Metatarsalgia

Metatarsalgia is ball of the foot pain.  Metatarsalgia is a catch all term for ball of foot pain. There are different types of ball of the foot pains.  In this article I will address general ball of foot pain.  The patient will have pain of the bones and or joints of the ball of the foot.  I will review general metatarsalgia and future articles I will address more specific ball of foot pain for example; Morton’s neuroma, plantar plate injury, metatarsal fracture, hammertoes.  

With ball of foot pain one would have pain, discomfort, soreness of the ball and may or may not have inflammation, bruising or temperature. 

There are many causes of metatarsalgia but not limited to; Position of the bones-metatarsals:

  • Foot biomechanics

  • Trauma 

  • Shoes

  • High arch foot type

  • Increased pronation

Symptoms-Pain, discomfort, inflammation usually develops over time, but can be acute.  Can form thickened callus or corn on the ball of the foot which usually develops over time and then suddenly becomes sore.

Examination of the foot- Check the foot for pain with palpation of the ball of the foot, range of motion of the ball of the foot joints and toes, presence of thickened skin, bone alignment and position, swelling. Also check muscle strength and toe position.   Imaging may be ordered ie xray, ultrasound, CT, MRI.

Treatment- As a generalization treatment would include but not limited to change of shoe gear a more supportive shoe also make sure shoes are not worn out.  Ball of foot pads- gel pad, metatarsal pad or U shaped pad to offload a metatarsal head. Topical, oral or injectable medications. Insoles or custom orthotics. Immobilization- wrap, cast or post op shoe.  Debridement of thickened callused skin.  Surgery.

As stated earlier I will address other ball of the foot problems in future articles.

Types of Orthotics

Foot.jpg

Custom molded orthotics are a device which repositions your feet in a more biomechanically efficient position.  The realignment of the muscles, tendons and joints allows the foot to function more efficiently.  The realignment takes the stress off the painful, malaligned or damaged tissues.  

There are different types of orthotics available. Custom molded structural and functional orthotics and accommodative ones.  Structural/functional orthotics  reposition and support the foot. Enhance biomechanical control of the foot motions and compensate for malalignment placing the foot in  a more stable position and take the stresses off the painful areas of the foot.  Accommodative orthotics reduce pressure under painful boney prominences, redistribute forces off of painful areas and give cushioning and minimal realignment of the foot.

After the history and physical examination of the feet and diagnosis is made custom orthotics may be one of the recommended treatment options.  Custom orthotics are used for many different medical indications; 

  • Structural – pes planus, pes cavus

  • Plantar fasciitis/heel spur syndrome

  • Arthritis

  • Morton’s neuroma

  • Metatarsalgia/periostitis

  • Hallux Abducto Valgus (bunion), Hallux Limitus, Hallux Rigidus

  • Corn/callus

  • Sesamoiditis

  • Diabetes

  • Calcaneal apophysitis

  • Tendonitis –Achilles, Posterior Tibial Tendonitis 

  • Ankle 

  • Sinus tarsi syndrome

  • Tarsal tunnel syndrome

  • Shin Splints

  • Overuse

  • Knee pain

  • Iliotibial band syndrome

  • Low back-SI

  • Hip pain

There are many different types of orthotic materials, corrections, modifications and accommodations available for the Podiatrist to choose from.   The choices depend on many factors; history, symptoms, diagnosis, what the Podiatrist is trying to achieve, foot type, activity, work, shoe type, weight, foot biomechanics/alignment.  

Orthotic shell is made from different materials including; plastics (polypropylene, polynyolene), composite, molds. There are many different cushioning and cover materials available; poron, PPT, neoprene, Spenco, nyplex, P Cell, plastizote, EVA, vinyl, leather, suede.   The prescription for orthotics includes the angles/degrees of correction that are measured and put into the orthotics. Also the Podiatrist decides on the heel and forefoot position, arch height, orthotic width and length.  For different foot issues different modifications and additions are put into the orthotics.  Heel pain would add a heel hole, plantar fasciitis heel  and forefoot accommodation, ball of the foot pain a metatarsal pad or bar, Morton’s neuroma a metatarsal pad or neuroma strip pad, Posterior Tibial Tendonitis or Dysfunction a inner arch flare and added material flare, sesamoiditis a dancer’s pad. Specific heel wedging for knee pain. 

The various types of custom molded orthotics available are;

  • general purpose

  • dress

  • sport general or specific

  • children

  • arthritic

  • diabetic

  • peripheral vascular disease.

There a lot of factors that are taken into account in choosing the right type of orthotic.  Orthotics may be one aspect of the treatment plan a Podiatrist can offer.   It is recommended to see a Doctor of Podiatric Medicine if one is considering orthotics to get a thorough evaluation, examination, diagnosis and treatment plan.