Metatarsalgia Workup

Author: Britt A Durham, MD; Chief Editor: Sherwin SW Ho, MD more...

Updated: Feb 28, 2010

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Laboratory Studies
Imaging Studies
Other Tests
Procedures
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Laboratory Studies

Although appearing clinically different from traumatic injuries to the first metatarsophalangeal joint, gout commonly presents with pain at the base of the first toe. Testing of uric acid levels, the erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may be helpful in excluding gouty arthritis and other rheumatologic conditions in subtle cases. Otherwise, laboratory studies are of little benefit in the evaluation of metatarsalgia. (See also the eMedicine article Gout.)

Imaging Studies

A radiographic foot survey is indicated as an initial imaging test and may be helpful in excluding other etiologies of forefoot pain.

Order repeat radiographs and a bone scan to assist the physician with diagnosing or excluding a metatarsal stress fracture. (See also the eMedicine article Metatarsal Stress Fracture.)

Ultrasonography provides useful information about possible pathologic conditions that may be responsible for pain in the metatarsal region of the foot, including bursitis, Morton neuroma, and joint effusions.^[9](See also the eMedicine article Bursitis.)

Yu and Tanner demonstrated that magnetic resonance imaging (MRI) is a powerful, noninvasive method for detecting and diagnosing many causes of pain in the metatarsal and midfoot regions, including conditions caused by trauma, circulatory disorders, arthritides, neuroarthropathies, and those that result in biomechanic imbalance.^[10]

Other Tests

F-Scan (Tekscan, Inc, South Boston, Mass) is an objective measurement system that is used to assess plantar pressures, identify the location of peak pressures, and help with the molding and placement of orthotic devices that can be most effective in dispersing excessive localized forces.

Procedures

A local digital nerve block just below the transverse tarsal ligament may be helpful in the diagnosis of an interdigital neuroma. Patients with an interdigital neuroma should receive relief after the injection.

Proceed to Treatment & Management

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

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 and Santa Clara County Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Russell D White, MD Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, 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, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

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

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

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding

References

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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.
McPoil TG, McGarvey T. The foot in athletics. In: Hunt GC, McPoil TG, eds. Clinics in Physical Therapy: Physical Therapy for the Foot and Ankle. 2^nd ed. New York, NY: Churchill Livingstone; 1995:207-35.
Quirk R. Metatarsalgia. Aust Fam Physician. Jun 1996;25(6):863-5; 867-9. [Medline].
Steinberg GG, Akins CM, Baran DT, eds. Metatarsalgia. Orthopedics in Primary Care. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:284-7.
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].
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. Jan 2007;28(1):61-3. [Medline].
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].
Iagnocco A, Coari G, Palombi G, Valesini G. Sonography in the study of metatarsalgia. J Rheumatol. Jun 2001;28(6):1338-40. [Medline].
Yu JS, Tanner JR. Considerations in metatarsalgia and midfoot pain: an MR imaging perspective. Semin Musculoskelet Radiol. Jun 2002;6(2):91-104. [Medline].
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. Jul 2000;27(7):1643-7. [Medline].
Kennedy JG, Deland JT. Resolution of metatarsalgia following oblique osteotomy. Clin Orthop Relat Res. Dec 2006;453:309-13. [Medline].
O'Kane C, Kilmartin TE. The surgical management of central metatarsalgia. Foot Ankle Int. May 2002;23(5):415-9. [Medline].

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