Keys To Identifying And Treating Vamp Disease

John Mozena, DPM, and Paul Clint Jones, DPM

Utilizing a couple of illuminating case studies, these authors look at the role improper shoe gear can play in compressive neuropathy and discuss treatment options.

   Shapiro and Gibbs originally described vamp disease as a commonly occurring problem in which the patient can develop inflammatory swelling on the dorsal aspect of the base of the hallux, secondary to the irritation from the vamp of the shoe.1 This can cause painful callus formation, irritating the extensor hallucis longus tendon with potential to cause infection in the area.

   A second type of vamp disease can occur at the first or second metatarsocuneiform joint or under the inferior extensor retinaculum. The problem can also involve the region under the extensor hallucis brevis muscle belly. Compression from the vamp of the shoe or lacing issues on the deep or superficial peroneal nerve results in pain for the patient. Kopell and Thompson referred to this compression as anterior tarsal tunnel syndrome.2,3

   In regard to the etiology of the metatarsocuneiform exostosis that can compress the nerve from shoe pressure, there are several possible mechanisms. Ankle sprains, trauma, tight fitting shoes, ski boots and faulty biomechanics are reportedly inciting factors.3,4 Neurologic conditions often occur in joggers and dancers, and can even be implicated in injuries resulting from athletes doing sit-ups with their feet hooked under a metal bar.4 The presence of edema, ganglion and a bony hyperostosis can also cause nerve compression.4

   The hypermobile, pronated foot can also be contributory to neuropathy in athletes.4 The maximally dorsiflexed portion of the metatarsal creates a jamming effect, which can result in the development of a subchondral bone and marginal exostosis formation. In the cavus foot, the structural abnormality leads more often to the hyperostosis. The plantarflexed first ray leads to compensation at the midtarsal and subtalar joints, which is more of a secondary cause of the exostosis rather than a primary pes cavus foot.4 An enlarged extensor hallucis brevis muscle belly can also cause irritation.

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