Metatarsalgia: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(24 intermediate revisions by the same user not shown)
Line 13: Line 13:
}}
}}
{{SI}}
{{SI}}
{{CMG}}{{AE}}{{S.M.}}
{{CMG}} {{AE}} {{S.M.}}


{{SK}} Capsulitis, Stone bruise, Ball-of-foot-pain
{{SK}} Metatarsophalangeal joint capsulitis, Stone bruise, Ball-of-foot-pain


==Overview==
==Overview==
'''Metatarsalgia''' (literally metatarsal pain, colloquially known as stone bruise) is a general term used to refer to any [[Pain and nociception|painful]] [[foot]] condition affecting the [[Metatarsus|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 [[joint]]s and [[bone]]s 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 excess pressure being transmitted into the second metatarsal head. Metatarsalgia is the inflammation of joint capsule surrounding these metatarsal heads due to 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.
'''Metatarsalgia''' (literally [[metatarsal]] [[pain]], colloquially known as stone [[bruise]]) is a general [[Term logic|term]] [[Usage analysis|used]] to refer to any [[Pain and nociception|painful]] [[foot]] [[condition]] [[Affect|affecting]] the [[Metatarsus|metatarsal]] region of the [[foot]] ([[area]] just before the [[toes]], commonly [[Reference|referred]] to as [[Ball (anatomy)|ball]]-of-the-[[foot]]). It is actually a common overuse [[injury]] that can [[affect]] the [[joint]]s and [[bone]]s of the [[metatarsals]]. Metatarsalgia is most often localized to the  the [[first metatarsal]] [[head]] (the [[Ball (anatomy)|ball]] of the [[foot]] just behind the [[big toe]]).  There are two small [[sesamoid bones]] under the [[first metatarsal]] [[Head (anatomy)|head]].  The next most [[Frequentist|frequent]] [[Site-directed mutagenesis|site]] of [[metatarsal]] [[head]] [[pain]] is under the [[Second metatarsal bone|second metatarsal]].  This can be due to either too short a [[first metatarsal bone]] or to "[[hypermobility]] of the first [[Ray (optics)|ray]]" ([[Metatarsal bones|metatarsal bone]] + [[medial cuneiform bone]] behind it), both of which [[result]] in [[Excess risk|excessive]] [[pressure]] being [[Transmittance|transmitted]] into the [[Second metatarsal bone|second metatarsal]] [[head]]. Metatarsalgia is the [[irritation]] and [[inflammation]] of [[joint capsule]] surrounding these [[metatarsal]] [[Head|heads]] due to [[Excess risk|excessive]] [[pressure]] over prolonged [[periods]] of [[Time series|time]]. [[Patient]] complaints of [[pain]] in the [[joint]] itself with the [[feeling]] of a marble in the [[Shoe insert|shoe]] or a bunched up sock.
 
==Pathophysiology==
*Metatarsalgia usually occurs due to excessive [[pressure]] at the [[metatarsal]] [[Head (anatomy)|heads]] over prolonged [[periods]] of [[Time-series|time]]<ref name="pmid14331319">{{cite journal| author=CALCAGNI V| title=[ON A CASE OF BILATERAL INTERMETATARSAL BURSITIS]. | journal=Minerva Ortop | year= 1965 | volume= 16 | issue=  | pages= 88-90 | pmid=14331319 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14331319  }} </ref>
*This [[Result|results]] in the [[irritation]] and [[inflammation]] of [[joints]], [[capsule]] or [[ligaments]] at [[metatarsal]] [[Head|heads]] ([[Ball (anatomy)|ball]] of the [[foot]]), [[Leading strand|leading]] to [[metatarsophalangeal joint]] capsulitis aka metatarsalgia
*Common sites of involvement include:
**[[First metatarsal bone|First metatarsal]] [[head]] (most common)
**[[Second metatarsal bone|Second metatarsal]] [[Head (anatomy)|head]]
**[[Third metatarsal bone|Third metatarsal]] [[Head (anatomy)|head]]
**[[Fourth metatarsal bone|Fourth metatarsal]] [[head]]


