In this week's blog we are going to discuss a topic that is common in runners and affects the bridge and ball of the foot, known as Metatarsalgia!
Similar to the metacarpals of the hand, the metatarsals are comprised of a proximal base, shaft and distal head. Along with the tarsals, the metatarsals help form the arches of the foot, which are essential in both weightbearing and walking.
The metatarsals are proximally connected to the tarsal bones and distally to the phalanges (toes), essentially connecting the ankle with the toes. They are named I to V medially to laterally, from the dorsal surface of the foot, with the big toe being number 1 and the little toe being number 5.
Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region (the area just before the toes, more commonly referred as the ball-of-the-foot). It is a common inflammatory condition occurring most frequently in the second, third and/or fourth metatarsophalangeal joints, or isolated in the first metatarsophalangeal joint. This is a disorder that can affect the bones as well as joints at the plantar forefoot.
There are several ways that metatarsalgia can occur, but the majority are related to foot and ankle biomechanical abnormalities. These abnormalities can lead to the fundamental definition of Metatarsalgia which is - the repetitive loading of a locally concentrated force in the forefoot during gait.
As this repetitive loading occurs, one or more of the metatarsal heads become painful and/or inflamed due to continued overloading.
Due to its irritation during our normal gait or running pattern It is common to experience acute, recurrent, or chronic pain with Metatarsalgia and the pain is often caused from poorly fitted footwear.
So how do we test for metatarsalgia? Firstly, it’s important to rule out other systemic diseases such as; Diabetic neuropathy, Inflammatory arthropathy, Neurological disease, and Vascular disease. Once these are excluded our examination begins proximally looking at:
· Any swelling, redness or heat in the area.
· Any stiffness or deformity (including length discrepancy) which might alter pressures on the forefoot?
· Tightness through the Achilles tendon or reduced ankle dorsiflexion range of motion
· The arches of the foot, are they excessively high (supinated)? or low (pronated)?
· Are there any Hammer or claw toes evident?
· Is there tenderness through the metatarsal heads or pain elicited on compression of the metatarsal heads.
Metatarsalgia normally responds very well to conservative treatment. Your health care practitioner will use local techniques to initially reduce pain and restore movement to forefoot. This may include ultrasound therapy, hot and cold packs, soft tissue release and joint mobilisations in combination with padding and taping techniques to unload the pressure on the metatarsal heads.
The pressure on the forefoot can be further reduced by engaging in specific stretching and strengthening exercises to restore movement to the joints and strength to the muscles in the foot. If altered foot posture is assessed to be a contributing factor then you may be recommended orthotic inserts in your shoes to provide long standing correction.
3 tips to help minimise the risk of developing metatarsalgia, include:
· Always ensure you are wearing the correct foot wear for the activity or sport you are engaging in.
· Avoid prolonged wearing of footwear that places:
o Excessive tightness on the forefoot (tight-fitting shoes)
o Excessive pressure through the ball of the foot (high heels)
· Ensure adequate rest periods between bouts of exercise.
· If you are returning to activity or sport, especially running, then follow a progressive increase in your loading, increasing the load by not more than 10%, per session.
So that’s an overview of what metatarsalgia is and how it occurs. If you have questions or comments, feel free to e-mail us at firstname.lastname@example.org and we will happily answer them for you.
If you suffer with pain through the ball of your foot, especially with walking or running, then call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.