Metatarsalgia (metatarsal pain) is more a nonspecific symptom like headache rather than a disease entity per se and can be due to a variety of causes.
Metatarsals are the bones in your foot immediately before the toes, or what is commonly referred to as the ball of the foot. Metatarsalgia usually manifests secondary to joint problems or irritation of a nerve and occurs due to overuse of the foot leading to increased stress in the metatarsal region.
It is more common at the heads of the second, third and fourth metatarsals, or locally at the first metatarsal head (just before the big toe). The causes of metatarsalgia are many.
You could develop it due to ill-fitting footwear or participation in high-impact activities like running or jumping or sports like tennis, soccer basketball with improper footwear, a high arch of the foot, a tight
Achilles tendon, hammer toe, claw toe, bunion, excess weight, arthritis, gout, Morton’s neuroma (a fibrous growth around a nerve), all of which interfere with the proper transfer of the weight of the body onto the metatarsals, leading to increased stress in that region.
Signs And Symptoms Of Metatarsalgia
The main symptom of metatarsalgia is pain. The onset may be gradual and chronic rather than acute. The pain is in the ball of the foot around the base of the first toe or the second, third and fourth ones.
It is usually described as aching or burning, worsening on standing, walking or running and relieved by rest. There could be tingling or numbness in the toes. Typically the patient may describe the discomfort as a feeling of walking on pebbles.
Tenderness can be elicited in the region of metatarsal heads. A callus may be present. There could be loss of sensation in the toes. In interdigital neuromas, squeezing the metatarsals elicits pain. A painful click could be produced on compressing the metatarsal heads, known as Mudler sign.
The diagnosis is based on history and clinical features. However, to pinpoint the underlying cause you may need to undergo X-ray of the foot to rule out foot problems; lab tests like uric acid levels, ESR and C-reactive protein to rule out gout. Ultrasound or MRI may be indicated in some cases.
Rest, application of ice packs on the affected area, analgesics like aspirin or ibuprofen are of help. Improper footwear needs to be changed, and if need be, insoles can be used. Off-the-shelf or custom made metatarsal pads and arch supports can be helpful. Underlying causes need to be addressed. Rarely, surgery may be necessary to correct the alignment of metatarsal bones.
If untreated, it could lead to pain in other parts of the foot or even the opposite foot. Hip pain or low back pain, limping could result. Avascular necrosis can occur. Joint instability, toe dislocations, chronic stiffness, loss in range of movement of affected parts are some of the other complications.
Prognosis and Prevention
If properly treated as above, prognosis is good. Wearing the right shoes and cushioned metatarsal insoles, weight reduction go a long way in preventing metatarsalgia. Any exercise regimen or sporting activity should be gradually increased in intensity depending on comfort level.
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