Forefoot Pain – Metatarsalgia

Metatarsalgia, which is one of the leading causes of pain in the anterior part of the foot, is an overuse injury . It gives symptoms with pain in the anterior fleshy part of the sole of the foot. It is common in those who do sports, who do sports, who use running and jumping, who wear narrow shoes, and who have structural deformities in their feet.

The metatarsal bones are the bones known as the metatarsal bones, which connect the ankle and the fingers. In medicine, the suffix “ -algia ” refers to pain. For example, arthralgia means joint pain, lumbalgia means low back pain. Metatarsalgia is also pain in the metatarsal bones. From this point of view, it refers to a complaint, not a specific disease. (Patient: My scallops hurt. Doctor: You have metatarsalgia. Patient: I just said that.)

Although metatarsalgia is not a vital problem, it can significantly impair quality of life. The person may have to take a break from the sport they are doing, and standing and walking for a long time may cause discomfort. Cold application and rest are simple self-administered methods for recovery. Using shoes suitable for the foot and insoles if necessary can improve metatarsalgia.

What Are the Symptoms of Metatarsalgia?

  • Sharp pain or soreness on the front of the sole of the foot, burning sensation.
  • The pain increases while standing, running and walking and is relieved by rest. It is more painful to stand and walk barefoot on hard floors.
  • There may be sharp pain, pain, numbness, tingling in the toes.
  • It may feel like there is a stone in the shoe.
  • Pain may be felt in a small area under the toes or across the entire width of the foot.
  • The pain usually does not come on suddenly; develops in a few months.
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Who Gets Metatarsalgia?

Those who do sports involving running and jumping, those who wear high-heeled shoes, those who are overweight, those who have foot problems such as hammertoes or calluses, and inflammatory rheumatic diseases such as rheumatoid arthritis and gout.

Which Department Should I Go to for Foot Pain?

Not every foot pain has to go to the doctor. Most of the time, foot pain occurs due to simple reasons such as standing or walking for longer than usual, and it resolves spontaneously in a few days with rest. However, in case of foot pain that does not improve in a few days, a physical therapy and rehabilitation specialist should be examined. Most foot pain does not require surgery. Orthopedics and traumatology specialists deal with the situations that require surgery.

Causes of Metatarsalgia

Often, a single cause cannot be found for metatarsagia, which means pain in the anterior part of the sole of the foot. All situations with increased load on the forefoot can cause this problem. Usually more than one cause works together.

Excessive activity or training: Metatarsalgia may occur, especially in long-distance runners. It is very important to wear sports shoes.

Certain foot types: Having a high arch can put more strain on the front of the foot (metatarsal bones). In people with the second toe longer than the big toe, a greater proportion of the load is placed on the second metatarsal head. The risk of metatarsalgia also increases with flat feet.

Foot deformities: Wearing very narrow or high-heeled shoes can lead to foot deformities. The “hammer finger”, where the finger is bent from the middle joint, and the “hallux valgus”, which is manifested by painful swelling at the root of the thumb, may cause metatarsalgia.

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Muscle imbalances: The muscles that lift the fingers up (extensors) are too tight, while the muscles that bend the fingers down (flexors) are weak. Tension of the Achilles tendon.

Excess weight: When you are overweight, the load on your feet also increases. Gaining weight in a short time can lead to metatarsalgia. Losing weight can alleviate the symptoms of metatarsalgia.

Old age and diabetes: The frequency of metatarsalgia increases in the elderly and those with diabetes.

Unsuitable shoes : High-heeled shoes put most of the load on the front of the foot. Thin shoes that are narrow at the toe and do not provide adequate sole support can also aggravate the problem. If the sneakers are too loose, the foot slips and rubs during movement. If the shoe is too tight, the pressure the foot is exposed to increases.

Stress fracture: Fractures called stress fractures may occur due to exposure to excessive load in the finger or comb bones. In this case, the way the person puts their foot on the ground changes due to pain. The change in load distribution may cause more strain on other bones.

Morton’s neuroma: It is a problem that usually develops as a result of the growth of connective tissue around the nerve fiber between the third and fourth metatarsal heads. It causes complaints similar to metatarsalgia. It is essentially a nerve entrapment. It can cause pain, numbness and burning sensations.

How Is It Diagnosed?

First of all, the patient’s complaints and risk factors are questioned. It is examined sitting and standing. Painful and sensitive areas are detected by examination. Check for deformity. X-rays can detect problems such as stress fractures. Bursitis and Morton’s neuroma can be detected with ultrasound. Foot MRI (implantation film) provides the visualization of many problems affecting the soft tissues.

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Treatment

If metatarsalgia is not treated, the person’s activities are limited. He can change the way he walks in order not to burden the foot. Due to changing biomechanics, pain may occur in other parts of the same foot, opposite foot, lower back or hip. Therefore, complaints should be treated without delay.

Rest, cooling the painful area with an ice pack for 15-20 minutes several times a day (the ice pack should be wrapped with a cloth to protect the skin), wrapping with elastic bandages to reduce edema, painkillers , wearing appropriate shoes, using metatarsal pads that can be placed in the shoes or arch support Using insoles are the first-line treatment options.

Foot massage is an effective method to relax anatomical structures in the foot and reduce pain.

Exercises that stretch the ankle and toes reduce pain, accelerate healing, and prevent recurrence of metatarsalgia. After the pain is gone, muscle strengthening can be done with isometric, isotonic and isokinetic exercises. Athletes can do activities that do not give weight to the feet, such as swimming, in order not to lose their condition during the recovery period.

Among the physical therapy methods, TENS and ultrasound therapy can be used.

If there are problems such as calluses, hammer toes, hallux valgus in the foot and if physical therapy cannot be healed, surgical options may come to the fore. In the treatment of Morton’s neuroma, cortisone injections (corticosteroid injections) can be applied.

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