Metatarsalgia: Causes and Treatments

Image Credits: The Foot And Ankle Clinic 

“Life is like a tree and its root is consciousness. Therefore, once we tend the root, the tree as a whole will be healthy.”- Deepak Chopra

What is metatarsalgia? 

Metatarsalgia, is an orthopaedic condition that affects the feet. It impacts the ball of the feet, and results in them becoming painful and inflamed. It is a predominantly lifestyle induced condition and can affect the quality of your life. With the appropriate treatments, the condition can be treated. With a little rest and appropriate footwear, you can manage the health of your feet. 

How is metatarsalgia diagnosed? 

Metatarsalgia is diagnosed via a physical examination that is conducted by your orthopaedic surgeon. The medical consultation will usually begin with an evaluation of your symptoms. Your orthopaedic surgeon will then examine your feet, in order to determine their current condition. Via a series of imaging techniques such as an X-ray, you will be able to find out if you have metatarsalgia, or if you are being impacted by conditions such as stress fractures. Stress fractures and other conditions to be outlined below, actually exhibit similar symptoms to Metatarsalgia. Imaging techniques will provide your orthopaedic surgeon with a clear picture of the internal workings of your feet. Alternate therapies that may be utilized to diagnose the condition include an ultrasound or an MRI. These tools will enable your orthopaedic surgeon to assess the soft tissues that are encasing your metatarsophalangeal joints.

How is metatarsalgia treated?

Once your symptoms are identified and validated as metatarsalgia, the treatment is usually achieved without surgical procedures. Surgery is only utilized as a necessity. In the initial phases of your treatment, your doctor may recommend that you utilize a metatarsal pad, a surgical shoe or a custom orthotic in order to cushion your feet. By changing your shoes to athletic shoes or to rocker shaped soled shoes, you will be able to create an environment of healing that will restore your feet. Great tips for your recovery include: 

  • Picking shoes with good soles, a wide toe box and a lower heel
  • Avoiding walking barefoot
  • Soaking and using pumice stone on your feet to help remove calluses. Removing these calluses can help relieve pressure. People with diabetes should consult their physician first before doing this.

[Reference 1]

The next level of treatment of your metatarsalgia includes the utilization of injection therapy or surgical procedures in order to treat any underlying pain points. 

What are the symptoms of metatarsalgia?

Metatarsalgia is a treatable condition, and if managed properly the symptoms will subside over time. During the active phases, there are a set of symptoms that patients often experience. These sensations include: 

  1. Feeling as if there are stones or marbles in the soles of your feet 
  2. A sharp burning sensation or shooting pain in the ball of your feet
  3. Numbness in your feet 

Prior to your orthopaedic consultation, it will be important for you to ensure that you track when you are experiencing these sensations. In some instances they may worsen when you stand, are in physical activity such as running, or are walking barefoot.

What causes metatarsalgia?

The majority of cases of patients with metatarsalgia are physically active people. Any activity that involves the placing of excessive forces on the feet, will ultimately place pressure on the front of the feet. When you evaluate the design of the body, you’ll notice that the feet actually bear the load of your entire body. A large force on a small surface area, will result in mechanical stresses on the feet. 

The motion of running involves the placement of a constant force on the ball of your feet. With high consistent stresses, there can be the induction of inflammation of the metatarsal area of the feet. The motion can then affect the tendons, ligaments and cartilage in the surrounding area of the bones. 

Metatarsalgia is a lifestyle induced condition. In instances where shoes are worn that are either too small, or too big are worn you may induce stresses to the feet that can cause a foot condition such as metatarsalgia. For active patients who wear shoes without padding and arch support, you can cause more pressure to be applied to the feet when the activities are initiated. 

Genetic conditions such as high arches, differing dimensions of the toes, calluses and hammertoes can impact the development of metatarsalgia. Weight gain can also impact the pressure that is applied to the feet. Additionally, if you have additional orthopaedic conditions that affect the gait of the body, you will have higher odds of developing metatarsalgia.

How is metatarsalgia classified?

There are differing stages of metatarsalgia that are classified as primary, secondary and iatrogenic. During the physical examination, there will be a weight test that is conducted to classify the phase of metatarsalgia that is present in a patient. During the diagnosis phase, there are treatment algorithms that are often applied to the patient’s anatomy in order to determine how severe their metatarsalgia is. One such algorithm is known as the Maestro Cascade.

How is metatarsalgia treated?

Conservative treatments for metatarsalgia include treatments that are based on physical therapy procedures. These include rest of the feet and the utilization of adjusted footwear. In some instances, gravity can work against you and cause the circulating blood to flow to your feet. With a condition such as metatarsalgia, elevation of the feet will balance the circulatory flow. 

With an icing regimen, one of the treatment plans for metatarsalgia involves the elevation of the feet. Where possible, you can utilize a pillow to elevate the feet. There is a pose in yoga that involves the elevation of the feet. If you have the capability, you can elevate your feet against a wall, and lay on your back for about fifteen minutes at the end of each day. 

If you are experiencing any pain symptoms you can actually take the time to create a pain management system. Have an adequate stock of pain relievers such as ibuprofen that will enable you to treat the pain and manage the inflammation. Consult with your physical therapist in order to improve your mobility and strength.

Surgical treatments for metatarsalgia are utilized if the aforementioned procedures aren’t effective. The surgical process is one that is utilized in order to realign metatarsal bones. Surgical processes are often deemed as controversial. The best treatment plan is one that identifies an optimal treatment plan. Treatment parameters include: 

*Physical Activities 

*Age 

*Footwear 

*Posterior Muscle Chain Flexibility 

*Forefoot morphology 

In orthopaedic surgery, there are geometric treatments that are utilized in order to identify what classification of metatarsalgia a patient has. There are algorithms that identify the classification of the patient. One such classification is known as the Maestro Cascade. 

Maestro Cascade

Image Reference: [3]

The Maestro Cascade is an algorithm for Metatarsalgia classification that was formulated by Maestro and Besse. The team differentiated several forefoot morphotypes according to the geometry of the feet. Via a vertical line that is drawn perpendicular to  the axis of the feet, the relative length of the metatarsals of the feet are calculated. Factoring in other geometric parameters of the feet, the classifications are validated. From these classifications, it is possible for categories such as the M2M3, M4M5. From this baseline, your orthopaedic surgeon will determine how best to realign the feet to ideal dimensions.

The Future of Treatment

With all medical treatments, it is possible to treat metatarsalgia with conservative and surgical procedures. With early diagnosis, rest and elevation will improve and restore the health of the feet. In extreme conditions, the patient will have to undergo surgery in order to realign the  metatarsals of the feet. At best, prevention is better than cure. 

References: 

[1] Metatarsalgia: Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/15890-metatarsalgia/management-and-treatment

[2] Metatarsalgia: Healthline : https://www.healthline.com/health/metatarsalgia#treatment

[3] Metatarsalgia Journal Article: https://www.researchgate.net/figure/Measurement-of-Maestro-criteria-and-of-the-M1M2-index-The-red-circles-indicate_fig1_312544160

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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