Metatarsalgia

Metatarsalgia
Other names: Stone bruise; forefoot pain
Potential area of pain in metatarsalgia
Specialty	Orthopedics
Symptoms	Forefoot pain[1][2]
Types	Primary, secondary, post surgery[3]
Causes	Metatarsal stress fracture, Morton neuroma, Freiberg disease, sesamoiditis, gout, bunion, tailor's bunion, corns, metatarsophalangeal joint[4][1][2]
Diagnostic method	Based on symptoms, examination, and X-rays[5]
Treatment	Different shoes, insoles, physiotherapy, steroid injections, surgery[6]
Frequency	Common[5]

Metatarsalgia is pain in the forefoot or ball of the foot.^[1][2] Some include pain at the base of the big toe while others do not.^[1][2] Often it is worsened by weight bearing.^[7] It may be associated with calluses, loss of the fat pad, joint deformity or instability.^[3]

Possible causes include metatarsal stress fracture, Morton neuroma, Freiberg disease, sesamoiditis, gout, bunion, tailor's bunion, corns, or the metatarsophalangeal joint.^[4][1][2] Risk factors include running, poorly fitting shoes, and certain anatomical characteristics.^[2][8] Diagnosis is generally based on symptoms, examination, and X-rays.^[5]

Initial management includes different shoes, insoles, physiotherapy, and steroid injections.^[6] Shoes that may help include those with a wide toe box or rocker bottom.^[5] Pain medication such as paracetamol or ibuprofen may be used.^[2] If after more than six months there is insufficient improvement surgery maybe considered.^[5]

Metatarsalgia is common, affecting about 80% of people at some point.^[5][9][10] Women are more commonly affected than men.^[5] It becomes more common with age.^[5]

Signs and Symptoms

Metatarsalgia is characterized by a pain in the ball of the foot.^[4]

Causes

Causes include:

• Morton's neuroma. When toes are squeezed together too often and for too long, the nerve that runs between the toes can swell and get thicker. This swelling can make it painful when walking on that foot. High-heeled, tight, or narrow shoes can make pain worse. This is common in runners, particularly of long distance. The ball of the foot takes a lot of weight over the years and if running on pavement or running in ill-fitting running shoes, the odds of developing Morton's neuroma increase. Changing to shoes that give the toes more room can help.^[11]
• Metatarsophalangeal joint sprain including plantar plate tear and turf toe^[12][9]
• Metatarsal stress fracture^[12]
• Sesamoiditis
• Fat pad atrophy^[10]

Diagnosis

Diagnosis is based on symptoms and examination, supported by medical imaging.

Management

The most common treatments are:^[13]

• Rest
• Ice
• NSAID
• Properly fitted shoes
• Metatarsal pads
• Arch supports

Removing excess callouses may be helpful. In extreme cases, injection or surgery may be indicated.^[14]

References

External links