Metatarsalgia refers to pain in the midfoot. Most often, they occur due to stress such as running.
What is metatarsalgia?
We talk about metatarsalgia when pain occurs in the midfoot. The discomfort is felt below the heads of the metatarsal bones (ossa metatarsalia), usually during weight-bearing activities. The term metatarsalgia is composed of the Greek terms “metatarsus” (metatarsus) and “algos” (pain). The metatarsal bones 2 to 5 are affected by the complaints, whereas pain in the first metatarsal bone is treated separately. The female gender is particularly affected by metatarsalgia, as women often wear shoes with high heels. In the context of metatarsalgia, a splay foot is formed because the metatarsal bones press on the sole of the foot. It is not uncommon for calluses to form underneath the foot. In medicine, a distinction is made between primary and secondary metatarsalgia. In the primary form, the cause of the pain is due to local triggers. In contrast, secondary metatarsalgia results from systemic diseases such as arterial circulatory disorders, gout or rheumatism.
Causes
In most cases, primary metatarsalgia is caused by overuse or poor posture. Promoting the metatarsal symptoms are claw toes, hammer toes or a crooked toe (hallux valgus). Increasing age also plays a role. Over the years, the protective fat cushion under the foot increasingly degrades and can no longer cushion the steps when walking. In the event of incorrect loading or overloading, metatarsalgia is then imminent. In most cases, metatarsalgia is seen in women who prefer to wear shoes with high heels or shoes that are too tight. This promotes a malformation of the foot, which then in turn causes pain in the metatarsus. But diseases of the foot can also be the cause of metatarsalgia. First and foremost, this includes tendonitis, in which the tendons that run toward the bone suffer from overuse, resulting in painful inflammation. Furthermore, ligament overload in the metatarsus can be responsible for metatarsalgia. Another common reason is injuries to the affected area, such as bruises and fractures. In rare cases, metatarsal discomfort results from chronic periosteum inflammation, soft tissue tumors, bone tumors, or aseptic bone necrosis. Secondary metatarsalgia is pain in the midfoot that results from an underlying condition. This usually involves chronic conditions such as osteoarthritis that originate in other areas of the body and spread to the midfoot. Other triggers for secondary metatarsalgia include rheumatic diseases or gout.
Symptoms, complaints, and signs
Metatarsalgia is noticeable by pain in the metatarsus. Under stress, the discomfort intensifies. In addition, calluses often form in the metatarsal region, which are often perceived as unpleasant. Only rarely do metatarsalgia present with other symptoms. If the patient suffers from the secondary form, there is sometimes a risk of additional impairments due to the triggering disease, such as gout or osteoarthritis. If a bone fracture is causative for metatarsalgia, there is a risk of redness and swelling as well as the formation of a hematoma (bruise). As the condition progresses, the bruise takes on a yellow-green color.
Diagnosis and course of the disease
If metatarsalgia is suspected, a visit to the doctor is advisable. The physician first deals with the patient’s medical history. In doing so, he inquires about what footwear the affected person uses and whether there may be any malpositions. Also important are previous bone fractures and any pre-existing conditions such as osteoarthritis. Following the questioning, the doctor examines the painful foot. Possible deformities can be determined. The physician also carefully palpates the foot. He can also use finger pressure to induce painful reactions of the foot. Furthermore, he checks the extent of the protective fat pad. Occasionally, it may also be necessary to take X-rays. This is especially the case when a metatarsal fracture is suspected. In most people, metatarsalgia takes a positive course.Thus, the problem can usually be solved by better footwear. However, problems can occur at an advanced stage, often requiring surgical intervention.
Complications
With metatarsalgia, sufferers primarily experience severe pain in the feet. This pain can take the form of either pain at rest or pain on exertion, significantly reducing the patient’s quality of life. Furthermore, pain at rest can also lead to sleep problems and thus to depression and other psychological restrictions. In most cases, the affected person also appears irritable and fatigued as a result. Metatarsalgia also has a negative effect on movement and can lead to restrictions in movement and thus also in everyday life. It is not uncommon for the affected regions to be restricted and for bruising to occur. Furthermore, the course of metatarsalgia strongly depends on the cause of the pain, so that a general prediction is usually not possible. In most cases, however, the symptoms can be limited relatively well, so that no further complications occur. With the help of painkillers or by sparing the feet, the discomfort can be significantly reduced. Special insoles can also have a positive effect on metatarsalgia and prevent complications. Surgical interventions are only necessary in a few cases. The patient’s life expectancy is not reduced by metatarsalgia.
When should you see a doctor?
