metatarsalgi

Metatarsalgia is a clinical condition defined by pain and soreness in the forefoot, typically beneath the heads of the metatarsal bones. The forefoot bears much of the body's weight during standing and walking, so increased pressure or structural abnormalities can produce forefoot pain.

Although any forefoot metatarsal head may be affected, the second and third heads are most commonly involved. Metatarsalgia is a syndrome with multiple potential causes rather than a single disease.

Common risk factors and causes include repetitive impact activities, prolonged standing, tight calves, obesity, and footwear with a narrow toe box or high heel. Structural issues such as hammertoes, bunions, flat feet, or reduced first-metatarsal height can raise forefoot stress.

Symptoms typically include aching, burning, or sharp pain in the ball of the foot, tenderness to touch, swelling, and pain that worsens with walking or standing. A physical examination evaluates forefoot pressure distribution and toe alignment.

Diagnosis is primarily clinical; imaging such as X-rays can assess bone alignment, and MRI or ultrasound may evaluate soft-tissue causes.

Initial treatment is nonoperative: rest, ice, nonsteroidal anti-inflammatory drugs, and activity modification. Footwear with a wide toe box and lower heel, silicone metatarsal pads, and custom orthotics can offload pressure. Injections and physical therapy may help; most patients improve without surgery.

Surgery is considered for persistent or structurally based pain after conservative care. Options include distal metatarsal osteotomies to shorten or realign the metatarsal head, plantar plate repair, or, in severe arthritis, joint fusion. Outcomes vary.