METATARSALGIA

Fergus RossEducation and Training

Salts Tech Step

DEFINITION

Pain in the forefoot region is referred to as metatarsalgia and it can be caused by a number of underlying pathologies

Aetiology

Articular Extra-articular

CapsulitisFlexor Tendonopathy

Capsular TearInter Digital Neuroma

SynovitisMetatarsal Stress Fracture

Arthritis

Avascular Necrosis

Risk Factors

ExtrinsicIntrinsic

Running Surface Foot Function

Running Shoes Foot Type

Running Style Foot Posture Index

Plantar Pressure

Feel

Move

Specific Test

• Plantar Digital Neuroma

Decision Making

TreatmentNSAIDs

Running Shoes

Foot Orthoses

Night Splints

Padding and Strapping

Physical Therapies

Steroid Injections

Surgery

Case Study

48 year old male novice marathon runner was referred with pain in the forefoot of this left foot.

The patient was otherwise healthy and participated in other sports

Both the patient and the GP were unsure of the cause of the pain and he had been prescribed a course of NSAIDs and refererred for an examination and foot orthoses if appropriate

History

A thorough medical history demonstrated no major illnesses, operations or a history of lower limb injuries

No significant family medical history

The most significant factor was the increase in running and purchasing new running shoes

The foot was painful during activity and the patient noticed it was very uncomfortable on the hard tiled floor in the shower when he had forgotten his flip flops

Presenting Complaint

The pain was under the second and third metatarsal heads but it was worse directly under the second metatarsal phalangeal joint

The pain tended to occur during the warm up and then disappear. It would then return towards the end of the run sometimes causing the patient to stop.

There was no swelling but the area was tender on palpation and when you extend the 2nd MPJt

Differential Diagnosis

Plantar Capsulitis

Synovitis

Flexor Hallucis Longus Tendinopathy

Bursitis

CAD/CAM EVA Orthoses

Cushioning and Stability

References

Yates B, Merriman’s Assessment of the Lower Limb. Churchill Livingstone, 2009; pp422 – 424.

Alexander IJ, The Foot Examination and Diagnosis. Churchill Livingstone, 1990