Metatarsalgia
What is Metatarsalgia?
Definition:
Metatarsalgia is a general term used to describe pain and inflammation in the forefoot, particularly under the metatarsal heads (the ball of the foot). It is not a specific diagnosis but a symptom of underlying conditions that place excessive stress on the metatarsals.
Common Causes:
- Excessive Forefoot Pressure: Often due to high-impact activities (e.g., running, jumping).
- Foot Deformities: Hammertoes, bunions, or a high arch (pes cavus) can alter weight distribution.
- Improper Footwear: High heels or shoes with insufficient cushioning/support.
- Toe Length Discrepancy: A longer second toe (Morton’s toe) can shift pressure to the second metatarsal.
- Fat Pad Atrophy: Common with aging, reduces cushioning beneath metatarsal heads.
- Neuromas or Bursitis: Can coexist and worsen forefoot pain.
- Arthritis or Inflammatory Conditions: Rheumatoid arthritis or gout can cause metatarsalgia-like symptoms.
Symptoms:
- Burning, aching, or sharp pain under the ball of the foot.
- Pain worsens with activity and improves with rest.
- Feeling of walking on a pebble or bruise.
- Possible callus formation under one or more metatarsal heads.
Diagnosis:
- Physical Exam: Inspection for deformities, calluses, tenderness.
- Gait Analysis: Identifies abnormal pressure distribution.
- Imaging: X-rays (to assess alignment), ultrasound/MRI (to rule out neuroma, bursitis).
Treatment:
Conservative:
- Footwear Modification: Supportive shoes with wider toe boxes and metatarsal pads.
- Orthotics: Custom or off-the-shelf inserts to offload pressure.
- Activity Modification: Reduce high-impact activities.
- Physical Therapy: Strengthening, stretching, gait training.
- Ice & NSAIDs: To reduce inflammation and pain.
Surgical (if conservative measures fail):
- Metatarsal Osteotomy: Realigns and shortens the overloaded metatarsal.
- Soft Tissue Procedures: For associated deformities (e.g., hammertoes).
- Neuroma Excision/Decompression: If neuroma is present.
Prognosis:
Most cases resolve with conservative treatment. Surgery can be effective for chronic or severe cases but may carry risks like stiffness or transfer metatarsalgia.
