Orthopaedics - Painful feet?

‘Metatarsalgia’ is a medical term for pain in the ‘ball’ of the foot. This can range from mild discomfort after sporting activity to severe pain when walking short distances. The pain can be from several structures – from the bones, the joints, from the ligament under the joint (plantar plate) and in some cases from the nerve running beside the bones (Morton’s neuroma). Toe deformities can develop due to failure of these structures.

In most cases the primary problem is abnormal load distribution in the foot. This may be from tightness in the calf muscles, weakness in the muscles in the foot, bunions, arthritis or problems around the ankle. Badly fitting shoes and obesity can contribute. Four times your body weight goes through the ball of the foot on each step, so even being a few pounds overweight will significantly increases the pressure on your feet.

The first step in management is usually to take the pressure off the painful part of the foot, often with an insole from a podiatrist or by addressing any muscles weakness or tightness with physiotherapy.

If this does not improve the pain, then assessment by a foot and ankle specialist is the next step. Further investigations can be arranged such as x-rays, ultrasound and MRI scans, but often the diagnosis can be made by examination only.

There are several operations that are available to address the source of the pain, or to address any underlying cause.

The calf muscle can be lengthened; plantar plate tears can be repaired. Bunions can be corrected and toes can be straightened. Neuromas can be excised.

One of the newest techniques is the use of keyhole surgery to elevate the prominent bones. A distal metatarsal metaphyseal osteotomy (DMMO) is a procedure where the prominent metatarsal heads are cut through a tiny incision using a special burr. This allows the prominent bone to be elevated and take the pressure off the painful nerve. Toe deformities are corrected at the same time.

Metatarsalgia can generally be successfully treated in the modern foot and ankle practice.

This often is achieved by simple non-operative measure such as weight loss, footwear modification and exercise, but there are various surgical options if this fails.