Forefoot pain (metatarsalgia)
Literally, “metatarsalgia” means pain in the metatarsals of the foot, or forefoot pain.
The pain is commonly on the sole of the foot and often sharp, described as similar to walking on pebbles or like having a stone in the shoe. However, there are a variety of possible causes of metatarsalgia and consequently the type of pain described varies also. Some people describe localised pain to one or two toes whilst others describe more generalised pain or burning pain.
The main symptom is that of pain. Sometimes there is associated swelling in the foot although frequently there is none. There may be build up of hard skin over the painful area. This is called a callosity. People usually report more pain when taking weight through the affected foot but sometimes also complain of pain when at rest or in bed at night. Sometimes numbness accompanies pain into the toes. Depending upon the cause, some people might have noticed a problem with the shape of their foot or toes which may also be relevant. Overall, these symptoms can often interfere with comfort in shoes and ability to walk or play sport.
There are many causes of metatarsalgia and your surgeon will make a careful assessment to decide upon the correct diagnosis and treatment.
Problems with the mechanics of the foot (the way body weight is distributed)
- Overuse (eg sports)
- Hallux valgus (bunions)
- Hallux rigidus (arthritis of the big toe)
Problems with inflammation in the joints of the forefoot
- Arthritis (various different types can affect the foot)
Problems with the bones
- Fracture of a metatarsal
- “Stress reaction” in a metatarsal (can precede a fracture)
Problems with the nerves
- The most common nerve problem is called Morton’s neuroma. This occurs when one or more of the nerves supplying sensation to the toes are squeezed and irritated over a period of time causing scarring of the nerve and in turn more persistent pain in the forefoot (often including a burning pain and feeling of numbness in the affected toes).
Problems with the toes
- Deformed toes rubbing in the shoe
Finding the correct diagnosis and hence cause of the metatarsalgia is essential to being able to advise the correct treatment. Sometimes more than one diagnosis is present.
Your orthopaedic surgeon will talk to you to gain clues from the history of your condition and will then examine you. Xrays and other investigations such as magnetic resonance imaging (MRI) may also be required and the surgeon will discuss these with you. Only when a diagnosis has been made can treatment be initiated.
A ruptured tendon can be treated non-operatively with Plaster of Paris and then “functional” bracing or with surgery. Each method has its advantages and disadvantages. Non-operative treatment is associated with a much higher re-rupture rate, but surgery can be complicated by infection.
Using minimally invasive surgery, many of the problems encountered with older techniques are totally avoidable. However, the period of immobilisation after surgery for metatarsalgia (forefoot pain) in a brace is about eight weeks and it takes approximately six months to return to normal activity.