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