Metatarsalgia

There are many causes of pain in the forefoot, some of the most common are flexor plate dysfunction, capsulitis, Morton’s neuralgia and stress fractures. Also conditions such as Rheumatoid arthritis can first present as forefoot pain. Diagnosis is essential for the management of metatarsalgia.

Metatarsalgia is characterised by pain in the forefoot. The term literally means pain on the metatarsal (there are 5 metatarsal bones in the forefoot). Metatarsalgia is not a true diagnosis but rather it is a symptom. Patients with metatarsalgia present with pain in their forefoot, usually in the ball of the foot The pain is often described as aching and it is typically aggravated by standing and walking. In general metatarsalgia is caused by repetitive overloading of the forefoot leading to chronic localized tissue injury. Often the most symptomatic area is at the base of the 2nd or 3rd toe. Factors that may predispose to the development of metatarsalgia include: a bunion deformity, arthritis of the great toe, ligament instability of the mid-foot, an excessively tight calf muscle, a congenital foot deformity, and claw toe deformities.

 

Non-Operative Treatment

Patients respond well to non-operative treatment. If the underlying cause can be addressed non-operative treatment will be successful in the long-term. The principle of non-operative treatment is to off load the involved area. This can be done with a combination of comfort shoes, functional foot orthoses, activity modifications, calf stretching, foot muscle strengthening and NSAIDS (Non-steroidal anti-inflammatory drugs – you should consult your doctor or pharmacist before taking NSAIDS for the 1st time).

At podiatry clinics we have available some of the most advanced gait analysis equipment. the F-Scan In-Shoe pressure analysis system can often prove an invaluable tool in assessing the amount of load reduction post treatment.

Occasional a therapeutic steroid injection may also be indicated.

Operative Treatment

In a small percentage of patients, non-operative treatment will fail. In these patients, surgery may be helpful. There are a variety of procedures that have been proposed either in isolation or in combination. At podiatry clinics we have a sound knowledge of available surgical techniques and sound working relationship with all local foot surgeons. So if the need arises we can direct you to the most appropriate specialist.