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    Metatarsalgia

    TREATMENT continued...

    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.

    MEDICATION

    Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, are useful; however, they rarely provide a long-term solution.

    FOLLOW-UP

    Return to Play

    Returning to play for most injured athletes exposes them to the same traumatic conditions that resulted in the original injury. Therefore, the individual must be completely healed, free of symptoms, and prepared for resuming the stress and trauma inherent to his or her sport. Proper selection of running and training shoes is critically important to prevent re-injury.

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