Return to Play
The timetable for a patient's return to normal athletic function depends upon the nature of the injury and the specific demands of the particular sport. Resolution of the pathologic deficits that are associated with the injury includes restoration of flexibility, strength, aerobic fitness, good nutrition, and proprioception, which are required for each sport activity. Acceleration of physical activity should occur gradually and with stretching, both as a warm-up and warm-down.
Returning to play for most injured athletes exposes them to the same traumatic conditions that resulted in the original injury. Therefore, the individual must be completely healed, free of symptoms, and prepared for resuming the stress and trauma inherent to the sport. Track-and-field athletes should have normal orthokinetics, balance, and 90% of normal baseline strength before returning to play. Proper selection of running and training shoes is critically important to prevent reinjury.
Complications
Freiberg avascular necrosis can occur from a congenital, traumatic, or vascular etiology. An athletic injury is unlikely to be the sole cause of avascular necrosis; however, mechanical stress to the forefoot from high-impact sports may precipitate a previous predisposition to this condition. Progression of attritional ligamentous injury may result in a crossover deformity, joint instability, and toe dislocation. Loss of flexibility can lead to chronic stiffness and loss in ROM. (See also the eMedicine article Freiberg Infraction.)
Prevention
The preventive goal should focus on eliminating abnormal friction or pressure. Orthotics, metatarsal pads, and callus care can be used to prevent muscular and stress imbalances. Callus care includes razor debridement and buffing, which enhance tissue elasticity.
Some foot problems may not be caused by disease but by improper footwear. Proper positioning of the foot within the shoe depends upon appropriate fitting, as no 2 feet are the same. Athletes who perform on hard surfaces should make certain that new shoes have adequate cushioning. Rubber heels and soles that absorb shock better than other materials are helpful for athletes who perform repetitive running and jumping on hard surfaces.
Prognosis
Generally, with the treatment described in the Treatment section, the prognosis for metatarsalgia is good.
Education
Athletes who suddenly and dramatically increase training activity are at risk of forefoot injury. Whether the increase is in time or intensity, athletes should increase their levels of activity gradually, and they should never exercise through the pain.
Long-distance runners, women, and athletes who diet to qualify for certain weight divisions may experience bone loss from nutritional deficiency, predisposing them to foot injury. A well-rounded diet is necessary for healthy tissues.
The selection of footwear and orthotic devices is an important part of foot care and injury prevention. Warm-up and passive stretching increase vascular supply and flexibility.
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