Metatarsalgia

Metatarsalgia is pain in the forefoot or “ball of the foot”, often in the area under the second or third toe as a result of repetitive loading of the forefoot.  This condition is often associated with a change in activity resulting in the calf becoming tight.  As this occurs greater stress is applied to the ball of the foot when walking.  This condition is commonly misdiagnosed as Morton’s neuroma.

Symptoms:
Patients usually describe pain in the “ball of the foot” right at the base of the involved toes.  This can be an aching pain and is aggravated by standing, walking, or walking on hard surfaces.  Some patients note a burning sensation extending into the tips of the toes.  Swelling of the MTP joint is possible as is some clawing of the toes.  Patients typically report feeling as though they are walking on pebbles or the sock is balled-up in their shoe. 

Diagnosis:
The diagnosis of metatarsalgia is usually made by the history the patient provides and a physical examination.   X-rays of the feet and ankles, while weight bearing, are helpful in confirming the presence of a stress fracture or stress reaction and assessing alignment. 

Treatment:
The key to the cure is stretching the calf, specifically, the gastrocnemius muscle.  This is accomplished by performing  the ”runners stretch”  by placing the foot flat on the floor with the knee straight and leaning forward while supporting the upper body on a wall, chair back, counter top or the like.  The stretch is held for 10 to 15 seconds for 10 to 15 repetitions, performed a minimum of three times per day.  As the gastrocnemius muscle becomes more supple the ankle moves more freely and the stress on the foot decreases.  Another key is to off-load the involved area.  This can be done through the use of well-fitting shoes with an adequate toe box.  Metatarsal pads or, when indicated, custom orthotics can help in balancing forces applied to the foot.  Activity modification and the use of anti-inflammatory medications (in the absence of contraindications) may be helpful.  For some though, operative treatment will be necessary.  Depending of the specific condition of the foot, i.e. if a claw toe is present, your orthopaedic surgeon may perform a variety of procedures either in isolation or in combination.

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