Metatarsalgia

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Metatarsalgia
ICD-10 M77.4
ICD-9 726.70
MeSH D037061

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.

Synonyms and Keywords: Metatarsophalangeal joint capsulitis, Stone bruise, Ball-of-foot-pain

Overview

Metatarsalgia (literally metatarsal pain, colloquially known as stone bruise) is a general term used to refer to any painful foot condition affecting the metatarsal region of the foot (area just before the toes, commonly referred to as ball-of-the-foot). It is actually a common overuse injury that can affect the joints and bones of the metatarsals. Metatarsalgia is most often localized to the the first metatarsal head (the ball of the foot just behind the big toe). There are two small sesamoid bones under the first metatarsal head. The next most frequent site of metatarsal head pain is under the second metatarsal. This can be due to either too short a first metatarsal bone or to "hypermobility of the first ray" (metatarsal bone + medial cuneiform bone behind it), both of which result in excessive pressure being transmitted into the second metatarsal head. Metatarsalgia is the irritation and inflammation of joint capsule surrounding these metatarsal heads due to excessive pressure over prolonged periods of time. Patient complaints of pain in the joint itself with the feeling of a marble in the shoe or a bunched up sock.

Pathophysiology

Causes

Metatarsalgia can be caused by any of the following:

History and symptoms

Imaging Fingings

Following imaging tests may prove to be helpful in diagnosing and differentiating metatarsalgia from other causes of forefoot pain:

X-ray

X-ray helps to exclude other causes of forefoot pain

MRI

MRI helps to diagnose & differentiate other causes of pain in mid-foot and metatarsal regions such as:[2]

Bone Scan

A bone scan pinpoints to the places of inflammation

Ultrasound

Treatment

Conservative medical therapy

Surgery

Prevention

Primary preventive measures for metatarsalgia include the following:

References

  1. CALCAGNI V (1965). "[ON A CASE OF BILATERAL INTERMETATARSAL BURSITIS]". Minerva Ortop. 16: 88–90. PMID 14331319.
  2. 2.0 2.1 Ganguly A, Warner J, Aniq H (2018). "Central Metatarsalgia and Walking on Pebbles: Beyond Morton Neuroma". AJR Am J Roentgenol. 210 (4): 821–833. doi:10.2214/AJR.17.18460. PMID 29470159.
  3. Iagnocco A, Coari G, Palombi G, Valesini G (2001). "Sonography in the study of metatarsalgia". J Rheumatol. 28 (6): 1338–40. PMID 11409128.


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