Metatarsalgia refers to any pain in the foot related the heads of the metatarsal bones. These bones are the long bones of the midfoot which lead up to the toes. While metatarsalgia is a common general diagnosis, there are various specific causes for the pain.

If one of the metatarsal bones is elongated or prominent, this may lead to increased pressure underneath the heads of the bone. This is most common around the 2nd metatarsal since it is the longest of these bones. Patient may experience focal tenderness to the area, and they may also develop a callus as a result of the increase in pressure.

There are other deformities of the foot and ankle that can lead to increased pressure under the metatarsal heads. A tight Achilles tendon will cause the foot to be more contracted and can create more pressure under the forefoot. Additionally, patients who have high arches will have metatarsals that come down at a steeper angle and therefore incur more pressure under their heads. 

Older patients may experience atrophy of the fat that is naturally present on the sole of the foot. Without this fat padding present, these patients may develop pain around bony prominences, especially the metatarsal heads.

Metatarsalgia can also result from injury to the soft tissue structures around the joint comprised of the metatarsal and its adjacent toe. These injuries can result from trauma or from overactivity especially in athletes.

Treatment of metatarsalgia is specific to the specific type of issue the patient may have. For individuals who have increased pressure around a metatarsal head because of a tight Achilles or an elongated metatarsal, an off-loading pad may be dispensed to decrease pressure to the area. Custom orthotics are an excellent treatment option since they too can decrease the pressure in the painful area under the metatarsal head, and they are specifically customized based on the patient’s foot type. If a callus is present in the painful area, it may shaved down to reduce pain. If there is a specific soft tissue injury that is causing pain, it may be treated with RICE therapy, orthotics, or anti-inflammatory medications.

While the vast majority of metatarsalgia responds to conservative therapy, surgery may be indicated in some patients. Those who have pain due to an elongated metatarsal may benefit from a surgical procedure in which the bone is shortened to reduce stress beneath the head of the bone. If there is damage to a soft tissue structure around the joint of the toe known as the plantar plate, this can also be repaired surgically.

While metatarsalgia is an all-encompassing diagnosis for forefoot pain, there are various possible reasons a patient may be experiencing this form of pain. Do not hesitate to make an appointment at one of our offices to be properly worked up and treated for metatarsalgia. 

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