Metatarsalgia is a word that we sometimes hear from friends. They’ve been diagnosed with it and then they start explaining it to you. So what is metatarsalgia?
First of all, it is most important to realise that metatarsalgia is NOT a diagnosis! Metatarsalgia is not any one specific condition. It is rather, a generic term that people use to label general forefoot pain or pain in the balls of the feet. In essence it is a really great way of sounding like we know exactly where the problem lies but in reality, it is a broad term used to describe many conditions.
So what are these conditions? Basically it is any of the conditions which affect the metatarsal heads of the foot. These conditions include
bursitis
Plantar plate tears or ruptures
Losing the fat pad beneath the feet (Fat Pad atrophy or degeneration)
Joint inflammation
Nerve impingement or neuromas
Stress fractures of the metatarsal bones
Sesamoiditis (irritation of the two small bones underneath your big toe joint)
The metatarsals of the foot are indicated in the picture on the left by the ten green bones. They connect the toes of the foot to the midfoot and are essential in transferring the propulsive force to the ground when we move.
When you have metatarsalgia, it generally means that you have at least one of these conditions leading to general pain in the forefoot. Your clinician will go about finding out exactly which one of these conditions that applies to your pain. This is generally done through use of a full biomechanical assessment, possible x-ray and ultrasound referrals and through palpation and range of motion studies by the clinician.
The following pictures show what metatarsalgia may present like when carrying out a gait pressure analysis.
The following pictures of the right foot show a similar situation but you can see three distinct areas of pressure in the right forefoot where the patient’s metatarsal bones push on the ball of the foot, seen in the three peaks in the picture on the left.
As you can see, most of the pressure is happening under the first two metatarsal heads being the first thickened peak and then to a lesser extent the third and fourth in the second peak with the small peak being the fifth metatarsal.
So how do we treat these kinds of injuries? Well that depends on what your actual diagnosis is. We can use a range of treatment modalities from strapping and taping, cushioning, offloading, footwear changes, custom orthoses and other methods to improve the pain and get you back on your feet. The most important aspect of metatarsalgia is to get a diagnosis, so that the appropriate treatment can be applied. Once this is done your actual condition can be targeted and healing can occur.