Metatarsalgia

Metatarsalgia is the medical term used to refer to pain at the ball of the foot. In order to treat Metatarsalgia it is important to first diagnose the specific problem causing the pain. Common reasons for pain around the ball of the foot include:
Morton’s Neuroma
Sesamoiditis
Plantar plate tea
Freibergs Disease

Freibergs disease

Freibergs disease is avascular necrosis of the growth plate in the metatarsal bone. It most commonly occurs in the 2nd metatarsal. It is commonly diagnosed during adolescence however it can occur at any time. It is more prevalent in those who have a shortened 1st metatarsal as this puts more stress on the 2nd metatarsal bone.

Signs and Symptoms of Friebergs Disease

Common symptoms of Freibergs disease include pain and stiffness around the forefoot. This pain is particularly worse when pushing off with the effected foot or when wearing high heeled shoes. Pain is normally brought on by activity, including walking. The effected joint may also be swollen and have limited, painful passive range of motion.
Freibergs disease is normally diagnosed by X-ray. Due to the damage to the bone the effected metatarsal head will appear flattened.

Treatment

In initial stages of treatment immobilisation of the foot may be required if pain is significant. Long term management includes Foot Orthotics to offload the effected metatarsal head. Rocker adaptations to footwear may also help to further elevate pressure on the affected area.

Morton’s Neuroma

A Neuroma is a thickening of a nerve. They may develop anywhere in the body. A Morton’s Neuroma as the name for a Neuroma that develops on the interdigital nerves in the fore foot between the metatarsals. This inflammation is thought to occur due to the nerve being over stretched.

Signs and Symptoms of a Morton’s Neuroma

Burning or tingling sensation in the ball of the foot.
The feeling of walking on a pebble.
Numbness of toes.
Pain is worse in tight footwear or footwear with a high heel.
Positive Mulder’s click test

Treatment

Insoles to improve foot biomechanics to reduce the stretch on the nerve are often used to treat a Mortons Neuroma.
Footwear with a wide toe box to ensure the forefoot is not compressed in the shoe.
Improving intrinsic muscle strength and toe dexterity has been clinically proven to resuce pain caused by a Morton’s Neuroma.
Surgery is normally only considered as a last resort for this condition due to the potential risk of the Neuroma returning following removal.

Sesamoiditis / Sesamoid injury

A sesamoid bone is a bone located in a tendon. The largest sesamoid bone in the body is the Patella (knee cap). Sesamoiditis is the medical term for pain of the sesamoid bones. There a two small sesamoid bones located under the big toe joint. Sesamoiditis is a common cause of forefoot pain and is frequently seen in dancers, runners, people who frequently wear high heels or have a high arch.
The sesamoid bones in the foot can also fracture or dislocate.

Signs and Symptoms of Sesamoiditis

Symptoms include pain and swelling under the big toe joint. Pain is normally brought on by walking and is worse in high heels or shoes with very flexible, thin soles.
If a fracture or dislocation is present the person may not be able to bear weight on the inside of their feet. Confirmation of dislocation or fracture is normally by X-ray.

Treatment

Treatment for Sesamoiditis normally includes wearing shoes which have a thick sole unit with a rocker at the front. Sometimes simply changing footwear and not wearing shoes which cause pain is enough to treat mild Sesamoiditis.
If problems persist Foot Orthotics may also be required to offload the sesamoid bones. If a fracture is present resting the foot is critical to recovery as sesamoid bones are prone to non-union. This can result in a longer and unsatisfactory recovery.

Plantar Plate Tear

Plantar plate tears are a cause of fore foot pain that frequently go undiagnosed. This may be partly because not all healthcare professionals are aware of what a plantar plate is and therefore do not recognised when it is torn.
The plantar plate is a fibrocartilaginous structure which stabilises the metatarsophalangeal joints (MTPJ). It originates from the met heads and attaches into the bottom of the toes. It is also the attachment site for the plantar fascia.
When standing, walking and running the foot is loaded the arch lengthens. This results in the plantar fascia tightening which engages the plantar plate and pulls the toes into the floor. This mechanism is known as the reverse windlass mechanism.

Signs and Symptoms of Sesamoiditis

Pain around the affected toe joint.
This pain increases with activity; particularly activities which cause increased pressure to the fore foot such as fore foot running, bare foot walking and dancing.
Pain subsides with rest.
Effected toe is floating in air and has reduced toe plantar flexion strength.
Positive Lachmans test.

Treatment

To treat the injury forces being applied to the plantar plate need to be managed and reduced to allow for healing.
To reduce pressure on the plantar plate bare foot walking and wearing flexible shoes is not advisable. A shoe or trainer with a stiff sole unit and fore foot rocker is recommended. Taping the toe in a plantar flexed position can also be a good way to decreasing pain and offloading the plantar plate, allowing it to heal.
Insoles with a met dome to encourage plantar flexion of the toe and a cut out to offload the metatarsal head may be required to successfully heal the injured plantar plate.

Whether you are struggling with pain, having issues with mobility or training for a sporting event we will endeavour to find the best treatment to meet your individual needs and expectations.

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Phone number to book direct with our Private Clinic in Chester

Phone

07858865169

The address of our private clinic in Cheshire
Mercury House,
High St,
Tattenhall,
Chester,
CH3 9PX

The address of our private clinic in Mold
Grosvenor Street Physiotherapy,
10 Grosvenor St,
Mold,
CH7 1EJ