==Causes==
==Causes==
Metatarsalgia can be caused by any of the following:
Metatarsalgia can be [[Causes|caused]] by any of the following:
*Abnormal foot mechanics (putting excessive amount of weight bearing pressure on the ball of the foot beneath the toe joint)
*[[Abnormal]] [[foot]] [[mechanics]] (putting [[Excess risk|excessive]] [[Amount of substance|amount]] of [[weight]] bearing [[pressure]] on the [[Ball (anatomy)|ball]] of the [[foot]] beneath the [[toe]] [[joint]])
*Repetitive foot motion exerting pressure on the ball of foot resulting in connective tissue degeneration
*[[Repeating unit|Repetitive]] [[foot]] [[Motion (physics)|motion]] [[Exertion|exerting]] [[pressure]] on the [[Ball (anatomy)|ball]] of [[foot]] [[Result|resulting]] in [[connective tissue]] [[degeneration]]
*Severe bunion deformity
*High [[Leveling effect|level]] of [[Activity (chemistry)|activity]]
*Second toe longer than the big toe
*Tight [[Achilles tendon]]
*Structurally unstable arch of the foot
*Severe [[foot]] [[deformities]] such as:
*Tight calf muscles
**[[Bunion]]
*Improper fitting footwear (women’s dress shoes, other restrictive footwear with narrow toe box)
**[[Hammer toe]]
*High heels
*[[Second]] [[toe]] longer than the [[big toe]] (or short [[first metatarsal bone]]), disturbs the normal [[Foot|forefoot]] [[Balance disorder|balance]] which [[Lead|leads]] to the [[Shift work|shift]] of an increased [[Amount of substance|amount]] of [[weight]] to the [[second metatarsal bone]]
*High impact activities/sports involving running or jumping without proper footwear/orthotics such as:
*[[Structure factor|Structurally]] unstable [[Arch support|arch]] of the [[foot]] i.e. high [[Arch support|arch]]
**Track and field running
*Prominent [[metatarsal]] [[Head|heads]]
*[[Excess risk|Excessive]] [[pronation]]
*Tight [[toe]] [[Extensor muscle|extensor muscles]]
*Weak [[toe]] [[Flexor muscle|flexor muscles]]
*[[Hypermobile]] first [[foot]] [[bone]]
*[[Improper rotation|Improper]] fitting [[Foot|footwear]] ([[Womens Pack|women’s]] [[dress]] [[Shoe insert|shoes]], other [[Restriction|restrictive]] [[Foot|footwear]] with narrow [[toe]] [[box]])
*High [[Heel|heels]]
*High [[Impacted|impact]] [[Activity (chemistry)|activities]]/[[Sports medicine|sports]] (involving [[running]] or [[jumping]]) without proper [[Foot|footwear]]/[[orthotics]] such as:
**[[Tracking changes|Track]] and field [[running]]
**Tennis
**Tennis
**Football
**[[Footballs|Football]]
**Baseball
**Baseball
**Soccer
**Soccer
*Older age (thinning of foot fat pad leads to more susceptibility to pain in the ball of the foot)
*Older [[age]] (thinning of [[foot]] [[fat pad]] [[Lead|leads]] to more susceptibility to [[pain]] in the [[Ball (anatomy)|ball]] of the [[foot]])
 
==History and symptoms==
==History and symptoms==
* The primary symptom of metatarsalgia is the pain at the end of one or more of the metatarsal bones (ball of the foot)
* The primary [[symptom]] of metatarsalgia is the [[pain]] at the [[End-group|end]] of one or more of the [[metatarsal bones]] ([[Ball (anatomy)|ball]] of the [[foot]]) with the following [[Characteristic impedance|characteristics]]:
* Pain is increased by walking barefoot or running
** [[Pain]] is either sharp or dull
* Pain comes on gradually over a period of several months, not suddenly
** It worsens on [[weight]] bearing such as [[walking]] ([[Barefoot social work|barefoot]]) or [[running]]
* Patient has a feeling of:
** It comes on gradually over a [[period]] of several months, not suddenly
** A <nowiki>''marble''</nowiki> in the shoe
* [[Patient]] has a [[feeling]] of:<ref name="pmid29470159">{{cite journal| author=Ganguly A, Warner J, Aniq H| title=Central Metatarsalgia and Walking on Pebbles: Beyond Morton Neuroma. | journal=AJR Am J Roentgenol | year= 2018 | volume= 210 | issue= 4 | pages= 821-833 | pmid=29470159 | doi=10.2214/AJR.17.18460 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29470159  }} </ref>
** A <nowiki>''marble''</nowiki> in the [[Shoe insert|shoe]]
** [[Walking]] on <nowiki>''pebbles''</nowiki>
** A bunched up sock
** A bunched up sock
** Standing on a <nowiki>''pea''</nowiki>
** [[Standing]] on a <nowiki>''pea''</nowiki>
* Swelling at the base of toe
* [[Patient]] often perceives it as a [[feeling]] of [[lump]] inside or underneath the [[foot]]
* Difficulty wearing shoes
* [[Swelling]] at the [[base]] of [[toe]]
* Crossover toe (end-stage of capsulitis)
* Difficulty [[Wear red day|wearing]] [[Shoe insert|shoes]]
* [[Crossover (genetic algorithm)|Crossover]] [[toe]] ([[End-stage disease|end-stage]] of capsulitis)
 
