| Description:
Metatarsalgia is a common overuse injury described as pain in the forefoot associated with increased stress over the metatarsal head region. Metatarsalgia often is referred to as a symptom, rather than as a specific disease. Common causes of Metatarsalgia include inter-digital neuroma, metatarsophalangeal synovitis, vascular necrosis, sesamoiditis, and inflammatory arthritis; however, these causes often are diagnosed separately.
Problems it causes:
The primary symptom of Metatarsalgia is pain at one or more of the metatarsal heads. Diffuse forefoot pain and mid foot pain are often present in athletes with combinations of high-impact inflammatory conditions.
- Pain typically is aggravated during the mid stance and propulsion phases of walking or running.
- A history of gradual chronic onset is more common than acute presentation. Chronic symptoms may be of gradual onset over 6 months.
- Morton neuroma (inter-digital neuroma) produces symptoms of Metatarsalgia due to irritation and inflammation of the digital nerve located in the web space between the metatarsal heads. Patients with Morton neuroma may complain of toe numbness, in addition to pain in the forefoot. The term Morton neuroma is a misnomer because no neuroma truly exists. Rather, the lesion results from a mechanical entrapment neuropathy.
- Pain and tenderness are experienced on the plantar surface of the metatarsal head, which often is accompanied by the development of a callus formation (plantar keratosis).
What Causes It:
- The foot frequently is injured during sports activities.
- As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads.
- Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues.
- The following factors can contribute to excessive localized pressure over the forefoot:
- High level of activity
- Prominent metatarsal heads
- Tight toe footwear
- Light weight and flexible footwear
- Hammertoe deformity
- Hyper mobile first ray
- Tight Achilles tendon
- Excessive pronation
- Some anatomical conditions may cause individuals to have forefoot problems.
- A high arch with stress to the forefoot, as seen with pes cavus foot type, often causes pain in the metatarsal region.
- Individuals with a Morton toe have a short first metatarsal bone. The normal forefoot balance is disturbed, which results in abnormal subtalar joint pronation. This pronation results in the shift of an increased amount of weight to the second metatarsal.
- Hammertoe deformity causes Metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal heads.
- Toes also share some weight bearing.
- Hallux valgus may create abnormal foot biomechanics.
- These musculoskeletal problems may contribute to forefoot trauma in athletes. Callus is formed as a skin reaction to prolonged pressure, with the skin becoming thickened and hyperkeratotic.
How to help the pain:
Wearing shoes with extra toe is the first step. Shoes that squeeze the foot will intensify the pain and damage the foot more. Shoe that have extra cushion such as running shoe or specialty shoes will reduce the pressure.
Orthotics can be made to redistribute body weight of the metatarsals allowing them to heal. |