Forefoot pain / Metatarsalgia

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What does Forefoot pain / Metatarsalgia mean?

Forefot pain / Metatarsalgia is a term that describes strictly any pain in the ball of the forefoot. The causes are various and include a “trapped nerve” (Morton’s Neuroma), abnormal load-bearing during gait e.g. as a result of a bunion or a tight calf muscle or inflammation from arthritis, to name the most common.

How is the diagnosis of Forefoot pain / Metatarsalgia made?

As always the diagnosis is made by analysing the history and various elements of the complaint, examination findings and special investigations such as x-rays and/or other imaging technologies such as Ultrasound or magnetic resonance scanning (MRI). Occasionally a diagnostic local anaesthetic injection can be useful to localise the problem.

What treatments are available?

Any treatment depends on the diagnosis but generally footwear modification and off-loading strategies e.g. by insoles (orthotics) are the mainstay of non-operative treatment. Anti-inflammatory medication as tablets or injection (steroids) can also be used. When these measures fail to alleviate symptoms surgery can be necessary.

What does surgery entail?

In the case of a Morton Neuroma excision of the abnormal nerve is often successful in curing the forefoot pain in the long term but a small risk of pain recurrence remains.
If abnormal weight-loading is the cause correction of the underlying deformity such as that of a bunion or release of tight calf muscles can be beneficial.