Metatarsalgia

Metatarsalgia is a term utilized to cover any forefoot pain, especially metatarsal pain. In most cases, it refers to tenderness that develops in the joints amidst the metatarsal bones in the foot as well as the phalanges bones of the toes.

What are the indications of metatarsalgia?

The signs and symptoms usually include forefoot pain that is aggravated when bearing weight, especially during the middle phase and push-off phase while walking when the foot is still in contact with the floor.

Metatarsalgia
The signs and symptoms usually include forefoot pain that is aggravated when bearing weight, especially during the middle phase and push-off phase while walking when the foot is still in contact with the floor.

The metatarsal pain occurs gradually along with tenderness felt if the MTP joints beneath the ball of the foot is pressed. It is usually the 2nd, 3rd and 4th toes that are involved and frequently affects more than a single joint at the same time.

During the initial phases, a separation between the toes might be evident and called as the “V sign”. If the toe is passively flexed or bent, it triggers pain. In addition, there are also calluses beneath the foot due to the excess pressure.

What are the causes?

The usual cause of metatarsalgia is the inflamed synovial sheath surrounding the MTP joints. This is typically due to the excess pressure on the joints over an extended time. Other contributing factors include:

  • Overpronation – this increases the pressure on the forefoot which increases the likelihood for inflammation.
  • A raised or stiff arched foot – this increases the pressure on the forefoot.
  • Shortened 1st metatarsal bone
  • Extensor tendons straighten the toes – if these are tightened, it results to inflammation.
  • Wearing ill-fitting shoes can compress the forefoot
  • Certain conditions such as bunions or hammertoe
  • Aging process
  • Gout
  • Stress fracture of the metatarsals
  • Morton’s neuroma
  • Arthritis
  • Diabetes

Management

The treatment for metatarsalgia is aimed on alleviating the pain and determining and treating any biomechanical or structural causes.

  • NSAIDs such as ibuprofen can minimize the pain and inflammation.
  • Padding for the foot can be used to provide protection and evenly distribute the weight on the metatarsal bones.
  • Wear flat shoes with adequate space for the foot

In some cases, a podiatrist might assess the position and gait pattern of the foot and if it is needed to use customized orthotics or insoles. In some cases, the doctor might even recommend a corticosteroid injection into the foot. Even traction is applied longitudinally on the toe to improve the joint space to alleviate the symptoms.

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