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Metatarsalgia

  • Author: Britt A Durham, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Jan 22, 2015
 

Background

Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. Metatarsalgia is often referred to as a symptom, rather than as a specific disease. Common causes of metatarsalgia include interdigital neuroma (also known as Morton neuroma), metatarsophalangeal synovitis, avascular necrosis, sesamoiditis, and inflammatory arthritis; however, these causes are often diagnosed separately. (See also the Medscape Reference articles Physical Medicine and Rehabilitation for Morton Neuroma, Surgery for Morton Neuroma, and Avascular Necrosis.)

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Epidemiology

Frequency

United States

Athletes who participate in high-impact sports that involve the lower extremities commonly present with forefoot injuries, including metatarsalgia.[1, 2]

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Functional Anatomy

Body weight is transferred to the foot by gravity. This transfer of force is increased to the forefoot during the mid-stance and push-off phases of walking and running.[2, 3] In the forefoot region, the first and second metatarsal heads receive the greatest amount of this energy transfer. Peak vertical forces reach 275% of body weight during running, and a runner may absorb 110 tons per foot while running 1 mile.[2] Pressure studies have shown that runners spend most of the time weighted over the forefoot while running.

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Sport-Specific Biomechanics

Athletes who take part in high-impact sports that involve running or jumping are at high risk of forefoot injuries.[1, 2] Although track-and-field runners are exposed to the highest level of traumatic forces to the forefoot, many other athletes, including tennis, football, baseball, and soccer players, often present with forefoot injuries.

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Contributor Information and Disclosures
Author

Britt A Durham, MD Director of Risk Management, Department of Emergency Medicine, Martin Luther King Medical and Trauma Center, King-Drew Medical Center; Assistant Professor of Emergency Medicine, Drew College of Medicine; Assistant Clinical Professor of Emergency Medicine, UCLA School of Medicine; Partner and Chief Financial Officer, Durcress Medical Group, California Medical Board District Medical Consultant, Lakewood Atheletic Sports Medicine Team Physician

Britt A Durham, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Anthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD is a member of the following medical societies: California Medical Association, Santa Clara County Medical Association, Monterey County Medical Society

Disclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Daniel Kaplan, MD, to the development and writing of this article.

References
  1. Hockenbury RT. Forefoot problems in athletes. Med Sci Sports Exerc. 1999 Jul. 31(7 suppl):S448-58. [Medline].

  2. Safran MR, McKeag DB, Van Camp SP, eds. The foot: endurance events, marathon. Manual of Sports Medicine. Philadelphia, Pa: Lippincott-Raven; 1998. 485, 558-9.

  3. McPoil TG, McGarvey T. The foot in athletics. Hunt GC, McPoil TG, eds. Clinics in Physical Therapy: Physical Therapy for the Foot and Ankle. 2nd ed. New York, NY: Churchill Livingstone; 1995. 207-35.

  4. Quirk R. Metatarsalgia. Aust Fam Physician. 1996 Jun. 25(6):863-5; 867-9. [Medline].

  5. Steinberg GG, Akins CM, Baran DT, eds. Metatarsalgia. Orthopedics in Primary Care. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999. 284-7.

  6. Kang JH, Chen MD, Chen SC, Hsi WL. Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study. BMC Musculoskelet Disord. 2006. 7:95. [Medline]. [Full Text].

  7. Tóth K, Huszanyik I, Kellermann P, Boda K, Róde L. The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy. Foot Ankle Int. 2007 Jan. 28(1):61-3. [Medline].

  8. Endres S, Quante M. Oedema of the metatarsal heads II-IV and forefoot pain as an unusual manifestation of Lyme disease: a case report. J Med Case Reports. 2007. 1:44. [Medline]. [Full Text].

  9. Iagnocco A, Coari G, Palombi G, Valesini G. Sonography in the study of metatarsalgia. J Rheumatol. 2001 Jun. 28(6):1338-40. [Medline].

  10. Yu JS, Tanner JR. Considerations in metatarsalgia and midfoot pain: an MR imaging perspective. Semin Musculoskelet Radiol. 2002 Jun. 6(2):91-104. [Medline].

  11. Chalmers AC, Busby C, Goyert J, Porter B, Schulzer M. Metatarsalgia and rheumatoid arthritis--a randomized, single blind, sequential trial comparing 2 types of foot orthoses and supportive shoes. J Rheumatol. 2000 Jul. 27(7):1643-7. [Medline].

  12. Kennedy JG, Deland JT. Resolution of metatarsalgia following oblique osteotomy. Clin Orthop Relat Res. 2006 Dec. 453:309-13. [Medline].

  13. O'Kane C, Kilmartin TE. The surgical management of central metatarsalgia. Foot Ankle Int. 2002 May. 23(5):415-9. [Medline].

  14. Pearce CJ, Calder JD. Metatarsalgia: proximal metatarsal osteotomies. Foot Ankle Clin. 2011 Dec. 16(4):597-608. [Medline].

  15. Schuh R, Trnka HJ. Metatarsalgia: distal metatarsal osteotomies. Foot Ankle Clin. 2011 Dec. 16(4):583-95. [Medline].

  16. Lui TH. Percutaneous dorsal closing wedge osteotomy of the metatarsal neck in management of metatarsalgia. Foot (Edinb). 2014 Dec. 24(4):180-5. [Medline].

  17. Pérez-Muñoz I, Escobar-Antón D, Sanz-Gómez TA. The role of Weil and triple Weil osteotomies in the treatment of propulsive metatarsalgia. Foot Ankle Int. 2012 Jun. 33(6):501-6. [Medline].

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