Metatarsalgia

Metatarsalgia is a non-specific diagnosis of pain in and about the MT head or MTP joint and adjacent soft tissue structures. Underneath each of the metatarsals is a bursal sac (a synovial fluid filled bag) when the foot distorts either by pronation or supination the 1^st metatarsal doesn’t properly bear its share of the weight and the weight is shifted to the metatarsals (usually the 2^nd & 3^rd metatarsals) and the bursal sac becomes inflamed causing pain. It is a description of a region of pain, NOT diagnosis. Metatarsalgia can be broken down into a number of different diagnoses such as Capsulitis, Synovitis, or Neuroma.

Morton’s Neuroma

Typically occurs between the 2^nd and 3^rd metatarsals. There is a transverse metatarsal ligaments that goes from the 5^th metatarsal to the 1^st metatarsal, and as you pronate, the 1^st metatarsal moves up and out medially, and the 5^th metatarsal moves up and out laterally and you transfer more of your body weight onto the 2^nd, 3^rd,& 4^th metatarsals. The transverse ligament is stretched tightly. Weight is also being transferred from the 1^st metatarsal to the lesser metatarsal heads, squishing the plantar nerves between the 2^nd, 3^rd and 4^th metatarsals.

The Schwann cell reacts by enlarging the nerve sheath, creating this benign tumor or cyst called a morton’s neuroma. If left untreated, it could get larger and larger and eventually separate the toes.

Treatment for Morton’s Neuroma

Lower the head of the 1^st metatarsal, both the 5^th and 1^st metatarsals will come down on their respective axes, relieving the stress on the transverse ligament, taking the weight off the 2^nd, 3^rd, 4^th metatarsals, when you remove weight off of a nerve, the body is in a constant state of replacing itself.

Determining the type of metatarsalgia can be done by determining the location of pain, radiation or lack of characteristics of the pain, when the pain is present.

Etiology:
In a cavus foot (high arch foot), metatarsalgia usually develops because of the angle of the metatarsal bones in the high arched foot. The high angle increases the amount of pressure place on the metatarsal heads.

Symptoms:
- Sensation of walking on a pebble
- Shooting pain in middle toes (neuroma)
- Sharp pain toward instep (fracture)
- Aching joint pain when bending toes
- Callus under ball of foot
- Swelling, redness at ball of foot

Treatment:
Foot orthoses to control and/or support the transverse arch with a metatarsal pad or bar to unload and redistribute pressure evenly throughout the metatarsal heads.