‘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 pressure.
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.