Metatarsalgia can be a bit of an umbrella term used to cover any forefoot pain. Usually the term Metatarsalgia refers to inflammation which occurs in the joints between the metatarsal bones and phalanges bones in the foot.
Metatarsalgia most commonly occurs in the MTP joints or metatarsal phalanges joints of the 2nd, 3rd, and 4th toes, although it can occur in any of them and is frequently in more than one joint at the same time. The symptoms with this can range from mild to severe and there may be many causes for the condition such as arthritis or even poorly fitted footwear.
Symptoms of Metatarsalgia are typically pain in the forefoot which is worse when weight bearing particularly during the middle phase and push off phase of walking when the foot is in contact with the ground. The pain usually comes on gradually as opposed to feeling a sudden sharp pain. There will be pain and tenderness when pressing in on the MTP joint.
In the early stages of metatarsal joint synovitis a separation between two toes may be seen and is known as the V sign. Passive flexion of the toe or bending the toes down can stimulate pain. There may also be hard skin or calluses under the foot due to excess pressure. X-rays can be done to determine if there is any degeneration of the joint itself which may be contributing to the painful symptoms.
Causes of metatarsalgia
The cause of metatarsalgia pain is from the synovial sheath or membrane around the MTP joints becoming inflamed, usually from excess pressure on the joints over a period of time. Contributing factors include:
- A high or rigid arched foot (pes cavus) may increase the likelihood of metatarsalgia by increasing the pressure on the forefoot.
- Over pronation of the foot is where the foot rolls in or flattens too much during the gait cycle. This will increasing pressure on the forefoot making inflammation more likely.
- A shortened first metatarsal bone can cause excess pressure to go through the second metatarsal bone. This is known as Morton's foot.
- The extensor tendons extend or straighten the toes. If these are tight this can lead to inflammation.
- Poorly fitting footwear may compress the forefoot or if the athlete laces up shoes too tightly this can also compress the forefoot increasing the likelihood of joint inflammation.
- Conditions such as hammer toe or bunions. Hammer toe is a condition which causes one or more of the small toes to bend upwards at the joint. A bunion is a deformity or the joint at the base of the big toe.
- Age - older people are more susceptible and degeneration of the bones is more likely.
- Stress fractures of the metatarsals. A stress fracture is a hairline fracture which has gradually occurred with over use.
- Repetitive high impact such as running or jumping.
- Arthritis resulting in general wear and tear of the joints in the foot.
- Diabetes which is responsible for a number of foot complications.
- Morton's neuroma which is pain caused by compression and inflammation of the nerve between the 3rd and 4th toes.
- Gout which is a form of arthritis caused by a build up of Uric acid in the joint.
Ultimately treatment of metatarsalgia involves providing relief from the pain and identifying and treating any structural or bio-mechanical causes.
What can you to do treat metatarsalgia?
NSAID's such as ibuprofen (non steroidal anti inflammatory drugs) may reduce pain and inflammation. Always speak to your Doctor first. Use padding to protect the foot and re-distribute weight on the metatarsal bones. A Metatarsal lift compression pad which is inserted into the front of the shoe is ideal. Use gel type shock absorbing and cushioning insoles which have the cushioning material in the forefoot. Wear flat, spacious shoes the do not restrict the forefoot. Stretch your calf muscles regularly throughout the day.
What can a professional do?
A doctor or sports injury professional can commission X-rays, MRI's or Ultrasound scans which can be used to look inside the foot to view any damage, arthritis or degeneration of the bones. Blood tests may be taken to diagnose any underlying medical causes such as diabetes or gout.
A podiatrist may assess your foot position and gait walking pattern and If necessary custom orthotics or insoles can be made to correct the movement of the foot. A doctor may inject a corticosteroid injection into the foot. Traction applied longitudinally to the toe can increase the joint space relieving symptoms.