Pain in the metatarsal region may be based on overuse or overstressing of the body. If the discomfort gradually recedes during a break and disappears completely after a restful night’s sleep, no doctor is needed. In these cases, recovery is often achieved after just a few hours. In the future, the body’s resilience should be taken into account when performing sports or work activities, as well as during leisure time. Timely and sufficient rest or restructuring in the performance of necessary tasks can already lead to permanent freedom from symptoms. A visit to the doctor is necessary as soon as the pain already occurs during the performance of normal activities or it no longer subsides. If there is swelling of the foot, if sufficient rest does not relieve the symptoms, or if discoloration of the skin is noticed, a doctor should be consulted. If the pain increases in intensity or spreads further, a doctor is needed. It is always advisable to consult a physician before taking any pain medication. Complications or further impairments may occur, which must be clarified in advance. If a bruise develops or calluses develop on the affected region, a doctor should be consulted.
Treatment and therapy
Treatment of metatarsalgia can be conservative or surgical. One of the most important conservative measures is for the patient to replace his incorrect footwear with shoes that fit properly. This means that he must refrain from wearing shoes that are too tight and high heels. This measure is often enough to bring about a lasting improvement in the symptoms, as the foot then recovers on its own. Support can also be provided by insoles in the shoes, which can be precisely adapted to the shape of the patient’s foot. At the beginning of the treatment, the patient also receives medication to relieve the pain. If the calluses that have developed have a negative effect on the aesthetics of the foot, there is the option of removing them yourself or having them removed by a professional podiatrist. In the case of pronounced metatarsalgia, however, surgery may be necessary. This usually involves shortening the metatarsal bones in an osteotomy. It is not uncommon for the surgeon to shift the heads of several metatarsals simultaneously four to eight millimeters toward the center of the body during the procedure.
Outlook and prognosis
Normally, the prognosis of metatarsalgia is favorable. In this disease, the affected person has the opportunity to bring about numerous improvements in his or her health by himself or herself. In addition to medical care, the patient’s cooperation is desired and required in everyday life with this disease. Otherwise, there will be an increase in health impairments or a chronification of the complaints.For a positive development and thus a favorable prognosis, restructuring should take place in the performance of daily duties. Movement patterns must be optimized and, in parallel, the body should be sufficiently relieved. Often, the fulfillment of professional tasks or leisure activities should be optimized. The patient should learn to react to the signals of his organism and bring about changes in time. In a physiotherapy session, exercises are trained to bring about a significant improvement in the situation. These training sessions should also be implemented on the patient’s own responsibility outside of the sessions in order to positively support the healing process and bring about long-term changes. Without the cooperation of the affected person, usually only temporary improvements are seen. In some cases, surgical intervention is necessary. This is associated with the usual risks. Nevertheless, it is often the only way to achieve lasting relief from the symptoms. Wearing appropriate footwear contributes significantly to a positive outlook and optimization.
Prevention
To prevent metatarsalgia from occurring in the first place, only appropriate footwear should be worn at all times. For sports activities, the use of insoles is useful. These can adapt optimally to the shape of the foot.
Aftercare
The aftercare of metatarsalgia often leads to a change in the usual routines. Accompanying measures can alleviate the symptoms, which has a positive effect on the patient’s quality of life. There are various self-help options, which the doctor explains in direct conversation with the affected person. The typical swelling in the foot area and often in other parts of the body causes pain. These are reduced by taking the appropriate medication. Patients should follow the doctor’s instructions for these remedies exactly in order to avoid overdosing. Comfortable footwear helps against the foot pain. Sports activities should be limited until complete recovery and, if possible, only in consultation with the attending physician. With the help of a physiotherapist, an individual exercise program is developed, which patients can carry out themselves following detailed instructions. The exercises improve their fitness and make them feel better. This has a positive effect on their overall condition and increases their quality of life.
Here’s what you can do yourself
Those who suffer from metatarsalgia do not always have to have this treated surgically. Often it is already sufficient to change the footwear. Affected people should avoid shoes that are too tight and high heels. This is usually enough to provide lasting relief from the symptoms and to achieve a recovery of the foot. In addition, insoles can be used, which can be adapted exactly to the shape of the foot. Painkillers prevent the pain of malpositioning and further discomfort in the first period. The calluses that have already developed can be removed with the help of a gentle pumice stone and other aids from the drugstore. To avoid injury, however, professional foot care should be sought for large calluses. Furthermore, sufferers should determine the cause of metatarsalgia and take the necessary countermeasures. Since pain in the metatarsus is usually caused by poor posture or malpositioning of the toes, surgery is often the only option. Therefore, people who are affected by metatarsalgia should definitely talk to their family doctor or an orthopedist. The doctor can advise further strategies to reduce the pain and regain a healthy gait.
