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.
Patients with an interdigital neuroma component of injury can benefit from a nerve block in combination with administration of long-acting steroids. Individuals with primary metatarsalgia receive little benefit from these types of injections.
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. Patients should continue self-mobilization exercises, including long-axis distraction and dorsal/plantar glides as directed by the practitioner.
Shoe modification with an orthosis may be the only treatment required, although in severe cases, surgical realignment of the metatarsal bones may be required to balance weight bearing.
In cases where conservative treatment has failed to provide relief of symptoms, surgical intervention may be required.
A patient may be referred to an orthopedic or podiatric specialist if the condition is not improving or is worsening.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen, are useful; however, they rarely provide a long-term solution.
Return to Play
The timetable for return to normal athletic function depends upon the nature of the injury and specific demands of the particular sport. Resolution of the pathological deficits associated with the injury includes restoration of flexibility, strength, aerobic fitness, and proprioception, which are required for each sport activity.
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 the sport. Proper selection of running and training shoes is critically important to prevent re-injury.
The preventative goal should focus on eliminating abnormal friction or pressure. Orthotics, metatarsal pads, and callus care can be used to prevent muscular and stress imbalances. Callus care includes razor debridement and buffing, which enhance tissue elasticity.
Some foot problems may not be caused by disease but by improper footwear. Proper positioning of the foot within the shoe depends upon appropriate fitting, as no two feet are the same. Athletes who perform on hard surfaces should make certain that new shoes have adequate cushioning. Rubber heels and soles that absorb shock better than other materials are helpful for athletes who perform repetitive running and jumping on hard surfaces.
Prognosis generally is good, with the treatment described in the Treatment section.
Athletes who suddenly and dramatically increase training activity are at risk of forefoot injury. Whether the increase is in time or intensity, athletes should increase their levels of activity gradually and never exercise through the pain.