Diagnosis
In order to be able to make a diagnosis of metatarsalgia, a detailed doctor-patient consultation (anamnesis) is required first, during which, among other things, the footwear and the associated posture of the foot, but also any previous illnesses, such as arthrosis or a previous fracture in the area of the metatarsus, must be asked. The inspection, i.e. the examination of the feet, can be helpful because the doctor can recognize possible deformities, but the actual finding of the metatarsalgia cannot be made in this way. Therefore it is important that the doctor additionally palpates the foot (palpation).
This can lead to increased calluses in the area of the metatarsus, in addition it is possible that the pressure with the fingers on the metatarsus provokes pain in patients. In most patients, palpation can also reveal that the protective fat pad underneath the foot is narrower than it would be physiologically.With the help of these three examination methods – anamnesis, inspection and palpation – metatarsalgia can usually be inferred very reliably. However, the doctor may also request an X-ray of the foot, especially if there is suspicion of a fracture in the metatarsal region, which was the cause of the metatarsalgia. Further diagnostic measures are not necessary.
Symptoms
In the case of metatarsalgia, the patient complains of pain in the metatarsal region, which gets worse especially during exertion. In addition to the load-dependent pain, there is usually an increased callus formation in the area of the metatarsus, which the patient may find unpleasant or disturbing. Further symptoms are rare in metatarsalgia, unless it is a secondary metatarsalgia caused by a previous arthrosis or gout, in which case the symptoms of arthrosis or gout are added.
In the case of metatarsalgia caused by a fracture, it is also possible that swelling and redness, possibly even bruising, may occur in the area of the metatarsus, whereby the bruises change color over time and then appear more yellowish-greenish. During therapy it is important on the one hand to alleviate the patient’s symptoms, and on the other hand it is important to avoid a renewed outbreak of metatarsalgia in the future. For this reason, it is initially highly advisable that the patient wears suitable footwear and avoids high heels and shoes that are too tight.
In many cases, this method alone can help the patient and the foot recovers “on its own”. Insoles that are precisely adapted to the shape of the foot can provide additional support. Since the patient usually complains of pain in the early stages even though he is already wearing suitable shoes, it can help to apply local painkillers at the beginning to prevent a wrong gait caused by the pain.
The aesthetically disturbing calluses can either be removed by the patient himself or with the help of a professional pedicure. In case of a fracture, however, the patient may need additional surgery to achieve optimal healing. In the case of metatarsalgia, which is already far advanced, it may also be necessary to perform surgery in which the metatarsal bones are shortened and the heads of the metatarsals are thus pulled further back. This alters the shape of the foot and its size, but in rare cases the operation itself can also trigger metatarsalgia, so it is particularly important to see your doctor in good time and to make sure that you wear suitable footwear.
