Metatarsalgia

Metatarsalgia
ICD-10	M77.4
ICD-9	726.70
MeSH	D037061

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List of terms related to Metatarsalgia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Metatarsalgia (literally metatarsal pain, colloquially known as stone bruise) is a general term used to refer to any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals. Metatarsalgia is most often localized to the the first metatarsal head (the ball of the foot just behind the big toe). There are two small sesamoid bones under the first metatarsal head. The next most frequent site of metatarsal head pain is under the second metatarsal. This can be due to either too short a first metatarsal bone or to "hypermobility of the first ray" (metatarsal bone + medial cuneiform bone behind it), both of which result in excess pressure being transmitted into the second metatarsal head.

Causes

Metatarsalgia can be caused by any of the following:

• Abnormal foot mechanics (putting excessive amount of weight bearing pressure on the ball of the foot beneath the toe joint)
• Repetitive foot motion exerting pressure on the ball of foot resulting in connective tissue degeneration
• Severe bunion deformity
• Second toe longer than the big toe
• Structurally unstable arch of the foot
• Tight calf muscles
• Improper fitting footwear (women’s dress shoes, other restrictive footwear with narrow toe box)
• High heels
• High impact activities/sports without proper footwear/orthotics
• Older age (thinning of foot fat pad leads to more susceptibility to pain in the ball of the foot)

Treatment

• First step in the treatment of metatarsalgia is determining the cause of the pain and then carrying out the measures to eliminate that cause

Conservative medical therapy

• Following are the conservative measures for the treatment of metatarsalgia:
  • Changing the improper fitting footwear with shoes having:
    • High and wide toe box (allowing the foot to spread out)
    • Rocker sole (decreases the stress on the ball-of-the-foot)
  • Unloading the pressure to the ball-of-the-foot by following foot-care products:
    • Orthotics with metatarsal pad which is placed behind the ball-of-the-foot (relieves the pressure, and redistributes the weight from painful area to the more tolerant areas)
    • Gel metatarsal cushions
    • Metatarsal bandages

References

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