Metatarsalgia is a non-specific term for pain in
the forefoot. The generally accepted theory
is that the pain is occurring in or near the
metatarsal heads, the metatarsophalangeal
joints (MPJs) or is caused by soft tissue injury.
It can be a challenging problem because of
the vagueness of the symptoms and the vast
conditions it could encompass. Metatarsalgia
can have a multitude of causes, making it vital
to identify the aetiology and treat the specific
causes of this complex condition.
The multiple causes of Metatarsalgia can
include biomechanical imbalance, systemic
disease or localised pathology, which all require
different approaches to treatment. A differential
diagnosis may include neuroma, capsulitis,
bursitis, plantar plate tear, stress fracture, fat
pad atrophy, Freiberg’s infraction, rheumatoid
arthritis, sesamoiditis and calluses.
The mainstay in treating Metatarsalgia is
non-operative management.
Podiatrists have a fundamental understanding
of anatomy and biomechanics, and emphasising
a thorough history and physical examination
can aid in identifying the diagnosis and creating
a treatment plan.
Metatarsalgia can usually be easily managed by
offloading the injured area and improving foot
function through;
• Orthotics – The goals of orthotic therapy
in treating metatarsalgia are rebalancing
the metatarsal load and, when necessary,
cushioning the affected metatarsal heads.
• Metatarsal pads, metatarsal bars- The primary
purpose of metatarsal pads is to transfer the
weight proximally to the metatarsal shafts.
• Footwear advice and footwear modifications
• Modification of weight bearing activity that
may be stressing the area
Metatarsalgia isn’t confined to one particular
gender or age group, although it is women
who wear high heels, and those types of
shoes contribute significantly to the problem.
However, athletes of either gender who run,
walk, play tennis, etc. in worn-out, too-tight or
improper shoes can develop the problem, as can
anyone who for, whatever reason, wears shoes
that cause the forefoot to receive too much
Early intervention is the most important
part in helping these patients achieve the
best and fastest results possible. Podiatry
is an essential ingredient in treating this
debilitating condition. If you see this
condition with any of your patients, please
think of referring to us so that we can assist
you in getting the best results possible
for your patients. We would welcome the
opportunity to dialogue with you.