Metatarsalgia: Treatment is the key to identify the cause!
Metatarsalgia is divided into flaccid and compressive, and the key to treatment of this disease is to identify the cause.
Metatarsalgia refers to the pain of the forefoot stem and bony surface (i.e. the bottom of the forefoot) caused by strain or nerve compression or irritation of the transverse arch of the forefoot.
Most of the flaccid metatarsalgia is congenital, mainly due to chronic injury to the transverse arch caused by congenital abnormal development of the first metatarsal bone, as primary metatarsal enthesopathy and bone hypermobility.
Clinical manifestations.
(1) pain on the forefoot surface during walking, which is a persistent burning pain.
(2) Widening of the forefoot with callus on the second and third bony surfaces.
(3) Facet pressure pain, which is relieved by lateral compression of the bone.
(4) There may be abnormal movement of the first tarsal joint with pain.
Diagnosis based on.
(1) persistent burning pain on the forefoot surface when walking, callus on the forefoot sole, and pressure pain, while lateral squeezing of the bone may relieve the pain
(2) X-ray film shows widening of the gap between the first and second bones and inversion of the first bone.
Treatment principle: relaxation pain can often be effective by non-surgical treatment, and only very few need surgical treatment.
Compression pain is related to improper shoe wearing
Due to long-term extrusion of the bony part by external forces resulting in long-term pressure or stimulation of the toe nerve causing interstitial neuritis or neurofibroma, it is mostly associated with wearing high-heeled shoes or narrow-headed shoes.
Clinical manifestations.
(1) pain in the forefoot when walking, paroxysmal radiating pain, stabbing or knife-like pain, pain radiating to the third and fourth toes, sometimes forcing to stop walking or standing due to severe pain.
(2) The affected foot is elongated and the forefoot is crushed.
(3) There is pressure pain on the surface, while lateral compression of the bone may aggravate or cause pain.
(4) The third and fourth toes may have abnormal sensation.
Diagnosis based on.
(1) paroxysmal radiating pain on the forefoot surface when walking, radiating to the toes of the affected foot is slender, with pressure pain on the surface, while lateral squeezing of the bone may aggravate or cause pain.
(2) A lump can be felt on the face of the third and fourth toe. The disease is mostly found in middle-aged and older women aged 30-50 years, and in those with narrow and lax feet, mostly unilateral.
Treatment principle: surgical treatment is required with satisfactory results.