Metatarsalgia

Metatarsalgia

Article by J.Miller, S.Armfield

What is Metatarsalgia?

The most common source of Ball of Foot pain is metatarsalgia. The term originates from the medical term metatarsals (long bones of the foot) and algos (the Greek word meaning pain).

The metatarsal bones design equally shares the weight of a person during walking and daily activities. When you disrupt this delicate balance between bones, the result can be mild to intense foot pain, plus ultimately foot deformity. The term metatarsalgia refers to the number of problems people can experience in this area.

Causes of Metatarsalgia

The causes of metatarsalgia pain attribute to several factors, from bone abnormalities to systemic diseases such as diabetes.

The most common cause is an alteration of the posture in the long bones (metatarsals) of the foot. These bones absorb the weight during walking, and if one of the bones descends through weakness or lack of support, is abnormally long or fractured from stress, it will create dysfunction among all bones.

Other causes include:

  • An enlarged metatarsal head,
  • Arthritis or any degenerative disease of the joints,
  • Systemic conditions such as diabetes, which can cause nerve-type pain in the foot,
  • Calluses or skin lesions that cause the unevenly distributed weight on your foot,
  • Ageing, which tends to thin out or shift the fatty tissue of the footpad,
  • Sports that place tremendous pounding on the ball of the foot, like jogging,
  • Ill-fitting shoes that put pressure on the bones of the feet,
  • Small toe box shoes, which cramp and compress your toes.

Symptoms of Metatarsalgia

The main symptom of metatarsalgia is a pain in the ball of the foot, and is most pronounced when walking (especially on your toes) or engaging in sports. Since the foot supports the body in all its activities, chronic pain in the ball of the foot impacts the ability to perform ordinary tasks.

  • Discomfort when wearing shoes and socks.
  • Pain during activities where there is foot impact, such as running.

Metatarsalgia Treatment

Treatment of metatarsalgia depends on the cause. Here are a few suggestions to help alleviate the pain and discomfort associated with this condition:

Footwear Orthotics or Metatarsalgia Accessories

metatarsal domes

  • Metatarsal domes or pads that help separate the foot bones and relieve pressure on the metatarsals.
  • Supportive foot arch orthotics and insoles to prevent the abnormal collapsing of the arch.

Footwear

Taking a good look at the shoes you wear is the first step in eliminating and preventing the painful condition of metatarsalgia. The objective is to find appropriate footwear that distributes the weight and pressure evenly across the foot rather than concentrates it in the foot’s toes and ball. Fashion designers are very inconsiderate of people suffering from metatarsalgia.

Massage

Massage the afflicted area to relieve swelling pressure, increase local circulation and reduce your pain.

Anti-inflammatory Medications

Over-the-counter medications such as Ibuprofen, Voltaren, etc., may reduce the symptoms but do not correct the main “postural” reasons for irritation, so a recurrence is likely. Please consult your doctor before taking these drugs.

Corrective Metatarsalgia Exercises

Relief and Prevention

PhysioWorks physiotherapists have designed dynamic corrective foot posture exercises that they have been prescribing and fine-tuning over the past decade. These exercises aim to correct the dynamic muscle control of your foot. Ideally, if we can help you retrain your foot muscles, you won’t need to wear shoes with orthotics to solve your problem passively.

metatarsalgia treatment

Our foot muscles are ordinarily effective and efficient. It is common for these muscles to weaken and become lazy. The good news is that most foot muscle weakness can be retrained successfully within weeks.

Please consult your physiotherapist for specific advice. Your physiotherapist will also inspect other reasons for your foot collapsing, such as muscle tightness or referred pain from your back.

Surgery for Metatarsalgia

When metatarsalgia does not respond to these treatments, you may require surgical solutions. Consult your physiotherapist or a podiatrist for further options and considerations related to metatarsalgia.

Article by John Miller

Common Youth Leg Injuries

Why are Children's Injuries Different to Adults?

youth sports injuries

Adolescent Leg Injuries

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (Anterior Cruciate Ligament) Injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal Injuries

Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries

Common Stress Fracture Related Conditions

General Info

Spinal Stress Fractures

Lower Limb Stress Injuries

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.