Metatarsalgia is pain in the forefoot. The term literally means pain on the metatarsal (there are 5 metatarsal bones in the forefoot). The pain is characterized as aching and it is often worsened by standing and walking. In general, metatarsalgia is caused by repetitive overloading of the forefoot. The most symptomatic area is the base of the 2nd or 3rd toe. Factors that may lead to the development of metatarsalgia include:
- A Bunion Deformity
- Arthritis of the Great Toe
- Ligament Instability of the Midfoot
- An Excessively Tight Calf Muscle
- A Congenital Foot Deformity
- Claw Toe Deformities
Non-Operative Treatment
Patients with Metatarsalgia respond well to non-operative treatment. The goal of non-operative treatment is to off load the involved area. This can be accomplished by a combination of the following methods:
- Comfort Shoes: Heels and pointed toe shoes will worsen symptoms. Shoes with a stiff sole and a slight rocker bottom contour can help take force off of the forefoot.
- Metatarsal Pads: When fitted appropriately metatarsal pads will help bear weight away from the involved metatarsal heads.
Figure 2: Metatarsal Pad
- Soft Orthotics: Soft accommodative orthotics can cushion the localized force and decrease the chance of repeated injury.
- Hammertoe Crest Pad: For patients with an associated clawtoe deformity, it may be helpful to use a hammertoe crest pad or toe taping to bring the toe back into a normal position.
- Activity Modification: A calf muscle contracture will increase stress on the forefoot. Stretching the calf will help ease the pain.
- Anti-inflammatory Medications (NSAIDs):NSAIDs are helpful when symptoms are moderate to severe as they can modify the perception of symptoms. This gives other non-operative treatments time to allow the overloaded area to heal.
- Corticosteroid Injections: Injecting corticosteroids into the involved joint can give temporary relief (1-3 months) in certain cases.
Operative Treatment
In rare cases, non-operative treatment does not work. If the above treatments fail, surgery may be helpful.
It is essential that the primary cause of the metatarsalgia be addressed. If a clawtoe is present, it may be necessary to address this deformity surgically. There are a variety of different ways to surgically correct a clawtoe deformity. The technique chosen depends on the extent of the deformity, the stiffness of the toe, and the surgeon’s preference. If the joint at the base of the involved toe (MTP joint) is swollen it may be helpful to remove the inflamed synovial lining (synovectomy).
If the second and/or third metatarsal heads are long, it may be beneficial to perform a metatarsal shortening osteotomy. By shortening the metatarsal the loading characteristics can be changed and the tendency to load one or more of the metatarsal heads can be altered. If a Bunion deformity is present this deformity may need to be corrected in order to address the abnormal weight bearing of the forefoot.