==Imaging Fingings==
Following [[Imaging studies|imaging tests]] may prove to be [[Help Menu|helpful]] in [[Diagnose|diagnosing]] and [[Differentiate|differentiating]] metatarsalgia from other [[causes]] of [[Foot|forefoot]] [[pain]]:
===X-ray===
[[X-ray]] [[Help Menu|helps]] to exclude other [[causes]] of [[Foot|forefoot]] [[pain]]
 
===MRI===
[[Magnetic resonance imaging|MRI]] [[Help Menu|helps]] to [[diagnose]] & [[differentiate]] other [[causes]] of [[pain]] in mid-[[foot]] and [[metatarsal]] [[Region of interest|regions]] such as:<ref name="pmid29470159">{{cite journal| author=Ganguly A, Warner J, Aniq H| title=Central Metatarsalgia and Walking on Pebbles: Beyond Morton Neuroma. | journal=AJR Am J Roentgenol | year= 2018 | volume= 210 | issue= 4 | pages= 821-833 | pmid=29470159 | doi=10.2214/AJR.17.18460 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29470159  }} </ref>
* [[Trauma|Traumatic]] [[disorders]]
* [[Circulatory]] [[conditions]]
* [[Arthritis]]
* Neuroarthropathies
* Other [[conditions]] [[Leading strand|leading]] to biomechanical [[imbalance]]
 
===Bone Scan===
A [[bone scan]] pinpoints to the [[Place cell|places]] of [[inflammation]]
 
===Ultrasound===
*[[Ultrasound]] [[imaging]] of [[foot]] gives [[Value (mathematics)|valuable]] [[Information science|information]] regarding the alterations responsible for [[Causes|causing]] metatarsalgia
*It also [[Help Menu|helps]] to [[Detectable warning|detect]] & exclude other [[causes]] of [[pain]] in the [[metatarsal]] [[foot]] [[Region of interest|region]]. These [[conditions]] include:<ref name="pmid11409128">{{cite journal| author=Iagnocco A, Coari G, Palombi G, Valesini G| title=Sonography in the study of metatarsalgia. | journal=J Rheumatol | year= 2001 | volume= 28 | issue= 6 | pages= 1338-40 | pmid=11409128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11409128  }} </ref>
**[[Morton's neuroma]]
**[[Bursitis]]


==Treatment==
==Treatment==
* First step in the treatment of metatarsalgia is determining the cause of the pain and then carrying out the measures to eliminate that cause
* First [[Step function|step]] in the [[Treatments|treatment]] of metatarsalgia is determining the [[Causes|cause]] of the [[pain]] and then [[Carrying capacity|carrying]] out the [[Measure (mathematics)|measures]] to eliminate that [[Causes|cause]]
===Conservative medical therapy===
===Conservative medical therapy===
* Following are the conservative measures for the treatment of metatarsalgia:
* Following are the conservative [[Measure (mathematics)|measures]] for the [[Treatments|treatment]] of metatarsalgia:
** Changing the improper fitting footwear with shoes having:
** [[Change detection|Changing]] the [[Improper rotation|improper]] fitting [[Foot|footwear]] with [[Shoe insert|shoes]] having:
*** High and wide toe box (allowing the foot to spread out)
*** High and [[Wide and fast|wide]] [[toe]] [[box]] (allowing the [[foot]] to [[Spreading activation|spread]] out)
*** Rocker sole (decreases the stress on the ball-of-the-foot)
*** Rocker [[Sole (foot)|sole]] (decreases the [[Stress (medicine)|stress]] on the [[Ball (anatomy)|ball]]-of-the-[[foot]])
** Unloading the pressure to the ball-of-the-foot by following foot-care products:
** Unloading the [[pressure]] to the [[Ball (anatomy)|ball]]-of-the-[[foot]] by following [[foot]]-[[Care centers|care]] [[Product (biology)|products]]:
*** Orthotics with metatarsal pad which is placed behind the ball-of-the-foot (relieves the pressure, and redistributes the weight from painful area to the more tolerant areas)
*** [[Orthotics]] with [[metatarsal]] pad which is [[Place cell|placed]] behind the [[Ball (anatomy)|ball]]-of-the-[[foot]] (relieves the [[pressure]], and redistributes the [[weight]] from [[painful]] [[area]] to the more tolerant [[Area|areas]])
*** Gel metatarsal cushions
*** [[Gel]] [[metatarsal]] cushions
*** Metatarsal bandages
*** [[Metatarsal]] [[bandages]]
===Surgery===
===Surgery===
* In some cases, off-loading of the joints doesn't eliminate the pain
* In some [[Case-based reasoning|cases]], [[Off balance|off]]-[[Loading dose|loading]] of the [[joints]] doesn't eliminate the [[pain]]
* In such cases, patient should be referred to foot and ankle surgeon for the surgery for pain relief
* In such [[Case-based reasoning|cases]], [[patient]] should be [[Reference|referred]] to [[foot]] and [[ankle]] [[surgeon]] for the [[surgery]] for [[pain relief]]


