Metatarsalgia

The metatarsalgia is pain located on the floor of the foot at the metatarsal, particularly in the area corresponding to the head of the metatarsal bone. Metatarsalgias are the most common cause of pain in the sole of the foot. They represent between 75% -80% of the reasons for consultation for foot pain .

They are more frequent in women than in men in a 4/1 ratio. They manifest themselves especially in adulthood, being rare to find them in children or adolescents.

Localized pain in the metatarsal support area is already metatarsalgia by itself, but in most cases in which this occurs it is usually associated with another pathology of the foot, either biomechanical or dermatological, which in most cases is the cause of it.

There are many types of metatarsalgias and they are usually classified according to the cause that produces them. In this way, we can find mechanical metatarsalgia, nerve compression metatarsalgia, inflammatory metatarsalgia, hyperpressure metatarsalgia, metatarsalgia due to generalized diseases or traumatic metatarsalgia. The influence of footwear on the appearance of metatarsalgia explains the highest percentage of them in females.

Why is it produced?

The causes of pain in the forefoot are multiple. Most metatarsalgias are related to a biomechanical alteration of the foot as a whole that concentrates an exaggerated pressure on a certain surface of the front part of the foot in its plantar support. This is the case with mechanical metatarsalgia or hyperpressure metatarsalgia.

The fact that certain structures of the front part of the foot, normally a metatarsal bone and its capsular and muscle-ligamentous structure, bear a greater pressure during the gait cycle, produces an inflammation at this level that initially affects the parts soft composed of the joint capsule and the ligaments and tendons that are in the vicinity. This fact is known by the name of capsulitis, bursitis or tendinitis, each of them referring to the inflammation of the joint capsule, the serous bag or the tendon respectively.

The repeated pressure on these structures causes a progressive trauma capable of initiating an inflammatory process that will be accompanied by pain and therefore the appearance of metatarsalgia.

Within mechanical metatarsalgia we can find those related to the following deformities:

• Hallux Valgus.
• Taylor Bunion or Tailor’s Bunion.
• Equine foot .
• Cavo foot .
• Flat foot .
• First ray insufficiency syndrome.
• Syndrome of insufficiency of the middle radii.
• Metatarsal overload of the first radius.
• Metatarsal overload of the middle radii.
• Other processes unrelated to functional and biomechanical alterations of the foot can also cause pain in the forefoot. These are diseases located at this level, such as:
• Osteonecrosis of the metatarsals.
• Acute or chronic osteomyelitis.
• Rheumatoid arthritis
• Gout .
• Osteoarthritis
• Morton’s neuroma .
• Painful compressive foot syndromes.

All these diseases will cause pain in the forefoot, but the mechanism that develops this symptom is totally different from one disease to another. There is another type of metatarsalgia associated with dermatological problems, such as the presence of calluses or corns located on the sole of the foot. The fact that a callus develops on the sole of the foot in the metatarsal support area, will cause an inflammation of the area and develop the corresponding pain due to the encrustation mechanism of a foreign body, which in this case is the callus. or the hardness in the sole of the foot.

The presence of warts or papillomas in the plantar area of ​​the foot can also cause pain at this level, especially when they are located under the head of the metatarsal bone, coinciding with the area of ​​support during the gait cycle and which is accentuated in the phase of taking the foot off the ground.

Any other dermatological lesion located in this area can cause pain, as this is an area of ​​great friction during ambulation.
Compressive neurological syndromes, whether caused by a neuroma or neuritis, will also cause metatarsalgia. In this case, the cause of the pain may or may not be related to the correct functioning of the foot. Either way, compression at the level of the nerve will cause burning pain associated with a sensation of electrical conduction.

Symptoms of metatarsalgia

The quintessential symptom in the case of metatarsalgia is pain in the anterior part of the foot, in the metatarsal support area. Sometimes the pain can radiate towards the dorsal area of ​​the metatarsophalangeal joint or extend from the root of the finger to affect the entire digital structure.

Metatarsalgia pain has different qualities and intensities, each one obeying the cause that causes it. Mechanical pain is usually more intense as the day goes on and increases with exercise and standing. An arthritic pain occurs in the morning and is slightly relieved by exercise and warming up the joint. Neurological pain is associated with burning sensations and electrical current conduction and is usually relieved by rest and taking off shoes.

Therefore, metatarsal pain presents differently depending on the cause that causes it.

Apart from pain, the existence of inflammation in the forefoot is associated with symptoms such as:

• Swelling of the soft tissues of the affected area.
• Increased temperature of the inflamed area.
• Redness of the skin.

If metatarsalgia is associated with a dermatological problem, the pain in the front part of the foot will be another symptom in addition to those of having a callus, a hardness, a wart or a papilloma. Generally, all metatarsalgias are aggravated by the use of shoes with a high heel and a pointed toe, which explains its higher incidence in females.

How is it diagnosed?

The diagnosis of metatarsalgia will be aimed at revealing the causes that have produced the appearance of pain at this level. In this sense, a physical examination of the patient is necessary in which the structure of the foot, the patient’s footprint, the alienations of the lower limbs and the person’s gait are analyzed.

The radiological study is essential to investigate the bony structures of the foot at this level. Generally, an increase in pressure maintained for a certain period by a metatarsal bone, usually causes a thickening of the cortical bone of the same, which is made evident in the radiographic image by an increase in bone density at this level.

The use of computer systems that are capable of recording the pressures supported by the foot during gait help dramatically in the diagnosis of mechanical or hyperpressure metatarsalgia. These devices are capable of measuring the pressure supported by a certain area of ​​the foot and thus help us to make a correct diagnosis.

Metatarsalgia treatment

The treatment of metatarsalgias depends on the cause that produces them.

Regardless of the cause of metatarsal pain, pain management can be solved with the use of anti-inflammatory or analgesic drugs. Corticosteroid and local anesthetic injections are also used in the treatment of certain metatarsalgias.

In the case of mechanical metatarsalgias, the solution is usually directed to the use of orthopedic insoles that solve the pressure imbalance that occurs during walking. Orthotic insoles are often designed to relieve the affected metatarsal area and distribute the pressure with other areas of the sole of the foot that are more unloaded, thereby increasing the support surface and reducing pressure.

Podiatric surgery can also solve the problems of hyperpressure or biomechanical alterations. This treatment is usually applied in case of failure of conservative treatment and is the last therapeutic alternative to solve the problem of metatarsal pain. The surgery is performed under local anesthesia and does not require hospitalization, allowing the patient to go home after the intervention. Normally, the recovery process usually takes about a month, depending on the technique used and the cause of metatarsalgia.

Avoiding metatarsalgia

To prevent the appearance of metatarsalgias, it may be useful to follow some of the tips that are detailed below:

• Do not wear high-heeled shoes that transfer more support to the front of the foot.
• Go to a podiatrist to treat any digital deformity that could affect the distribution of loads on the sole of the foot.
• Remove calluses and corns from the sole of the foot regularly by going to a Podiatrist for delamination.
• Treat any warts or papillomas that appear on the foot to avoid the appearance of pain.
• Do not wear narrow footwear that compresses the foot and can cause a nerve entrapment developing neuritis or neuroma.
• Monitor the wear of the sole of the shoe in the metatarsal support area. If the wear is excessive or accelerated, it is proof that there is an over-support at this level.