis can be suggested.

Bibliography:

Desmarais Y. Lésions articulaires micro-traumatiques du pied chez le danseur. Sciences et Sports 1986; 1: 331-336.

Poux D, Demarais Y, Parier J. Le Lisfranc microtraumatique du danseur. In: Expansion scientifique française ed, Podologie 1997, Entretiens de Bichat, journée de podologie 1997, Paris 1997: 91-94.

Thiescé A. Le geste dansé et ses conséquences en rhumatologie. Paris: ed Printel, Laboratoires Ciba-Geigy 1996.

Thiescé A. Pied et danse classique. Encycl Méd Chir (ELSEVIER, Paris), Podologie, 27-140-A-65, 1999, 7p.