Metatarsalgia
Dusty Narducci, MD, and Heidi James, MD
Background
- Pain beneath metatarsal heads; middle metatarsal most commonly affected
- Risks include
- Abnormally high arch
- Improper shoe selection/fit
- Tight achilles tendon
- Hammer toes
- Hallux valgus deformity
- Rheumatoid arthritis
- Abnormally long second metatarsal
- Differential diagnosis includes
- Arthritis
- Morton’s neuroma
- Stress fracture
- Plantar warts
Clinical Findings
- Symptoms/signs
- Burning or cramping at metatarsal heads
- Worse with activity
- Improves with rest
- Diagnosis is clinical
Management
- Nonoperative treatment
- Proper shoe fit with use of hard-soled shoe or cast
- Gait or footwear changes
- Physical therapy
- Soak in warm water and trim calluses
- If conservative management fails
