METATARSALGIA
Fergus Ross
Education and Training
Salts Tech Step
DEFINITION
Pain in the forefoot region is
referred to as metatarsalgia and it
can be caused by a number of
underlying pathologies
Aetiology
Articular
Extra-articular
Capsulitis
Flexor Tendonopathy
Capsular Tear
Inter Digital Neuroma
Synovitis
Metatarsal Stress Fracture
Arthritis
Avascular Necrosis
Risk Factors
Extrinsic
Intrinsic
Running Surface
Foot Function
Running Shoes
Foot Type
Running Style
Foot Posture Index
Plantar Pressure
Feel
Move
Specific Test
• Plantar Digital Neuroma
Decision Making
Treatment
NSAIDs
Running Shoes
Foot Orthoses
Night Splints
Padding and Strapping
Physical Therapies
Steroid Injections
Surgery
Case Study
48 year old male novice marathon runner was referred with pain in
the forefoot of this left foot.
The patient was otherwise healthy and participated in other sports
Both the patient and the GP were unsure of the cause of the pain
and he had been prescribed a course of NSAIDs and refererred for
an examination and foot orthoses if appropriate
History
A thorough medical history demonstrated no major illnesses, operations or
a history of lower limb injuries
No significant family medical history
The most significant factor was the increase in running and purchasing new
running shoes
The foot was painful during activity and the patient noticed it was very
uncomfortable on the hard tiled floor in the shower when he had forgotten
his flip flops
Presenting Complaint
The pain was under the second and third metatarsal heads but it was worse
directly under the second metatarsal phalangeal joint
The pain tended to occur during the warm up and then disappear. It would
then return towards the end of the run sometimes causing the patient to
stop.
There was no swelling but the area was tender on palpation and when you
extend the 2nd MPJt
Differential Diagnosis
Plantar Capsulitis
Synovitis
Flexor Hallucis Longus Tendinopathy
Bursitis
CAD/CAM EVA Orthoses
Cushioning and Stability
References
Yates B, Merriman’s Assessment of the Lower Limb. Churchill Livingstone, 2009;
pp422 – 424.
Alexander IJ, The Foot Examination and Diagnosis. Churchill Livingstone, 1990