Metatarsalgia

MetatarsalgiaMetatarsalgia (Forefoot or ball-of-foot pain) is the pain in the ball of the foot most commonly caused by the overuse injury of the foot.

Description


Metatarsalgia is a pain of the foot in the metatarseal area (ball-of-the-foot). Affected persons may experience constant or acute pain sometimes accompanied by the numbness of the distal parts of the toes. This condition is widely spread among the athlets and obese persons.


Causes


Exposure to excessive pressure on the foot and metatarseal area is a usual cause of the disorder. There is a bunch of factors that lead to abnormal weight distribution and can trigger the foot pain.

The high level of activity, prominent metatarsal heads, tight toe extensors (muscles), weak toe flexors (muscles),bunion or arthritis of the big toe, hammertoe deformity, hypermobile first foot bone, tight Achilles tendon, excessive side-to-side movement of the foot when moving, walking, and badly fitting footwear increase the pressure over the foot. Podiatric physicians suggest that people with some specific shapes of the foot are more likely to be affected. This includes a high-arched foot, or a foot with an extra-long metatarsal bone.
All these factors also increase the risk of the trauma in sportsmen.

Morton’s or interdigital neuroma causes irritation and inflammation of the nerve of the foot and leads to metatarsalgia. Diabetes may also contribute to metatarsalgia as long as the disease affects the nerves (neuropathy).


Risk factors


Matatarsalgia is common among the athletes involved in high-impact sports (running, jumping, tennis, baseball, etc.). People who suffer from obesity or overweight are more likely to develop the condition. Those who can’t afford fitting footwear or every day wear high heels may also develop metatarseal pain.

Symptoms


The pain may be acute or chronic, it can be isolated near the big toe or involve the whole region under the 2nd, 3rd, and 4th metatarsal bones heads. Usually the pain occurs or worsens when a person is running or walking. Metatarsalgia in athletes is usually accompanied by the bursitis.

Symptoms of metatarsalgia also include a sharp, burning  or aching sensation in the foot, shooting pain on the sole of the foot, tingling feeling or numbness in the toes. Sometimes the affected persons describe their sensations as if they were walking on the stones.

Long-lasting course of the metatarsalgia may lead to the paining feeling in other parts of the body due to altered posture and gait from the foot pain.

[Read also: Trench foot]

Diagnosis


To detect interdigital neuromas the metatarsal squeeze test is used. The foot is grasped at the metatarsal heads and then squeezed to compress them together. This compression between the metatarsal heads may produce a painful click (a Mulder sign).

X-ray examination of the foot is performed to evaluate the cause of the pain. An ultrasound examination is helpful to identify bursitis or Morton neuroma.

Sometimes an MRI is performed to detect the cause of the condition.

Treatment

  • During the acute phase of the disorder RICE therapy is used. This therapy includes rest, icing, compression, and elevation. Compression implies the application of a pressure bandage. For the first 24 hours patient is recommended to avoid putting the weight on the foot. The condition requires the passive range of motion (PROM) therapy when the therapist or equipment moves the joint through the range of motion with no effort from the patient;
  • As the treatment of metatarsalgia supportive shoes are worn along with the semi-rigid corrective devices;
  • An affected person should return to usual activities gradually and carefully. An athlete may be recommended to avoid the pain-causing exercises;
  • If the pain is caused by the high foot arch an orthotic device is highly effective;
  • Shoes should be changed with an orthotic. Orthotic inserts and schock-absorbing pads may also be prescribed;
  • Wearing low heels (less than 1″ or 2.5 cm);
  • Non-steroidal anti-inflammatory medications are administered to alleviate the pain (ibuprofen, naproxen);
  • During the recovery phase physical therapy is necessary. The main aim of the treatment is to restore the biomechanics of the foot and reduce the pressure. In order to strengthen the muscles pain-free, isometric, isotonic, and isokinetic exercises are performed;
  • Morton’s neurome is the indication to administrate a nerve block along with steroids;
  • Swimming is recommended to maintain the physical form of an affected person;
  • Sometimes the condition demands surgical correction of the metatarsal bones.