==Prevention==
==Prevention==


[[Primary prevention|Primary preventive]] [[Measure (mathematics)|measures]] for metatarsalgia include the following:
* [[Avoidance reaction|Avoid]] high [[Leveling effect|level]] of [[Activity (chemistry)|activity]] putting excessive [[pressure]] on the [[Ball (anatomy)|ball]] of the [[foot]]
* [[Avoidance reaction|Avoid]] excessive [[pronation]]
* [[Avoidance reaction|Avoid]] high [[Heel|heels]]
* [[Avoidance response|Avoid]] [[Improper rotation|improper]] fitting [[Foot|footwear]] such as [[Womens Pack|women’s]] [[dress]] [[Shoe insert|shoes]] or other [[Restriction|restrictive]] [[Foot|footwear]] with narrow [[toe]] [[box]]
* [[Avoidance response|Avoid]] high [[Impacted|impact]] [[Activities of daily living|activities]] or [[Sports Medicine|sports]] (involving [[running]] or [[jumping]]) without proper [[Foot|footwear]]/[[orthotics]] such as:
** [[Tracking changes|Track]] and field [[running]]
**Tennis
**[[Footballs|Football]]
**Baseball
**Soccer


==References==
==References==

Latest revision as of 20:55, 19 August 2020

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

WikiDoc Resources for Metatarsalgia

Articles

Most recent articles on Metatarsalgia

Most cited articles on Metatarsalgia

Review articles on Metatarsalgia

Articles on Metatarsalgia in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Metatarsalgia

Images of Metatarsalgia

Photos of Metatarsalgia

Podcasts & MP3s on Metatarsalgia

Videos on Metatarsalgia

Evidence Based Medicine

Cochrane Collaboration on Metatarsalgia

Bandolier on Metatarsalgia

TRIP on Metatarsalgia

Clinical Trials

Ongoing Trials on Metatarsalgia at Clinical Trials.gov

Trial results on Metatarsalgia

Clinical Trials on Metatarsalgia at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Metatarsalgia

NICE Guidance on Metatarsalgia

NHS PRODIGY Guidance

FDA on Metatarsalgia

CDC on Metatarsalgia

Books

Books on Metatarsalgia

News

Metatarsalgia in the news

Be alerted to news on Metatarsalgia

News trends on Metatarsalgia

Commentary

Blogs on Metatarsalgia

Definitions

Definitions of Metatarsalgia

Patient Resources / Community

Patient resources on Metatarsalgia

Discussion groups on Metatarsalgia

Patient Handouts on Metatarsalgia

Directions to Hospitals Treating Metatarsalgia

Risk calculators and risk factors for Metatarsalgia

Healthcare Provider Resources

Symptoms of Metatarsalgia

Causes & Risk Factors for Metatarsalgia

Diagnostic studies for Metatarsalgia

Treatment of Metatarsalgia

Continuing Medical Education (CME)

CME Programs on Metatarsalgia

International

Metatarsalgia en Espanol

Metatarsalgia en Francais

Business

Metatarsalgia in the Marketplace

Patents on Metatarsalgia

Experimental / Informatics

List of terms related to Metatarsalgia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

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.

Template:Diseases of the musculoskeletal system and connective tissue

de:Metatarsalgie it:Metatarsalgia


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Metatarsalgia&oldid=1653424"