Metatarsalgia

Aka: Metatarsalgia

1. Definition
   1. Pain beneath Metatarsal head
2. Etiology
   1. Abnormally high arch
   2. Improper shoe selection
   3. High heeled shoes
   4. Tight Achilles tendon
3. Associated Conditions
   1. Hammer toe (Claw toe)
   2. Hallux Valgus deformity
4. Symptoms
   1. Burning or cramping pain at Metatarsal heads
   2. Middle Metatarsal heads usually affected
   3. Symptoms worse with activity
   4. Relieved by rest
5. Signs
   1. Tender calluses develop under Metatarsal heads
   2. Dorsal contractures of metatarsophalangeal joints
6. Management
   1. Hard soled shoe or cast for 4-6 weeks
      1. Casting especially indicated for fifth Metatarsal
   2. Transfer weight from Metatarsal heads to neck or shaft
      1. Low-heeled shoe with sufficient forefoot room
      2. Anterior Metatarsal bar
         1. Transfers weight behind Metatarsal heads
      3. Metatarsal pads
   3. Sorbothane pads
      1. Available at Running stores
   4. Visco Heels
      1. More expensive
   5. Trimming or paring callus with pumice stone
      1. Provides only temporary relief
      2. Pressures must be removed from Metatarsal heads
      3. Calluses disappear with time if pressure changed
   6. Warm soaks
   7. Surgery
      1. Indicated if conservative management fails