Metatarsalgia
Understanding this condition
Metatarsalgia refers to pain under the forefoot, at the base of the toes, over the weight-bearing area of the metatarsal heads (the ends of the long bones of the foot). It is not a disease in itself but a symptom with several possible causes.
Static metatarsalgia (the most common) is linked to a permanent imbalance of loading — a metatarsal that is longer or lower than the others, a "round" forefoot, or a thinning of the plantar fat pad with age. Dynamic metatarsalgia is related to overloading during walking. Associated deformities often aggravate symptoms: hallux valgus transferring load to adjacent rays, hammer toes altering weight distribution, cavus foot. The condition particularly affects women after the menopause.
Symptoms
Pain under the forefoot, on weight-bearing, aggravated by prolonged walking and wearing heels. A burning sensation or feeling of walking on pebbles.
Calluses localised under the painful metatarsal heads. Forefoot fatigue at the end of the day.
How can it progress?
Persistent metatarsalgia can cause progressive gait changes (antalgic limp), with consequences for the knee and hip. Calluses can become complicated (infection, fissures), especially in diabetic patients.
Without correction of the underlying cause, pain tends to worsen.
Treatment options
First line: orthopaedic insoles offloading the painful metatarsal heads, appropriate footwear, weight loss if necessary, physiotherapy. This provides relief in the majority of cases.
When the cause is an identified bony deformity (a metatarsal that is too long or too low), a realignment osteotomy (Weil) may be proposed. A consultation and X-ray workup clarify the indication.