CURRENT CONCEPTS IN TREATING METATARSALGIA

Metatarsalgia is a broad term for forefoot pain. It can be caused by overuse or increase in pressure to the metatarsal heads during gait/propulsion. It has been estimated that 90% of all foot disorders occur in the forefoot. Some tests that can be performed for metatarsalgia include: plantar plate provocation test, silverskold testing as well as visually assessing the feet - sullivans sign for example.

Diagnostic testing - xrays, ultrasounds, MRI can also help determine if a neuroma, tenosynovitis, bursitis, plantar plate rupture/tear are present. There are 3 primary classifications of metatarsalgia: plantarflexed, elongated metatarsal, enlarged metatarsal head. Secondary metatarsalgia occurs due to distal placement of the fat pad or conditions that overload the forefoot. Iatrogenic metatarsalgia can also occur due to post-surgical complications after bunion surgery for example.

Conservative care can include: rest, NSAIDs, padding, splinting, orthotics, stretching, injections, footwear modifications/footwear advice. Shockwave therapy may also be beneficial. 

Courtesy of Barry Block, editor of PM News