Pathogenesis (development of disease) The metatarsus, consisting of the metatarsal heads, joints, tendons, ligaments as well as connective tissue, acts as a “shock absorber”. It compensates for pressure or compression loads and unevenness of the ground. Due to an incorrect distribution of the load of the metatarsal bones (lat. Ossa metatarsalia I-V (plural/multiple), numbered from … Metatarsal Pain (Metatarsalgia): Causes
If metatarsalgia is due to a systemic disease (disease affecting an entire organ system) such as hyperuricemia (gout), its therapy is the primary focus. General measures Shoes should have a soft sole. Avoid shoes with high heels – if a heel, then only a low one Prefer shoes that are cobbled wide in the front. … Metatarsal Pain (Metatarsalgia): Therapy
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Brachymetatarsia – relatively rare congenital bone growth disorder; most commonly affects the fourth metatarsal, which stops growing in length earlier than the other bones; most likely autosomal dominant inheritance Hollow foot (pes cavus or pes excavatus). Musculoskeletal system and connective tissue (M00-M99). Arthritis (inflammation of the joints), unspecified. … Metatarsal Pain (Metatarsalgia): Or something else? Differential Diagnosis
The following are the most important conditions or complications that may be contributed to by metatarsalgia (metatarsalgia): Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). High arch (pes excavatus) Musculoskeletal system and connective tissue (M00-M99). Hallux valgus (synonyms: bunion; crooked toe). Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99). Chronic pain conditions, unspecified. … Metatarsal Pain (Metatarsalgia): Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin in the area of the affected foot (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes [isolated tenderness under the affected metatarsal head usually correlates with a … Metatarsal Pain (Metatarsalgia): Examination
2nd order laboratory parameters – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Uric acid in blood serum – if hyperuricemia / gout is suspected.
Therapy goals Reduction of pain and thus increase of mobility. Diagnosis finding Therapy recommendations Anti-inflammatory drugs (non-steroidal anti-inflammatory drugs, NSAIDs), e.g. ibuprofen or acetylsalicylic acid. See also under “Further therapy“. Further notes In an open-label single-center study, 15 women were treated with a hyaluronic acid filler (injection of 20 mg/ml hyaluronic acid and 3 mg/ml … Metatarsal Pain (Metatarsalgia): Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification. X-ray of the foot (dorsoplantar and the lateral X-ray = standard planes of foot X-ray diagnostics) [luxations of the MTP joints (metatarsophalangeal joints; connect the metatarsal bones with the toe bones); flexion … Metatarsal Pain (Metatarsalgia): Diagnostic Tests
If symptoms persist or recur despite conservative therapy, surgery based on the cause of metatarsalgia should be considered. An increasingly less used procedure in this regard is osteotomy (“Weil osteotomy”/separation of bone; subcapital shortening osteotomy). This involves raising or shortening one or more heads of the ossa metatarsalia (metatarsal bones) (position correction) in order to … Metatarsal Pain (Metatarsalgia): Surgical Therapy
To prevent metatarsalgia (midfoot pain), attention must be paid to reducing individual risk factors. Behavioral risk factors Improper footwear such as high heels or shoes with poorly cushioning soles.
The following symptoms and complaints may indicate metatarsalgia (midfoot pain): Activity-dependent pain (stabbing, burning) in the area of the mid forefoot. Painful calluses in the area of the metatarsal heads. Advanced stage: ulcers (skin ulcers), Klavi (corns). Warning signs (red flags) Metatarsalgia on exertion and at rest → think of: Narrowing syndrome of a common … Metatarsal Pain (Metatarsalgia): Symptoms, Complaints, Signs
Medical history (history of illness) is an important component in the diagnosis of metatarsalgia (midfoot pain). Family history Are there frequent musculoskeletal disorders in your family? Social history What is your profession? Do you often wear shoes with high heels? Current medical history/systemic history (somatic and psychological complaints). Are you experiencing pain? If yes, when … Metatarsal Pain (Metatarsalgia): Medical History
