The term metatarsalgia refers to pain in the forefoot located at the metatarsal heads. It is the most common form of foot pain and one of the most frequent causes of pain in humans. It is caused by an inflammatory process that may result from overuse, poor footwear choices, or anatomical abnormalities of the feet that increase pressure in this area. Metatarsalgia can occur in people of all ages and activity levels.
Metatarsal drop can be considered a disease of civilization. Walking on flat, hard surfaces and the daily use of shoes with stiff soles (even worse with high heels) reduces the flexion movements of the toes, while extension movements dominate. As a result, toe pressure during walking is minimal, increasing the load on the metatarsal heads.
Other causes of metatarsal drop may include:
Metatarsal drop is often secondary to problems of the big toe. In hallux valgus, for example, the first metatarsophalangeal joint is often painless, but secondary pain may develop under the head of the second, third, or even fifth metatarsal, as walking shifts weight to the outer edge of the foot.
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The main symptom is forefoot pain during weight-bearing. This pain may be sharp and stabbing, or present as a burning sensation, sometimes described as walking on pebbles. Other symptoms include toe pain or numbness and the formation of calluses beneath the painful areas.
In most cases, clinical history and examination are sufficient to diagnose conditions causing metatarsal drop. However, if a specific pathology such as Morton’s neuroma is suspected, radiographic evaluation and MRI are required.
In the acute phase an anti-inflammatory drug can help reduce inflammation and pain as can local cortisone injections. Particularly important as mentioned is the use of appropriate footwear especially when walking a lot or when playing sports. Shoe inserts, which are made of foam material, fit nicely inside your shoes and prevent shocks. Special insoles must be adapted to each patient and each foot. As metatarsal lesions are related to the dynamic anterior triangle of the foot, a simple pedogram is insufficient. Additional information with gait studies is also necessary for their construction. Silicone metatarsal pads placed inside the shoes just below the metatarsal heads reduce the pressure on the affected area.
Finally, we protect the foot from additional injury by avoiding any additional pressure on it by limiting sports or other intense activities.
When conservative treatment no longer offers any help or there are specific pathologies that need to be treated then we resort to surgical treatment.
The surgery must restore the normal biomechanics of the forefoot and functionality must take precedence over aesthetic parameters. Interventions only on the soft tissues are performed when the deformities are mild but osteotomies are normally required to restore the normal anatomy of the foot. Modern techniques have been developed in recent years with the use of special instruments, thus achieving an excellent result with faster rehabilitation.
Runners have an increased chance of developing this condition due to the significant force exerted on the foot when running.
Hammertoe develops when you wear shoes that are too narrow, causing the toe to curl downwards with a bend in the middle joint, pushing the metatarsal heads down.
Since most of your body weight is transferred to the front of the foot when you move, the extra weight can mean extra pressure on the metatarsals.
High heels, which transfer extra weight to the front of the foot, are one of the main causes of this condition in women. Sneakers without proper support and padding also cause metatarsal problems.
Toe strengthening exercises, as well as stretching of the Achilles and the foot, help to improve the function of the foot.
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