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Metatarsalgia

WHAT IS IT?

The word “metatarsalgia” means pain in the metatarsal bones, and we use it to define, in general, pain in the forefoot located around the metatarsal heads and phalangeal joints. This is the most frequent location for foot pain.

CAUSES

Metatarsalgias, which encompass multiple disorders causing pain located in the forefoot, are divided into three groups:

• Metatarsalgias of mechanical origin: caused by overloading of the metatarsal heads due to having high arches or club foot; first ray insufficiency syndromes, such as Morton’s toe, metatarsus varus, flat foot, plantar fat atrophy, weakness in the intrinsic muscles of the foot due to ageing and the use of inappropriate shoes; first radius strain syndromes, such as hallux rigidus or sesamoiditis; and middle ray insufficiency syndromes with overloading of the first and fifth secondary metatarsal bones, among others.
• Metatarsalgia due to disorders in the forefoot: At bone level: necrosis, fractures, tumours and osteitis; at joint level: arthritis and osteochondritis; at soft tissue level: Morton’s neuroma, bursitis, verrucas and hyperkeratosis; onychosis and paronychia.
• Metatarsalgia caused by generalised disorders: due to neurological disorders: tarsal tunnel syndrome, complex regional pain syndrome and sciatica; due to vascular disorders, metabolic alterations, gout and diabetes.

Symptoms

The most common symptom in all metatarsalgias, and which defines the disorder, is pain in the forefoot. Beyond this, each disorder or syndrome which leads to the metatarsalgia will have its own specific symptoms and indications.

Mechanical metatarsalgias are caused by strain on the second and fifth metatarsal bones, and there is usually the presence of plantar hyperkeratosis, more commonly known as calluses which appear in where there is excessive pressure.

TREATMENT

Treatment will depend on the cause leading to the metatarsalgia.

Conservative treatment consists in taking weight off the forefoot, including weight loss, the use of insoles and wide-fitting footwear. Non-steroid anti-inflammatory medication, analgesics, cortico-anaesthetic injections and physiotherapy may also be applied.

Surgical treatment is applied once conservative treatment has failed. The surgery most frequently used in the Arthroscopic Surgery Unit is osteotomy of the necks of the affected metatarsal bones, with percutaneous techniques to elevate the head and alter the way they rest. This type of surgery can be carried out on an outpatient basis, using local anaesthetic in the foot, or sedation, and enables the use of orthopedic shoes. Recovery time varies depending on the number of osteotomies and their consolidation.

The Arthroscopic Surgery Unit systematically applies intra-operative platelet-rich plasma (PRP) to assist bone consolidation and reduce inflammatory reaction.