METATARSALGIA
Metatarsophalangeal joint synovitis or more commonly referred to as metatarsalgia is inflammation to the ball of the foot. It is due to constant, repetitive small forces that cause the soft tissue around the ball of the foot to become inflammed. Symptoms associated with this synovitis include:
- forefoot pain which is worse on weight bearing
- tender when pressed around the ball of the foot
- aggravated when the toes are pulled upwards
- aggravated by high heeled shoes
- callus over the region of the foot
There are a number or reasons why the soft tissue becomes inflammed:
- inappropriate footwear
- tight calves and other muscles
- excessive over-pronation (flatterning of the feet)
Metatarsalgia is treated conservatively initially by addressing the causes that put stress on the region. Forefoot padding is provided to redistribute the pressure and promote healthy foot alignment. It is of paramount importance that appropriate footwear is worn to allow healing to occur. Tightness in the calves and poor foot posture and function are corrected via customized prescription orthoses. This will reduce the shearing forces on the forefoot. Other tight muscles will be identified and a stretching program will be devised. Relief of symptoms can be accelerated by icing, anti-inflammatories and corticosteroid injections.
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METATARSAL STRESS FRACTURE
A metatarsal stress fracture refers to a small crack in one of the long bones in the forefoot (usually the second metatarsal). Unlike a normal fracture, this fracture is not caused by one severe blow. Instead, it is due to constant, repetitive small shocks that cause the metatarsal bone to fail. Symptoms associated with a stress fracture include:
- forefoot throbbing pain which is not severe initially
- pain worsens with activity and also at night
There are a number or reasons why the bone fails:
- recent change in training (including frequency, duration, intensity, training surfaces, reduced recovery)
- tight calves and other muscles
- excessive over-pronation (flatterning of the feet)
- Morton’s foot type: second metatarsal is longer than the first metatarsal
- inappropriate footwear
Stress fractures are treated conservatively by addressing the causes, which put stress on the bone. This is achieved by stopping the above training errors. Tightness in the calves and poor foot posture and function are corrected via customized prescription orthoses and appropriate footwear. Other tight muscles will be identified and a stretching program will be devised. An X-Ray is taken in and if this fails to bring up a stress fracture, a MRI is suggested. In addition to the above treatment protocols, 4-8 weeks of weight-bearing rest is required.
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MORTON'S NEUROMA
Morton's Neuroma is an entrapped nerve that becomes inflamed and thickened due to constant irritation from the surrounding bony structures forming an enlarged bundle of nervous tissue. It often called an ‘inter-digital’ neuroma because it is found between the toes of the foot, most commonly the 3rd and 4th toes. Symptoms associated with a neuroma include:
- dull burning sensation radiating towards the toes
- stinging sensation that can be described as being similar to an electric shock
- pins and needles in the toes
- pain under the ball of the foot is also often experienced
There are a number or reasons why constant irritation on the nerve occurs that leads to a neuroma:
- Unstable foot
- imbalance in the structure of the foot causing abnormal motion
- Poor fitting footwear
- tight shoes restrict room subsequently pressing the bones together and sandwiching the nerve
Initially a neuroma is treated conservatively. This is achieved by addressing the instability within the foot via customized prescription orthoses. Increasing the width of footwear, which may be sandwiching the foot bones together, may also be necessary. In 75% of cases this is sufficient to alleviate symptoms. The next step if this has not been totally successful is a corticosteroid injection to reduce the inflammation. In a small number of cases, surgery may be necessary. This is the last and most permanent course of action. An incision is made in the top of the foot and the entrapped nerve excised. Obviously the results are permanent, but not with out some side affects such as loss of sensation. Your Podiatrist can discuss this course of treatment with you should it be required.
