Anterior Metatarsalgia



Anterior Metatarsalgia


Dominic Jacobelli, MD

Kenneth Bielak, MD, FACSM, FAAFP, CAQSM



BASICS


DESCRIPTION



  • Pain in the plantar aspect of the metatarsal (MT) heads


  • Metatarsalgia can be thought of as a symptom rather than a specific disease.


  • Primary metatarsalgia develops from intrinsic factors, such as a long first ray, hallux valgus, or other congenital deformities.


  • Secondary metatarsalgia may result from trauma, overuse, or poor footwear.


EPIDEMIOLOGY

Athletes in high-impact sports involving the lower extremities (dancing, running, jumping)


ETIOLOGY AND PATHOPHYSIOLOGY



  • Repetitive/excessive stress combined with intrinsic and extrinsic factors


  • The 1st MT head usually carries 30% of the load in weight-bearing. A normal MT arch ensures this balance by providing adequate padding around the 1st MT head. A pronated or splayfoot can disturb this balance, resulting in an abnormally high pressure over the 2nd through 5th MT heads. Over time, reactive tissue can form a callus around the MT heads, which further compounds pain.


RISK FACTORS



  • Foot deformities: overpronation, pes planus, pes cavus, hallux valgus, prominent MT heads, hammertoe deformity, Morton foot (short 1st MT and a relatively long 2nd MT)


  • Muscle imbalance or soft tissue dysfunction: tight Achilles tendon or toe extensors, weak toe flexors, laxity in the Lisfranc ligament


  • Extrinsic factors: obesity, high heels, poorly fitted or worn-down shoes


  • Dermatologic issues: calluses and warts


  • Fat pad atrophy or displacement


  • Iatrogenic changes from surgeries resulting in unequal force distribution



COMMONLY ASSOCIATED CONDITIONS



  • Intrinsic foot muscle weakness


  • Calluses and warts


  • Hallux valgus or rigidus


  • Hammertoe or claw toe


  • Morton syndrome (long 2nd MT)


  • Freiberg infraction (aseptic necrosis of a MT head, most commonly the 2nd, as seen in adolescent sprinters)


Mar 14, 2020 | Posted by in SPORT MEDICINE | Comments Off on Anterior Metatarsalgia
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