ICD 10 - M77.4
Metatarsalgia is a broad diagnosis for a condition that describes pain around the head of the metatarsals, metatarsophalangeal joints and neighboring soft-tissue. Forces from physical activity applied on the forefoot can cause metatarsalgia. Most cases, around 90%, of metatarsalgia are biomechanically driven.
There are three types of metatarsalgia:
- Primary Metatarsalgia: This type of metatarsalgia is caused by the anatomical relationships of the metatarsals to each other. In this case, as an example, having a pathological condition in the first metatarsal can cause metatarsalgia in the second metatarsal due to altered biomechanics.
- Secondary Metatarsalgia: This type of metatarsalgia is caused by indirect mechanics. This type of metatarsalgia is driven by autoimmune disorders, neurological disorders and conditions like gout.
- Iatrogenic Metatarsalgia: This type of metatarsalgia is caused by surgical correction for other pathologies that altered the biomechanics in the foot and caused metatarsalgia.
- Pain and swelling around the metatarsal heads or fat pad of the forefoot
- Increased pain during physical activity
- Having varying overcompensating gaits
To diagnose a patient with metatarsalgia, the clinician will need to observe the past medical history of the patient and also perform a biomechanical examination of the patient. A gait analysis is likely to be needed to correct pathological biomechanics. X-ray and other imaging studies may also be ordered.
Treatment is usually conservative and begins with the RICE protocol. Stretching is useful to correct posture and release tightness in the gastrocnemius. Wearing modified shoes with additional padding and orthotics can also be ordered to help minimize the forces experienced in the area and to correct any pathological gait.
Different kinds of surgery options are available depending on the cause of the metatarsalgia to lengthen the gastrocnemius, repair the plantar plate or perform a tendon transfer. Osteotomies may also be performed if necessary.