Metatarsalgia is a common foot condition that involves pain in the forefoot, usually arising following significant stress and injury to the head of the metatarsals.
The weight of the body is naturally transferred to the feet when standing and there is a transfer of force between the feet and the ground during simple movements such as walking.
The first and second metatarsal heads are subjected to the most stress in this transfer of energy and may be required to support up to 275% of the body weight during high-impact activities such as running.
Therefore, athletes that participate in these activities are more likely to exposed the metatarsals to high levels of stress, which can result in pain and inflammation.
There are several possible causes of metatarsalgia and it is associated with several other condition of the foot, including:
- Interdigital neuroma (Morton’s neuroma)
- Metatarsophalangeal synovitis
- Avascular necrosis
- Inflammatory arthritis
Some people are at an increased risk of metatarsalgia, such as those that participate in high-impact sporting activities or wear tight fitting or high-heeled shoes that place more stress on the metatarsals.
The primary symptom of metatarsalgia is pain in the foot, which may affect one or both feet. The pain typically presents gradually and gets worse over time, although it can also present suddenly following a specific injury.
The details of the pain can vary and sometimes affects a small area but sometimes affects the entire foot. It can be described as feeling there is a pebble stuck in the foot, or as a burning, aching, shooting, tingling or numb sensation.
Diagnosis of metatarsalgia is usually made based on the reported symptoms of the individual but further investigation is warranted if the pain particularly severe or does not resolve with standard treatment. This may include blood tests, X-ray imaging or other scans to investigate the involvement of other health conditions.
The first step in relieving the pain associated with metatarsalgia is to allow the foot to rest and recover and avoid any identified causes.
For example, if ill-fitting shoes or high impact sports are likely to have caused the condition these should be avoided during the recovery period. For athletes that want to continue with high levels of physical activity, alternative low-impact sports such as cycling or swimming can be recommended.
It is important for affected individual to allow their body to rest sufficiently. Elevating the feet can help to reduce the pressure and aid healing, in addition to using cold therapy (e.g. an ice pack) to reduce inflammation.
Pads or insoles inserted into the shoes that help to absorb the shock and cushion the feet are also very useful support the feet. This helps in both the treatment and prevention of future injury.
Pharmacological management can also help to relieve the pain for the immediate term. Simple analgesic medications, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDS) can be very effective to relieve pain and reduce inflammation.
Although most cases of metatarsalgia can be managed adequately with these techniques, some require more specialized treatment. This may include corticosteroid injections to cope with the pain or surgery to correct the structural abnormalities of the foot.