Initial treatment includes regular icing and application of a pressure bandage. The doctor may also recommend not putting weight on the foot for the first 24 hours. After the first 24 hours, the doctor may start passive range of motion (ROM) and ultrasound treatments. Using metatarsal pads and other orthotic devices can help provide relief, even in the early phases of treatment.
Rehabilitation begins on the first day of injury with the goal of restoring normal range of motion, strength, and function. Semi-rigid corrective devices worn in supportive shoes are an effective treatment for metatarsalgia. Supportive shoes worn alone, with or without soft corrective devices, may not provide adequate pain relief.
It's important to not disrupt the healing process. Stretching and strengthening exercises should be done carefully, and returning to a higher-level activity should be gradual and done with caution to prevent re-injury. This obvious decreased level of activity may not be acceptable to some athletes unless they understand the relationship of the pain and activity. The health care provider will likely discourage an the athlete from trying to continue activities that provoke pain.
Removing the callus is not advised because the callus is a response to pressure and is not the primary disease. The health care provider may shave down the callus to provide temporary relief. It is, however, important to avoid bleeding from excessive debridement and the use of acids and other chemicals.
If symptoms are acute with a short duration, abnormal pronation of the subtalar joint in the ankle can be the primary cause. The doctor may recommend using orthotic devices in these cases. Chronic symptoms respond better to a metatarsal bar that can be added to the running or athletic shoe.
Individuals with a high arch who experience pain from metatarsalgia respond well to an orthotic device that provides total contact to the medial longitudinal arch because preventing collapse of the arch reduces the stress on the metatarsal heads. Patients with a Morton toe respond well to a rigid orthotic with an extension underneath the first metatarsal bone.
The primary focus of treatment is restoration of normal biomechanics and relief of pressure in the symptomatic area. Therapy needs to allow the inflammation to subside or resolve by relieving the repeated excessive pressure.
Once the athlete is pain-free, isometric, isotonic, and isokinetic exercises will be started for strengthening. Passive range of motion exercises will progress to active exercises as the inflammation resolves. Therapy to increase range of motion allows improved forward progression of the tibia over the foot with reduced stress on the forefoot. Strengthening the toe flexor muscles may allow for greater weight-bearing capacity on the toes.