What is it?

Metatarsalgia is pain located under the forefoot. It has many causes and a specific clinical examination usually determines its aetiology and a targeted treatment can then be proposed.

The body’s weight is distributed between the five metatarsals (bones in the midfoot, linking with the toes). The first bone, linked to the big toe, receives 2.5 times more weight than the others. The rest of the weight is then divided among the other metatarsals. Any imbalance of this relationship causes a cascading change meaning that an extra burden falls onto one or more of the other metatarsals. Pain then develops specifically under the overburdened metatarsals.

métatarsalgies et premier métatarsien court
  • Fig. 1

    Normal foot
    Pressure is distributed equitably between the different metatarsals (in blue)

  • Fig. 2

    First short metatarsal that does not bear enough weight and therefore transfers its burden to the adjacent metatarsals, which are painful (in red)

Bony protrusions can be felt when palpating the plantar region, at the base of the toes; these protrusions correspond to the heads of the metatarsals and are a specific representation of the painful area.

Clinical presentation

There are many causes but they are all characterised by an overloading of the forefoot. The problem is always located under the metatarsal heads, and protrusions can be easily palpated at the base of the toes.

Traditionally, the second metatarsal is the first affected. Pain is experienced when walking and when standing for prolonged periods; the pain improves with rest and increase when wearing high heels.

When should you consult a specialist?

If the pain persists despite restricting the excess burden or if the pain becomes incapacitating, it is advisable to consult a specialist. A comprehensive and specific clinical examination will help make an accurate diagnosis and offer the appropriate treatment.

The examination is generally completed by a radiological evaluation, to refine the diagnosis and determine the cause of the condition.

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