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Metatarsalgia

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.

Individuals with a high arch who experience pain from metatarsalgia respond well to an orthotic device. Patients with a Morton neuroma respond well to a rigid orthotic with an extension underneath the first metatarsal bone.

Recovery Phase

Physical Therapy

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 disappears. 

Recreational Therapy

Alternate forms of conditioning and training during healing should be encouraged. For example, swimming is an excellent exercise for maintaining physical conditioning while the patient is in a restricted weight-bearing phase of healing. 

Other Treatment

Patients with an interdigital neuroma can benefit from a nerve block in combination with long-acting steroids. Individuals with primary metatarsalgia receive little benefit from these types of injections.

 

Maintenance Phase

Physical Therapy

As inflammation subsides, an orthotic device often is the only intervention required to maintain normal mechanical function. These devices are necessary to distribute force away from the site of injury. At the very least, regular replacement of shoes, especially for runners, can help to maintain support for the foot.Patients should continue self-mobilization exercises, including long-axis distraction and dorsal/plantar glides as directed by the practitioner.

Surgical Intervention

Shoe modification with an orthotic may be the only treatment required, although in severe cases, surgical realignment of the metatarsal bones may be required.

Consultations

A patient may be referred to an orthopedic or podiatric specialist if the condition is not improving or is worsening.

WebMD Medical Reference from Medscape

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