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  • Robin R Varghese, PT.

MET A TARSan like ALGIA? Are you encountering forefoot pain (Metatarsalgia)? We have the solution!

Forefoot pain can be bothersome as the discomfort can be intolerable and lead to deterioration in the gait pattern, and affect the quality of life. Metatarsalgia is a general term for pain in the area of the metatarsophalangeal joints. It is a condition in which the ball of your foot becomes painful and inflamed. It is commonly seen in those who participate in activities that involve running and jumping. Foot deformities and shoes that are too tight or too loose can also lead to this condition.


The pain is often localized to the first metatarsal head. Metatarsalgia of the first MTP joint often results from a traumatic episode or degenerative arthritis.

Next most frequent site of metatarsal head pain is under the second metatarsal and third metatarsal heads.

  • The various causes include

  1. Mechanical factors like overuse, anatomic misalignment, foot deformity, and degenerative changes.

  2. Nonmechanical causes include RA, gout, or other arthropathies.

Most common causes include:

  • Interdigital nerve pain (Morton neuroma)

  • Metatarsophalangeal joint pain

  • Sesamoiditis

  • Submetatarsal head fat pad atrophy typically associated with aging[3]

Factors that can cause excessive pressure are:

  • Participating in high impact activities without proper footwear and/or orthotics

  • Older age as the pad in the foot tends to thin out making it much more susceptible pressure and pain

  • An imbalance in the length of the metatarsals

  • Majority seem to be related to foot and ankle deformity

  • Disturbances in gait

  • Morphology of the foot (e.g., increased bone length that protrudes into the bottom of the foot)

  • A shortened Achilles tendon

Metatarsalgia is often accompanied by excessive callus formation over a bony protrusion, with severe pain and pressure sensitivity around the callus


Risk factors

  • Having a high arch

  • Wearing high heels

  • Certain illnesses that cause joint inflammation, like osteoarthritis, rheumatoid arthritis and gout

  • Age. The fat pad that cushions the ball of your foot gets thinner over time

  • athletes who participate in high-impact sports

  • Track and field runners


Subtypes

  1. Primary metatarsalgia refers to symptoms arising from innate abnormalities in the patient’s anatomy leading to overload of the affected metatarsal. [11]

  2. Secondary metatarsalgia can be caused by systemic conditions such as arthritis of the MTP joint.

  3. Iatrogenic metatarsalgia can occur after (failed) reconstructive surgery.


Management

  1. Conservative management includes

  • NSAIDs

  • Orthotics

Orthotics with metatarsal pads may help redistribute and relieve pressure from the noninflamed joints. It corrects abnormal alignments like subtalar eversion and also covers the 1st ray elevation,

Rigid orthoses, carbon fiber plates, or external shoe bars or rocker soles may be necessary to reduce motion at the joint. It may be used in case of severe limitation of 1st Metatarsophalangeal motion or pain, as well.

2. Physical Therapy.


3. Surgical management may be needed if conservative therapies are ineffective.


Physical Therapy management is opted prior to surgical management. This includes:

  • Education

To suspend or reduce exercises and training until pain reduces, to use proper footwear which should not be too high or too loose and to keep pain and swelling under control by using analgesics and icing the area.

  • Orthoses

Used for pain relief, to reduce pressure under painful metatarsal head and to improve functional ability.

  • Stretching

6-week stretching program increased the maximal ankle dorsiflexion angle and length extensibility. The most important areas to focus on are the calf muscles, Achilles tendons, ankles, and toes.

  • Strengthening

Strengthening of key muscles can help in preventing metatarsalgia. Small foot muscle exercises have proven to improve pain threshold and reduced the peak contact pressure.

  • Icing, Ultrasound, Interferential therapy and taping.

Undertaking Physical Therapy at the right time, with the right therapist who knows the right technique to adopt; based on your individual therapy goal will save you of a great deal of time, stress and most of all, of your agony.


WE, at Valley Healing Hands provide the best Physical Therapy in Brownsville, Texas for forefoot pain or metatarsalgia and other foot related complaints. Our therapists are qualified and well versed in treating patients with forefoot pain successfully and will be more than happy to serve you too!






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