Metatarsalgia and Physiotherapy treatment

What is a Metatarsalgia?

• Metatarsalgia is a condition in which the ball of the foot becomes painful and inflamed. activities that involve running and jumping cause it. There are other causes as well, including foot deformities and shoes that are too tight or too loose.
• Overuse injuries from running and jumping activities are a prevalent cause of metatarsalgia. In addition, improperly fitting shoes, deformities of the foot, arthritis, and other illnesses may be the cause.

Causes of Metatarsalgia

• Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:

• Intense training or activity-distance runners are at risk of metatarsalgia, primarily because the front of the foot absorbs significant force when a person runs.
• But anyone who participates in a high-impact sport is at risk, especially if your shoes fit poorly or are worn.
• Certain foot shapes-A high arch can put extra pressure on the metatarsals. So can having a second toe that’s longer than the big toe, which causes more weight than normal to be shifted to the second metatarsal head.
• Foot deformities-Wearing too-small shoes or high heels can cause your foot to be misshapen. A downward-curling toe (hammertoe) and swollen, painful bumps at the base of your big toes (bunions) can cause metatarsalgia.
• Excess weight-most of body weight transfers to the forefoot when moving, extra pounds mean more pressure on the metatarsals. Losing weight might reduce or eliminate symptoms.
• Poorly fitting shoes. High heels, which transfer extra weight to the front of your foot, are a common cause of metatarsalgia in women. Shoes with a narrow toe box or athletic shoes that lack support and padding also can contribute to the problem.
• Stress fractures. Small breaks in the metatarsals or toe bones can be painful and change the way you put weight on your foot.
• Morton’s neuroma. This noncancerous growth of fibrous tissue around a nerve usually occurs between the third and fourth metatarsal heads. It causes symptoms that are similar to metatarsalgia and can also contribute to metatarsal stress.

Symptoms of Metatarsalgia

Symptoms of metatarsalgia can include:

• Sharp, aching or burning pain in the ball of foot — the part of the sole just behind toes
• Pain that worsens while stand, run, flex feet or walk — especially barefoot on a hard surface — and improves while rest
• Sharp or shooting pain, numbness, or tingling in toes
• A feeling of having a pebble in shoe
• may impair your ability of walk
• restrict your participation in daily activities.

Risk factors

Metatarsalgia can affect almost everyone, although the following factors increase your risk:

• Engage in high-impact sports that require jumping and sprinting.
• Put on high heels, ill-fitting shoes, or spiked footwear, such as cleats.
• Obese or overweight
• possess other foot issues, such as calluses on the soles of your feet and hammertoe
• possess an inflammatory form of arthritis, such as gout or rheumatoid arthritis

Diagnosis of Metatarsalgia

• Various foot problems can cause symptoms similar to those of metatarsalgia. To help pinpoint the source of your pain, your doctor will examine your foot while you stand and while you sit and ask about your lifestyle and activity level. You might need an X-ray to identify or rule out a stress fracture or other foot problems.

Treatment of Metatarsalgia

• Conservative measures — such as resting, changing shoes or using a metatarsal pad — might be all you need to relieve signs and symptoms.
• In rare cases, when conservative measures don’t relieve your pain and your metatarsalgia is complicated by foot conditions such as hammertoe, surgery to realign the metatarsal bones might be an option.

Physiotherapy Management of Metatarsalgia

physiotherapy for pain relief

• TENS: transcutaneous electrical nerve stimulation is an electrical modality that provides pain relief by providing pain modulation.TENS closes the gate mechanism at the anterior grey horn in the spinal cord. also stimulates endogenous opioid system which prevents the release of substance p at the anterior grey horn
• Ultra Sound: ultrasound is a therapeutic modality that generates ultrasound causes deep heat, provides micro-massage to soft tissue, increases flexibility, promotes healing of tissue as well, and improves localized blood supply to the area. and ultimately pain relief.
• HOT PACKS: Hot packs are packs that are immersed in the apparatus called hydrocollateral. they provide superficial moist heat. it relieves the muscle spasm, increasing blood circulation, and thus relieves the pain

• CONTRAST BATH: contrast bath work works on the principle of the combined effect of heat and cold the part alternatively immersed in the hot and cold temperature of hot water ranges from 36cto45c and cold water from 15c -20c.
• treatment begins with hot water and should end with cold water. treatment time varies between 15 to 30 minutes, with immersion in hot water around 3 minutes and in cold water around 1 minute.
• it relieves the pain.

