Metatarsalgia is a general term used to describe pain or discomfort in the forefoot around the area of the metatarsal heads (ball of the foot area), however discomfort in this area can usually be attributed to a specific condition.
The instigation of pain in this area can often be attributed to one or more of the following factors : tight fitting foot-wear, being over-weight, high heels, high intensity exercise (e.g. squash, running) or a trauma such as stepping on a pebble or off a kerb leading to bruising or fracture. Abnormalities in the gait cycle may also cause problems.
Specific conditions giving pain in the forefoot:
Morton’s Neuroma: This condition is most commonly felt as a sharp pain that shoots up from the Metatarsal area towards the ends of the two toes involved. It can also be felt as a burning sensation, tingling or numbness in this area. It comes about because the Plantar digital nerve that serves the skin of the toes becomes irritated, inflamed or is pinched between the Metatarsal heads (imagine tight footwear squeezing the foot). In severe cases the nerve may thicken due to the trauma or because of a fibroma (fibrous lump) or lipoma (fatty lump) occurring.
The most commonly affected toes are the 3rd and 4th, but the 2nd and 3rd toes are also susceptible. It tends to be unilateral I.e. only one foot tends to be affected . Three out of four sufferers are female.
A Podiatrist will attempt to alleviate the problem by placing a shaped pad under metatarsals 2,3 and 4, the idea being to lift and separate the heads of the bones so that the nerve is free from irritation. If this proves successful a simple insole with padding can be created to provide long term relief. In most cases this will prove sufficient.
Ultrasound can be used to try to disperse the neuroma but is varied in it’s success rate and cortisone injections usually only mask the problem for several weeks without curing it.
In chronic cases that don’t respond to the treatments above, surgery may be the ultimate answer so that the neuroma can be physically removed from the affected nerve.
Interdigital Bursitis: A Bursa is a fibrous sac of fluid that arises between a bone and a pressure area. Inter digital bursae are found between the Metatarsal heads and can become inflamed if the Met heads lay very close together, they may also pressurise the digital nerves.
Again padding can help to spread the met heads which in turn brings relief.
Stress (March) Fracture : Comes about after a single or repetitive trauma that fractures the metatarsal head. Something as simple as stepping heavily on a bump or stone or off of a kerb can cause this, especially in the elderly where bone density may be reduced. Runners are also common sufferers.
Symptoms include the sufferer feeling a building pain within the area, mostly on weight bearing, swelling and tenderness in the area is common and sharp pain when direct pressure is applied is usual.
X-rays can prove the diagnosis but can be inconclusive so scans are often used instead.
Initial treatment involves RICE : rest, ice, compression, elevate. Ice the area for around 20 mins per hour. Activity must be halted to allow healing. A Podiatrist would provide appropriate padding and insole/orthotic provision if indicated.
Freiberg’s disease: Most common in teenage girls, this condition is brought about by osteonecrosis (bone death) due to restricted blood supply. The 2nd metatarsal is usually affected.
Surgery is implicated in such cases.
Gout and Arthritis: Gout is caused by an excess of uric acid in the blood , the uric acid crystals cause inflammation in the joints of the body including the joints of the ball of the foot , especially at the base of the big toe. This problem is managed with a change in diet and tablets prescribed by the sufferers GP. It is an extremely painful condition.
Osteoarthritis is due to wear and tear of the joints where cartilage wears away and new bone may be laid down, this all limits joint flexibility and function leading to distortions e.g. bunions and hammer toes. Corns and callosities often arise as a result and the sufferer may need to seek the services of a Podiatrist to deal with these lesions.
Rheumatoid Arthritis is an autoimmune disease whereby the sufferer’s immune system attacks the synovium (tissue surrounding a joint) causing swelling and inflammation. The joints of the feet including the forefoot are often involved. It affects women 3 times as often as men and onset is usually between 40 and 60 years of age.
The Podiatrist can help by removing corns and callus that arise over distorted joints and provide protective insoles or padding.
Diabetes: This can affect the function of nerves in the feet and lead to pain in the metatarsal region. Diabetics should seek regular Podiatry treatments to help maintain good foot health.
Abnormal Gait: If a person has a type of gait (walking) that varies from recognised normal limits, pressure may be unevenly distributed such as in the ball of the foot area causing pain and lesions here.
In such cases a Podiatrist would perform a biomechanical examination to determine the reason for the abnormal gait and prescribe and fit orthotics to try to combat this problem.
Biomechanics and Orthotics can also be used to treat problems higher up the skeletal system e.g. Knee pain, hip pain, lower back pain, and your podiatrist should be able to examine and advise or prescribe accordingly.
For information, advice or a consultation contact us on 01664 569708.