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Metatarsalgia

EVALUATION

X-rays may be helpful in excluding other causes of forefoot pain.

A bone scan can pinpoint places of inflammation.

Ultrasound can help identify conditions such as bursitis or Morton neuroma that can be causing pain in the metatarsal region of the foot.

The doctor may also ask for an MRI to help detect and diagnose many causes of pain in the metatarsal and midfoot regions. These can include traumatic disorders, circulatory conditions, arthritis, neuroarthropathies, and conditions that result in biomechanical imbalance.

The doctor may also ask for other tests and procedures to help in the diagnosis and in determining the proper treatment.

TREATMENT

Acute Phase

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. At this point, a change in footwear is recommended.

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. The health care provider will likely discourage an athlete from trying to continue activities that cause pain.

Other Treatment

If there is a callus, the doctor may shave it down to provide temporary relief. It is, however, important to avoid bleeding from excessive debridement and the use of acids and other chemicals. In addition to shaving down the callous, it is important to determine the cause of the callous, which is a response to pressure.

If symptoms are acute but don't last long, 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.

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