Metatarsalgia
Metatarsalgia
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Metatarsalgia or ball of the foot pain is very common and will affect around 80% of the population at some point in their life. It is made up of a group of conditions that can cause pain and inflammation around the bones and joints in the ball of the foot. Finding comfortable footwear can be difficult. Treatment protocols for ball-of-the-foot pain almost always start with basic principles as advised in our W.A.S.P and S.T.O.P.S. options
Patient Signs and Symptoms
Patient Signs and Symptoms
Known cause of pain e.g. change in footwear or activity levels
Trauma -Gradually getting worse over time
+/- change of shape of toes
+/- Development of callous of affected area
+/- Partial or complete stiffness of affected area
+/- Inflammation discolouration
Significant Findings
Significant Findings
Oedema and/or inflammation
Pain on palpation of the affected metatarsal or joint
Pain at reaching end range of motion (passive movement)
Decreased range of motion/crepitus may indicate arthrosis or other osseous changes at the metatarsophalangeal joint
+/- Chronic hyperextension of the metatarsophalangeal joint may suggest plantar plate/collateral ligament rupture
+/- Pain at flexor crease or plantar metatarsal head (again may indicate plantar plate rupture)
Positive Lachman's (draw) test
Capsulitis (positive grind test)
Lack of fatty padding
Associated Findings
Associated Findings
Capsulitis/ Synovitis/ Bursitis
Capsulitis/ Synovitis/ Bursitis
Mechanical (shortened 1st ray, disorders of Hallux, inefficient metatarsal parabola)
Inflammatory Arthritis
Osteoarthritis
Joint Instability
Gout (blood screening required)
Metatarsal Abnormality
Metatarsal Abnormality
Freiburgs
Dorsiflexed/Plantarflexed
Elongated/shortened
1st ray hypermobility
Metatarsal Fracture
Metatarsal Fracture
Periosteal reaction
Stress fracture (History of Osteoporosis, had DXA been carried out)
Foreign body
Loose body
Others (rare)
Others (rare)
Avascular necrosis
Tumour
Bone infection
Imaging
Imaging
Not indicated at initial assessment unless history of trauma or to suspect osteomyelitis, however x-ray has low sensitivity and specificity for detecting acute osteomyelitis.
Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.
Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.
Differential Diagnosis
Differential Diagnosis
Plantar Digital Neuroma
Stress fracture/Fracture
Freiberg’s infraction
Bursitis
Gout (blood screening required)
Rheumatology/inflammatory arthritis (blood screening required)
Heloma durum
Ulceration
Peripheral neuropathy
Vascular insufficiency
Treatment not currently recommend based on evidence
Treatment not currently recommend based on evidence
Electrotherapy
Extracorporeal shock wave therapy (Low evidence of positive effect and evidence of adverse effects.
Supinatory Insoles (There is insufficient evidence to propose supinatory insoles for Morton’s neuroma)
No evidence to support NSAIDS in treating Morton’s neuroma.
Alcohol injection therapy
Radio-frequency ablation
Acupuncture
First line treatment options
First line treatment options
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