Metatarsal Pain (Metatarsalgia): Examination

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 callus].
      • Gait pattern (fluid, limping) [due to pain, the push-off phase is shortened]
      • Body or joint posture (upright, bent, Schonhaltung).
      • Malpositions (deformities, contractures, shortenings).
      • Muscle atrophies (side comparison!, if necessary circumference measurements).
      • Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
      • Foot
        • [Callus formation in the area of the heads of the ossa metatarsalia (metatarsals) II to IV? (Note: shoe wear can also provide important clues to areas of stress).
        • Examine position of small toes: Claw toe? Can lead to an increase in pressure under the metatarsal heads.
        • Advanced stage: ulcers (skin ulcers), Klavi (corns)]
    • Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion?); soft tissue swelling; tenderness (in mid forefoot area) [thinned fat pad in plantar area?; palpable heads of ossa metatarsalia (metatarsal bones) just under skin (in advanced stage)?]
    • Measurement of joint mobility and range of motion of the joint (according to the neutral-zero method: range of motion is expressed as the maximum deflection of the joint from the neutral position in angular degrees, with the neutral position designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
    • If necessary, special functional tests of the tasometatarsal joints [tarsal-metatarsal joints → stability?]
    • Sensitivity testing [Morton’s neuralgia (nerve compression syndrome)?]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.