Practice Essentials
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.)
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]
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.
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.
