Metatarsalgia

Findings

a)      Pain on standing or walking but, more particularly, on standing on tiptoes or running, when the forefoot impact on the metatarsal heads flares the pain.

b)      Tender to palpation over the joint on the plantar surface, and pain may be elicited on passive, dorsi- or plantarflexion of the joint.

c)      The foot may have claw toes and be in equines. This brings the metatarsal heads more prominently in contact with the ground. Overlying skin callus on the sole of the foot may be present.

d)     There may be an accompanying interdigital neuritis because the swollen capsule and soft tissue compress the nerve.

Cause

Impact on the metatarsal heads causes bony bruising, plus joint and soft tissue swelling. A clawed or subluxed metatarsal joint is more prominent. Metatarsalgia in several joints may be a presentation for systemic joint disease, such as rheumatoid arthritis.

Treatment

In a normal foot:

a)      Rest from impact sports, but train via non-impact cross-training.

b)      Electrotherapeutic modalities to settle inflammation, such as interferential, ultrasound and laser.

c)      Non-steroidal anti-inflammatory drugs.

d)     Fit a metatarsal, transverse and orthotic proximal to the metatarsal heads, to raise the metatarsal head from impact.

e)      Reintroduce impact with a transverse arch orthotic, and increment training into sprints via the Achilles ladder.

In the equines foot:

a)      A cast-made orthotic will spread the loads, and silicone pads under the tips of the toes will help them from exert pressure on the ground and reduce the force onto the metatarsal heads.

b)      If required, chiropody for the calluses.

c)      Avoid impact sports.

d)     Surgery.

Sports

a)      Metatarsalgia develops in a normal foot with sprint drills. Sprinting requires forefoot propulsion, and runners who have a low knee carry, such as shuffle runners, are unused to impacting and driving through the forefoot for speed. These drills need to be introduced more slowly so as to allow adaptation and conditioning of the bones and joint.

b)      Stop-start games, especially netball and soccer goalkeepers are endangered groups, because sudden stop is mandatory, it will impact on the metatarsals.

The athlete with equinus foot that develops metatarsalgia should consider switching to non-impact sports, but the foot may have adapted over the years, producing large protective calluses.  However, these people have often tried something new, or incremented their activity too fast, and only require treatment of the immediate problem and a return to their old technique to which they have good adapted.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English