Metatarsalgia

Abstract

Metatarsalgia, or the sensation of pain on the “ball” of the foot, is a common symptom presentation in orthopedic practice. This symptom can be caused by traumatic injury (MTP dislocations, metatarsal fractures, penetrating injury), neurologic conditions (Morton’s neuroma), degenerative or acquired/developmental conditions (hallux valgus, claw toe), or infectious/systemic conditions (diabetic foot ulcer, synovitis). A thorough history and physical examination is essential in the investigation of pain, as management varies significantly depending on the cause (surgical intervention for MTP dislocations versus rest and elevation for metatarsal stress fractures).

Define metatarsalgia.	Symptom of pain experienced in the ball of the foot
List three causes of metatarsalgia.	Traumatic (MTP dislocations)  Acquired (hallux valgus)  Infectious (synovitis/osteomyelitis)
Define Morton’s neuroma .	Compressive neuropathy of the interdigital nerve
Where is Morton’s neuroma most commonly located ?	Commonly involves the second/third interdigital nerve between the metatarsal heads
What physical exam findings are common with Morton’s neuroma?	Positive web space compression test  Mulder’s click (felt when squeezing metatarsals together)
What is the technique for operative managemen t of Morton’s neuroma?	Cut the interdigital nerve as far proximal as possible to prevent recurrence
Which metatarsal is the most common involved with stress fractures?	The second metatarsal
What is the best radiographic method to detect? Acute osteomyelitis or chronic?	Acute: MRI Chronic: X-ray