Metatarsalgia is a broad term to generally describe inflammation and pain of the metatarsal bones in the foot. This is a common problem occurring with overuse injuries often seen in people who participate in high impact sports or people who spend extended period of time performing weight bearing tasks with unsuitable footwear.
Pain, whether localised or diffuse, is the primary symptom of this condition. The pain is often isolated to the ‘head’ of the metatarsal bones and can be aggravated with weight bearing or direct palpation. The fact that the pain can be debilitating, it can result in the sufferer altering their walking patterns which can trigger other overuse issues including bursitis or stress fractures. The ‘overuse’ nature of the condition means that symptoms may not arise immediately rather they build up over a period of weeks to months before becoming noticed.
There are a number of factors that can be considered to potentially trigger metatarsalgia. Some relate to the structure of a persons foot while others relate to physical activity. Some common causes include but are not limited to:
– High level of activity/recent increase in activity.
– Lack of cushioning fat padding underneath the ball of the foot.
– Hammertoe deformity
– Tight toe extensor muscles with/without weak toe flexor muscles.
– Tight calf muscles; particularly Achilles tendon.
– Improperly fitting/inappropriate footwear.
– High arch feet
– Excessive rolling in of feet during gait.
– Excessively flexible first metatarsal.
A referral may be given to a patient for further imaging which can help diagnosis of the condition as well as differentiating from other conditions. Bone scans can pinpoint exact areas of inflammation though the scan itself is not very specific. X ray imaging can show whether there is any bony bruising, thickening, or joint changes which can indicate inflammatory response. Ultrasound imaging is useful in assessing for swelling which can indicate inflammation. Similarly it can be utilised to assess whther bursitis or a neuroma is present. Finally, MRI scans can also be utilised for an even more specific assessment of structural abnormalities as well as any potential joint changes.
Treatment options are often directed by the intensity of pain or the severity of the condition. Once the condition has been successfully diagnosed and causative aspect identified, clinicians can work to reduce discomfort, inflammation, restore effective range of motion and return the patient to pain free weight bearing. Some treatment aspects will include:
– Initial padding or offloading of painful regions.
– Strapping of affected foot to improve mechanical alignment.
– Icing of inflamed and sore areas.
– Compression bandaging of forefoot region.
– Mild, passive stretching of calf muscles.
– Orthotic corrective devices to provide cushioning as well as correcting alignment issues.
– Application of a metatarsal dome to redirect pressure away from sore regions.
– Change of footwear to appropriate script.
– Footwear modifications.
– Pharmaceutical therapies such as ibuprofen or paracetamol to control pain.
– Referral for surgical assessment or treatment in severe cases.
Prognosis for patients with metatarsalgia is generally good with a set treatment program aiming to address not only symptoms but also causative factors. Ensuring that symptoms do not recur requires ongoing patient commitment and diligence to ensure excessive strain is not reapplied to the affected regions. Podiatrist are able to provide ongoing patient education on methods of avoiding recurring metatarsal pain.
Dr Anel Kapur (Podiatrist)