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Nov 16, 2007 - MetatarsalgiaBack
METATARSALGIA
Definition:
Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, often referred to as the ball-of-the-foot). Metatarsalgia is usually located under the 2nd, 3rd, and 4th metatarsal heads, or isolated at the first metatarsal head (the big toe joint) when it is known as sesamoiditis. Sesamoiditis is discussed in more detail under a separate heading.
Cause:
With this common foot condition, one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. You may experience acute, recurrent, or chronic pain with metatarsalgia.
Poor foot function is the primary cause – if you over-pronated the joints on the ball-of-the-foot receive excess loading as the metatarsal arch collapses. Over pronation also causes a natural “shear force” in this region of the foot.
If you over supinated (also know as under pronation) the foot bears weight on a smaller area, usually only on the heel and balls-of-the-foot and the toes do not function properly. This leads to overloading of the forefoot and can lead to metatarsalgia. A short 1st metatarsal is a condition known as Morton’s foot. This leads to overloading of the second metatarsal head and can also cause metatarsalgia - the condition is discussed in detail in under a separate heading. As we get older, the fat pad in our feet tends to thin out, making us much more susceptible to pain in the ball-of-the-foot.
There are some intrinsic conditions that can lead to metatarsalgia – these include, Morton’s Neuroma (referred to as a separate heading), osteochondrosis and various types of arthritis. A fracture, stress fracture or direct injury can also lead to metatarsalgia.
Improper fitting footwear is a factor that may contribute to the condition and is more frequently seen in women’s dress shoes and other restrictive footwear. Footwear with a narrow toe box (toe area) forces the ball-of-foot area into a minimal amount of space. This can inhibit the walking process and lead to discomfort in the forefoot. Heels that are too high or participating in high impact activities without proper footwear and/or orthoses will lead to metatarsalgia by overloading the forefoot.
Treatment & Prevention:
The first step in treating metatarsalgia is to determine the cause of the pain.
Conservative (non surgical) treatment involves unloading pressure to the ball-of-the-foot. This can be accomplished with a variety of prescription orthoses that usually feature a metatarsal pad. The orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. If poor foot function is present, then the orthotic will incorporate motion control or cushioning and redistribution, whichever is most appropriate for the foot type. Intrinsic foot exercises have proven to be beneficial.
If improper fitting footwear is the cause of the pain, advice will be given on what is most appropriate at least to improve for the greater part of the day.
If systemic conditions are involved referral and involvement of a medical physician or physiotherapist / rehab professional will be advocated.
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