Metatarsalgia: Throw the kitchen sink at it


Metatarsalgia is not really something that you can throw the kitchen sink at, as there is not really such a thing as “metatarsalgia”. Metatarsalgia means pain (-algia) in the forefoot or metatarsal region (Metatars-). It should be obvious just from what the word means that pain in the forefoot (ie metatarsalgia) could be due to any one of literally 100’s of different things. To say that someone has metatarsalgia is like saying you have a sore knee or a headache, which those too could be due to literally any one of 100’s of different things. So, the term metatarsalgia is just a descriptive term for pain in the forefoot. It is not a diagnosis. There is no treatment that can be directed at “metatarsalgia”. There is plenty of treatment that can be directed at the different causes, but the actual diagnosis as to what is causing the pain in the forefoot needs to be determined first as the treatment for the different causes of it are all going to be different.

What can cause metatarsalgia?

There are a lot of different things that can cause pain in the forefoot. They will each have different symptoms and different treatments. There is no one cause of “metatarsalgia”.

Some of the more common reasons for pain in the forefoot can be:

Morton’s neuroma.
Plantar callus
Stress fractures
Rheumatoid Arthritis
‘Overload’ syndrome
Fat pad atrophy
Freiberg’s disease
Plantar plate tear

What is the treatment for metatarsalgia?

Just from that above short list of potential causes, it should be obvious that they are each gong to need a different treatment. That just goes to show as to why it is important to get the diagnosis right first. Using the wrong treatment for the wrong diagnosis is not going to be that helpful.

If it was due to a Morton’s neuroma, then that is going to need wider shoes, a metatarsal pad and maybe on injection. If its due to sesamoiditis, then that is going to need offloading padding in the short term and foot orthotics to get weight off the sesamoids in the medium term. A stress fracture is going to need rest and then a careful and gradual return to activity levels. Fat pad atrophy is going to need to be managed with cushioning insoles. A plantar plate tear is best managed with metatarsal pads and strapping to hold the toe in a plantarflexed position. A plantar callus is going to need to be debrided by a podiatrist and then further assessment as to what was causing the higher pressure to lead to the callus. And, so it goes on for the different causes. All are going to need a different treatment approach.

Forum Questions and Discussions on Metatarsalgia

Metatarsal pads and metatarsalgia
Foot orthotics for metatarsalgia
Quality of life and metatarsalgia
MRI of metatarsalgia
Metatarsalgia, an unusual thing happened to make it better

Personal Opinion

The term “metatarsalgia” should not be used. In particular it should not be given as as diagnosis. If you have been diagnosed with metatarsalgia, then go back or get a second opinion as to what it really is.

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