Metatarsalgia is a non-specific diagnosis of pain in and about the MT head or MTP joint and adjacent soft tissue structures. Underneath each of the metatarsals is a bursal sac (a synovial fluid filled bag) when the foot distorts either by pronation or supination the 1st metatarsal doesn’t properly bear its share of the weight and the weight is shifted to the metatarsals (usually the 2nd & 3rd metatarsals) and the bursal sac becomes inflamed causing pain. It is a description of a region of pain, NOT diagnosis. Metatarsalgia can be broken down into a number of different diagnoses such as Capsulitis, Synovitis, or Neuroma.
Typically occurs between the 2nd and 3rd metatarsals. There is a transverse metatarsal ligaments that goes from the 5th metatarsal to the 1st metatarsal, and as you pronate, the 1st metatarsal moves up and out medially, and the 5th metatarsal moves up and out laterally and you transfer more of your body weight onto the 2nd, 3rd,& 4th metatarsals. The transverse ligament is stretched tightly. Weight is also being transferred from the 1st metatarsal to the lesser metatarsal heads, squishing the plantar nerves between the 2nd, 3rd and 4th metatarsals.
The Schwann cell reacts by enlarging the nerve sheath, creating this benign tumor or cyst called a morton’s neuroma. If left untreated, it could get larger and larger and eventually separate the toes.
Treatment for Morton’s Neuroma
Lower the head of the 1st metatarsal, both the 5th and 1st metatarsals will come down on their respective axes, relieving the stress on the transverse ligament, taking the weight off the 2nd, 3rd, 4th metatarsals, when you remove weight off of a nerve, the body is in a constant state of replacing itself.
Determining the type of metatarsalgia can be done by determining the location of pain, radiation or lack of characteristics of the pain, when the pain is present.
In a cavus foot (high arch foot), metatarsalgia usually develops because of the angle of the metatarsal bones in the high arched foot. The high angle increases the amount of pressure place on the metatarsal heads.
- Sensation of walking on a pebble
- Shooting pain in middle toes (neuroma)
- Sharp pain toward instep (fracture)
- Aching joint pain when bending toes
- Callus under ball of foot
- Swelling, redness at ball of foot
Foot orthoses to control and/or support the transverse arch with a metatarsal pad or bar to unload and redistribute pressure evenly throughout the metatarsal heads.