Metatarsalgia

MetatarsalgiaMetatarsalgia is the name given to pain in the front part of your foot under the heads of your metatarsal bones ( ball of foot, just before toes). It is usually worse when standing or walking etc.  and occurs most frequently in the second, third/or fourth metatarsal joints or isolated in the first metatarsal joint. Metatarsalgia usually comes on gradually over some weeks rather than suddenly. The affected area of your foot may also feel tender on palpation by your physiotherapist.

Common causes identified by physiotherapists include:

  • Pes cavus or high arched foot.
  • Excessive pronation of the foot(foot rools inwards ie. with flat foot).
  • Clawing or hammer toes.
  • Tight extensor tendons of the toes.
  • Prominent metatarsal heads.
  • Morton’s foot – here there is a shortened first metatarsal, which results in an abnormal gait putting increased pressure on the second metarsal.
  • Over doing it in athletes such as runners and tennis players etc. can lead to inflammation in the joints due to the pounding they receive.
  • Being overweight puts extra stress on many areas of the foot including metatarsals.
  • Wearing high heels – forward force on feet increases the pressure on metatarsal area.
  • Having tightened calf muscles or poor ankle flexibility – this affects the normal gait pattern.
  • Poorly fitting or tight footwear can squeeze the metatarsal joints causing friction , inflammation and poor gait.

Simple measures can help to relieve the symptoms of metatarsalgia. These include:

  • Resting with your feet elevated where possible.
  • Losing weight if you are overweight.
  • Wearing supportive shoes that are well fitted, low-heeled and have a wide toe area.
  • Metatarsal pads and orthotic inserts for your shoes may help to relieve pain in your forefoot by reducing the pressure placed on the heads of your metatarsal bones.
  • Physiotherapy may also be helpful. This may include stretching out the spaces between the metatarsal and mobilising the joints of the foot or performing deep tissue massage to loosen your calf muscles or any other lower limb muscles that may be contributing to poor gait. Sometimes if a metatarsal head has dropped it can be manipulated back into place. Pain relief as a result of this mobilisation, when effective can be immense and long lasting.
  • Simple painkillers such as paracetamol and non-steroidal anti-inflammatories(NSAIDs) such as ibuprofen may help to relieve pain.

 

Plantar Fasciitis – Foot Pain

plantar-fasciitisPlantar fasciitis is a painful inflammatory condition of the connective tissue on the sole of the foot(the plantar fascia). It is often caused by overuse of the plantar fascia, the tendons that help form the arch of the foot , running from the heel along the sole of the foot towards the toes. The plantar fascia  basically acts as shock absorber for the foot during movement while helping maintain the arch of the foot during standing. Plantar fasciitis is easiest treated when caught early. Longstanding cases often demonstrate more degenerative changes in the tissue than just inflammatory changes. This condition is called termedplantar fasciosis and can be much more difficult to treat.

While plantar fasciitis is often attributed to overuse in  athletes, among non-athletic populations it is associated with a high body mass index in combination with  long periods of weight bearing( Mc Poil et al. 2008).  Also people with flat feet or high arches tend to be more at risk.  A Flat foot tends to put increased strain on the origin of the plantar fascia at the heel (calcaneus) as the plantar fascia attempts to maintain a stable arch during the propulsive stage of the gait(walking, running etc.). Excessive movement of the forefoot in relation to the heel  during movement can also predispose to plantar fasciitis. In people with high arches there may be excessive strain on the heel due to the foots limited range of movement and thus a decreased ability to adapt  to the ground during movement.

Plantar fasciitis is commonly also associated with tightness in the calves, hamstrings and gluteal regions. Muscles in these areas have a significant effect on gait and thus foot biomechanics . Biomechanics is basically the science of movement, so when you here the phrase ”poor biomechanics” used it is basically referring to inefficiency during movement.

With the condition the pain is usually gradual in onset and felt on the medial aspect of the heel. Initially it is worse in the morning and decreases with activity, often aching afterwards. Periods of inactivity during the day are generally followed by an increase in pain as activity is recommenced. As the condition becomes more severe, the pain may be present when weight-bearing and worsen with activity.

Treatment

Effective treatment uses a multifaceted approach which may involve some or all of the following ; the use of nonsteroidal anti-inflammatory drugs (NSAIDs), deep tissue massage of the plantar fascia and along with deep tissue work to loosen out the calves, hamstrings and gluteal regions where necessary, stretching exercises for the plantar fascia(DiGiovanni  et al. 2003) and calf muscles, avoidance of aggravating activity, biomechanical correction with orthotics, electro-acupuncture and cold compression of the heel bursitis, strengthening exercises for the intrinsic muscles of the feet(Dyck and O’Neill ,2004), taping the heel into inversion (short term solution)( Radford  et al. 2006),  changing to proper supportive footwear containing well supported arches and midsoles (Yamashita, M.H. 2005). In extreme cases when all else has failed corticosteroid injections may be considered if there is a bursitis in the heel (Crawford et al. 1999) with surgery used as a last resort. This condition is usually resolved swiftly by an experienced practitioner without the need for surgery or corticosteroid injections.

 

 

Physiotherapist based in Tralee , Co. Kerry and open 7am to 11 pm weekdays, 7am to 2pm Saturdays.Please ring 086-7700191 anytime to make an appointment. We also specialize in proper deep tissue massage.

 

References

Crawford, E., Atkins, D., Young, P. et al. Steroid injection for heel pain: evidence of short term effectiveness: a randomized controlled trial. Rheumatology 1999;38(10):974-7.

DiGiovanni, B.F., Nawoczenski, D.A., Lintal, M.E. et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective randomized study. J. Bone Joint Surg. Am. 2003;85-A(7):1270-7.

Dyck, D.D., Boyajian-O’Neill, L.A. Plantar fasciitis. Clin. Journal Sport Med. 2004;14:305-9.

McPoil, T.G., Martin, R.R.L., Cornwall, M.W. et al. Heel pain – plantar fasciitis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American Physical Therapy Association. J. Orthop. Sports Phys. Ther. 2008;38(4): A1-18.

Radford, J.A., Landorf, K.B., Buchbinder  R. et al. Effectiveness of low-dye taping foe the short-term treatment of plantar heel: a randomised trial. B.M.C.

Yamashita, M.H. Evaluation and selection of shoe wear and orthoses for the runner. Phys. Med. Rehabil. Clin. N. Am. 2005;16:801-29.