Metatarsalgia

, characterized by a painful sensation at the metatarsal bones (which together form the so-called forefoot).

Figure: in red, the point of the painful foot in those suffering from metatarsalgia is highlighted

A set of factors usually trigger its appearance, which, if taken individually, would hardly cause the same painful symptomatology.

The diagnosis of metatarsalgia requires an accurate physical examination and a careful analysis of the patient's clinical history. Based on the results of the diagnostic research, it is possible to establish the most appropriate conservative therapy. Surgical treatment is a very remote possibility, which is practiced only in very serious cases.

Brief reminder of the anatomy of the foot

Before describing metatarsalgia, it is helpful to remind readers of the bone structure of the foot.
The foot is mainly composed of:

Tarsal bones
Metatarsal bones
Phalanges

The tarsal bones, as a whole, are 7 and make up a structure called the tarsus. They are classified as broad bones. On the one hand, they are connected with the tibia and fibula (the connecting tarsal bone is the calcaneus); on the other, with the metatarsal bones.
The metatarsal bones (or metatarsals) are 5, arranged parallel to each other. These are long bones, at the ends of which the phalanges articulate.
The phalanges are also 5 and correspond to the toes. Each toe is composed of 3 phalanges, except the big toe, which has only 2 phalanges.

, among overweight individuals, among those who have feet with severe anatomical deformities, among those suffering from rheumatoid arthritis or gout and among those who practice sports, such as walking or running, at good levels.

. As highlighted by the red circle, a hollow foot has a very accentuated plantar arch, which prevents the support with the intermediate part of the foot. This leads, in the long run, to a poor distribution of body weight (which is concentrated on the heel and front of the foot) and a change in the position of the metatarsal bones.

Very strenuous training or physical activity. Medium-high level athletes who train daily tend to suffer from metatarsalgia. The sports activities most at risk are running, tennis, basketball, football and baseball, as they are all sports that involve a lot of running, the use of special footwear and, finally, the continuous impact on a hard surface. or disconnected.
For an amateur athlete, the dangers are lower, however other favoring factors (eg overweight) can more easily take over.
Some congenital or acquired foot deformities. The pes cavus, the hammer toes and the hallux valgus are the main defects of the feet that contribute to the onset of metatarsalgia.
Overweight and obesity. The excess body weight of obese or overweight people affects the lower limbs due to gravity. This leads to greater stress on knee, ankle and foot damage, and an "increased susceptibility to all types of injuries, including metatarsalgia.
Wear certain types of shoes. The shoes that most favor metatarsalgia are heels, worn by women, and shoes required in certain sports.
In addition, it seems that shoes that are too tight also play a decisive role.
Stress fractures. The after-effects of stress fractures in the feet (ie minor bone fractures caused by repeated microtrauma) can cause those who have suffered from them to assume a wrong walk that overloads the forefoot. This could cause, even after some time , the appearance of metatarsalgia.
Morton's neuroma. Morton's neuroma is a very painful disorder that affects the interdigital nerves of the feet (the interdigital nerves of the feet are the nerve endings between the various metatarsals).
painful ankle or inflamed Achilles tendon. To relieve these ailments, sufferers tend to take a different walk than normal. This can lead to overloading the forefoot and the appearance of metatarsalgia.
Freiberg disease. Also called metatarsal osteochondrosis, it is the cause of a process of necrosis that affects the second metatarsal of the foot.
Diabetes. One of the main complications of diabetes is the degeneration of the nerve endings, which reach up to the feet (including the fingers). To find out more, you can consult the article on the site dedicated to the diabetic foot.
Rheumatoid arthritis or gout. They are two inflammatory diseases of the joints that can give rise to severe pain in the ankles and forefoot.

The concept of concurrence of causes is easier to explain with a few examples.
Those who, in addition to suffering from obesity, also suffer from diabetes and / or have the habit of wearing the wrong shoes are more predisposed to metatarsalgia; or those who, with an inflamed Achilles tendon, continue to train and play sports without observing a rest period.

at the level of the forefoot. This sensation, of varying intensity, can be sharp, dull or burning, and tends to get worse when standing, running or walking for a long time.
Other characteristic symptoms of metatarsalgia, however less common than pain in the forefoot, are:

Shooting pains, tingling and numbness in the toes
Feeling of having pebbles in your shoes

APPEARANCE OF SYMPTOMS

Metatarsalgia can appear gradually, but also quite suddenly.
Gradual onset is common in cases of overweight / obesity, rheumatoid arthritis, and foot deformities. The sudden onset, on the other hand, is more frequent among those who decide to radically change some of their daily habits, for example by going from a sedentary lifestyle to an intense sporting activity, or by starting to wear every day types of shoes never worn before. .

WHEN TO SEEK YOUR DOCTOR

Before requesting a medical consultation for forefoot pain, it is good to keep the sore foot at rest for a short period; in fact, many times metatarsalgia problems are mild and can be solved with simple precautions (for example, avoiding shoes with heels, shoes that are too tight, long walks, etc.).
However, if, despite this, the painful sensations do not pass or even worsen, it becomes very important to contact the doctor for a thorough examination.

COMPLICATIONS

Metatarsalgia, if neglected or poorly treated, can lead to worsening of pain in the affected foot and / or the onset of back or hip problems.

or rheumatoid arthritis), prescribes further diagnostic tests, such as x-ray or blood tests.

, can practice sports, such as swimming or cycling, which involve less stress on the damage of the lower limbs.

Ice packs on the aching foot. The application of ice 4-5 times a day, for at least 20 minutes per pack, is an excellent analgesic solution (ie against pain). The ice-rest pairing is called the RICE protocol, where R stands for rest (in English it is "rest") and ICE for ice.

Elevation of the suffering limb. To reduce the stress on the limb, it is good to keep the suffering foot raised, compatibly with the activities carried out during the day.

Taking pain relievers and anti-inflammatories as needed. When the pain is very acute and intolerable, it is recommended to take drugs with pain-relieving and anti-inflammatory powers, such as NSAIDs (non-steroidal anti-inflammatory drugs), paracetamol or cortisone. Attention: cortisones, which are very powerful anti-inflammatory drugs, should only be taken on medical prescription, as their inadequate administration can cause unpleasant side effects.

Wear proper shoes. If the shoes worn daily are responsible for metatarsalgia, it is good to change the type of footwear. If an adequate solution cannot be found, it is advisable to contact a podiatrist, that is, an expert in the treatment and prevention of foot pathologies.

Apply anti-shock insoles to the inside of the shoes you usually wear. There are rubber, gel or cork insoles, which, when applied to shoes worn every day, reduce the impact of the foot against the ground. This remedy is especially important for runners, walkers and anyone who plays sports on a hard surface.

Bring special insoles for the cavus foot. Those who suffer from pes cavus can resort to the use of special insoles, which serve to normalize the abnormal arch and to ensure a more appropriate foot support.

Treatment of the favoring pathologies. The symptoms of metatarsalgia due to diabetes, rheumatoid arthritis, gout or overweight / obesity are also mitigated by treating (as far as possible, of course) the aforementioned pathologies.

SURGICAL TREATMENT

Surgery to resolve metatarsalgia is a therapeutic solution that is rarely considered and only in the absence of other effective remedies.
The operation is in fact reserved for very severe foot deformities and cases of Morton's neuroma characterized by severe and long-standing symptoms.