• If there is swelling then the ice pack in elevation will be beneficial.
• speedy ankle toes exercise reduces swelling and improves circulation under pressure with a leg in elevation
• faradic foot bath with voluntary intrinsic exercise: low-frequency current used to re-educate lumbricals, plantar interossei, abductor hallucis.
• appropriate shoe size
• metatarsal pad
• metatarsal bar
• shoe wedge
• Gait training

Complications

If left untreated, metatarsalgia can cause pain in the other foot or in the same foot as well as pain in other regions of the body like the hips or low back from the changed stride caused by the foot pain.

Self-Care

Try these strategies to see if they help relieve your metatarsalgia pain:

Rest. Avoid putting too much strain on your foot to prevent future injuries. When you’re done walking or standing, raise your foot. While you might have to give up your favorite activity for a while, low-impact activities like swimming or cycling can help you stay in shape.

Ice Pack on the impacted region. Several times a day, apply cold packs to the afflicted area for up to 20 minutes at a time. Use a small cloth to wrap the ice packs over your skin to protect it.

Utilize an over-the-counter analgesic. To relieve pain and inflammation, try aspirin, naproxen sodium (Aleve), or ibuprofen (Advil, Motrin IB, and other brands).

Wear appropriate shoes. Keep your shoe size in check and use high heels seldom. Wear footwear suitable for the sports you participate in.

Utilize metatarsal pads. To assist in relieving pressure from the sore spot, these ready-made pads are positioned in your shoes slightly ahead of the metatarsal bone.

Think about arch supports. Your doctor may suggest arch supports if insoles are ineffective in reducing metatarsal bone stress and enhancing foot function. Arch supports are available for purchase over the counter or can be made to order.

How to Prevent Metatarsalgia?

Although there are certain things you can do to prevent metatarsalgia, not all cases of it can be avoided. One possible way to avoid metatarsalgia is to:

• Selecting footwear with a lower heel, a wide toe box, and sturdy soles.
• Put in your shoes with cozy insoles.
• Avoid going barefoot.
• Calluses may be removed from your feet by soaking them and using a pumice stone. Pressure can be released by scraping off these calluses.
• keeping yourself at a healthy weight.

Prognosis

Your foot may be extremely painful and inflamed if you have metatarsalgia. The discomfort might start off suddenly or gradually worsen. You can also have other symptoms.

Resting your foot should be your first priority. Avoid engaging in any sports or activities that you believe might have contributed to the discomfort. Try not to stand or walk too much for too long. Keep your footwear supportive. Avoid prolonged lengths of time spent walking in your sock feet.

You should be able to cure metatarsalgia on your own and get well with a few simple procedures. You should consult your doctor for additional assessment if the pain persists despite at-home therapy.

Conclusion

The pain and discomfort of metatarsalgia can be severe. It could make it harder for you to take pleasure in the activities you enjoy. It’s possible that you can’t even walk. Fortunately, there are easy at-home procedures you may do to cure the illness yourself most of the time. Speak with your healthcare physician if rest and fresh shoes aren’t enough. They are able to assess your symptoms and decide whether you require more involved medical care.

FAQ

Author: Bhoomi Physiotherapist

Bhoomi Patel - Physiotherapist in Mobile Physiotheray Clinic, B - 01, Jagatnagar Society, Opp. Shaktidhara Society, India Colony Road, Tollnaka, Bapunagar, Ahmedabad.