​ASKPHYSIO

Metatarsals are the long bones in the feet.  1st ray is the metatarsal in line with the big toe.  The 5th metatarsal is the metatarsal in line with the little toe.

Metatarsalgia is pain of the forefoot brought about by abnormal foot biomechanics.

Also referred to as metatarsophalangeal joint synovitis.

Can involve an increased shearing load placed on the transverse ligaments and intrinsic muscles of the foot.  This can result in inflammation of the metatarsophalangeal joints (MTP).

Pain in the forefoot

Aggravated by weight-bearing

Pain comes on gradually

Joints are tender to touch

The 2nd MTP joint is the most commonly affected

Callous may be present under the affected joint

Excessive pronation

Hallux valgus

Hypermobility of the foot

Clawed foot

Rigid foot

R.I.C.E. Protocol

Anti-inflammatory medication for short term pain relief (if not contraindicated)

Wear activity-appropriate footwear, with cushioning.

If conservative management a corticosteroid injection may be required to settle the pain and inflammation.

X-ray may be useful to determine the degree of bony stress and degeneration.

Assessment to identify contributing biomechanical factors

Electrotherapy

Joint mobilisation

Padding to redistribute loading

Strapping

Podiatric referral if necessary

Prescription of exercises to strengthen the intrinsic muscles