Metatarsalgia

Metatarsalgia is the area on the sole of the foot, just before the toes, (ball of the foot). It is the condition in which the area can become swollen or bloat. It may cause pain, discomfort, and soreness to some people. 

Metatarsalgia can be caused due to different conditions affecting the foot. It is a common condition that mostly occurs due to:

• Mostly common above the age of 40.
• Aging.
• Prolonged training or activity for a long time.
• Arthritis.
• Obesity.
• Recent fractures.
• Morton's Neuroma.
• Unfit shoes.
• Wearing high heels very frequently.
• Diseases like hammertoe and calluses.
• Previous foot surgery.

Metatarsalgia is a disease that can trigger a lot of symptoms, some of which are mentioned below:

• Pain in the foot.
• Numbness.
• Burning sensation while walking barefoot, especially on a hard surface
• Feeling like there's a pebble in the foot.
• The pattern of walking looks different.

Pathology

Metatarsalgia can be referred to as pain in the ball of the foot it occurs as the front of the foot absorbs force which can lead to inflammation in the foot. This can disrupt the metatarsals and cause deformation of the toes, resulting in an improper way of walking. 

Physical examination:

The examiner will check for inflammation in the foot and ask the patient to rotate the foot during the examination, the examiner looks from behind to locate any deformity on the foot. Swelling and tenderness on the ball of the foot are early signs of Metatarsalgia.

Bone scan:

A bone scan can show the swollen areas in the foot. It can identify conditions such as motors neuron that can cause soreness in the foot and also helps in locating the reduction of the natural fat pad.

Ultrasound:

An ultrasound scans the number of tissues in the foot and helps to depict arthritis or swelling in the foot or torn tendons which makes it easier to understand the disease.

X-RAY:

An X-Ray can rule out other diseases also as it can help in understanding which bone is damaged or has a problem which makes it much easier to know the disease.

Magnetic resonance imaging (MRI):

Magnetic resonance imaging (MRI) helps to look for causes of pain in the metatarsal and midfoot regions. These can include arthritis, circulatory conditions, neuroarthropathies, traumatic disorders, and conditions that cause biomechanical imbalance.

Medications: Ibuprofen, Advil, Motrin IB, Naproxen sodium, aspirin, etc.

Note: Medication should not be taken without the doctor's prescription.

 Surgery: Surgery is required in some cases. It may be needed where conservative treatment fails in the management of Metatarsalgia. Osteotomy is one such surgery procedure we make a cut to the metatarsal bone and realign it so it can be fixed. 

Rest:

Rest is the key factor as it can worsen the pain if, avoided. Continuous activity can affect the metatarsals, so bed rest is the best home remedy recommended.

Cryotherapy:

Cryotherapy or cold therapy can be applied to the burning area for 15 minutes 2-4 times a day to reduce the pain and tingling. An ice pack is applied over the metatarsals when the burning sensation worsens, this helps to decrease the swelling surrounding the ball of the toe.

Thermotherapy:

Thermotherapy or hot packs provide superficial heat and relieve the muscle spasm, increasing blood circulation, and reducing pain.

Contrast bath:

A contrast bath works on the principle of the combined effect of heat and cold. The part is immersed alternatively in hot and cold water. The treatment begins with hot water and should end with cold water. Immersion in hot water for around 3 minutes and in cold water for around 1 minute, the treatment continues for 15 to 20 minutes.

Therapeutic ultrasound:

Therapeutic ultrasound is used by physiotherapists to increase the movement of soft tissues, and increase circulation, which helps reduce pain, increase circulation, and also enhance the health of the patient.

Transcutaneous electrical stimulation (TENS);

Transcutaneous electrical stimulation is a physiotherapy modality that provides pain relief by providing pain modulation. It closes the gate mechanism at the anterior grey horn in the spinal cord. These electrical stimulations stimulate the endogenous opioid system which prevents the release of substance p at the anterior grey horn.

Shockwave therapy:

Shockwave has proved its effectiveness in helping to heal ligamentous tissue such as the metatarsal joint capsule.

Metatarsal pad:

Metatarsal pads have a positive impact, as it reduces the pressure on the foot. It keeps the ball of the foot and toes positioned in the proper position. A metatarsal pad should be placed behind the ball of the foot so that relief is felt.

Kinesiology tape:

Kinesiology tape can improve blood circulation and also adds a protection layer over the ball on the foot. This can reduce pain when the patient walks barefoot.

Exercises:

Exercises are a very common factor in keeping the body healthy and physically fit, many of them can also help with Metatarsalgia. Some of them are mentioned below:

Toe pumps:  The patient sits in the bed comfortably, with his legs straight, and makes sure that the toes have enough space to move in any direction, then easily just flex the toes and then extend them, moving them backward and forth until the patient feels that the toes are loosening up.

Picking marbles Exercise: The patient is asked to sit down on a chair, place 2 cups of marbles on the floor, and one by one pick them up with the metatarsals. This can be tough when the patient lacks patience but it relieves and loosens the metatarsals.

Standing on a Single Leg: Balancing on one leg has many benefits for the whole body, it reduces stress from the metatarsals by stretching them easily. The exercises can be repeated 3-4 times a day. This can help the metatarsals in recovering quickly.

The patient is advised to take proper treatment and change the way of walking to avoid pressure and control excess body weight that can put a strain on the foot.