Forefoot Pain:
Metatarsalgia and Neuromas
The long bones in the front half of your foot are called metatarsal bones. Each bone ends in the front part of the foot in a joint, the metatarsophalangeal one, where the toes begin. When walking, the metatarsal bones support the body’s weight.
In between each of the metatarsal bones there are nerves which give the sensation to the toes. These nerves are called intermetatarsal nerves.
Why can I suffer from pain in the forefoot?
Pain can originate from one of the many structures present in the forefoot, as bones, nerves, muscles, tendons and ligaments. The most commonly involved structures are the metatarsal bones and the nerves that run in between them.
What is metatarsalgia?
Metatarsalgia means pain in relation to the metatarsal bones. It is caused frequently by high-heeled shoes and shoes with little shock-absorption soles. These two factors increase the pressure in the forefoot area. If there is more pressure in this area, it will create inflammation on the skin below the bone, frequently originating a hyperqueratotic area (callus formation), on the joint between the metatarsal bone and the toe, and on the nerves that run in between the bones.
Walking long distances over hard surfaces or just being on your feet for long time can put additional stress on the forefoot area, creating pain. Pain can be localized under any of the metatarsal bones. If you present also toe deformities (claw or hammer toes) pain under the metatarsal bones can increase. Overweight also is an important factor. In some cases having arthritis or having an increased arch in your feet can cause pain like metatarsalgia.
Signs and Symptoms
The most common symptom is pain in the forefoot area on the plantar side. You can feel as if you have a marble or small stone in your shoe. You can also have inflammation under your feet, associated or not to a callus.
What is a Neuroma?
An inflamed nerve is commonly known as a neuroma, or intermetatarsal neuritis. Neuromas occur most frequently in between the base of the third and fourth toes, or in between the base of the second and third toes.
Using high-heeled shoes or too tight shoe wear can create an inflammation around a nerve. This type of shoe wear will compress your bones and increase the pressure around the end of the metatarsal bones, thus creating inflammation in your nerves.
Signs and Symptoms
The most common complaint is pain in the forefoot area in between the toes. Pain generally starts progressively; you can feel as if you had a marble in between your toes; you can also feel numbness and/or tingling sensation in your toes. Symptoms can arise after being sitting long time, or being on your foot after a while.
Prevention
Using comfortable shoes, with a wide toe-box area, and adequate shock absorption sole should keep your feet without pain. It is also important to keep your weight under control, as it may be a precipitating factor.
Diagnosis and Treatment
Your surgeon will examine you, and determine if pain comes from your metatarsal bones, nerves, ligaments, tendons or other structures, with the aid of diagnostic exams such as x-rays, axial computed tomograms, or magnetic resonance imaging. A definite treatment will be recommended for you, which may consist in modifying certain activities, insole use, use of shock absorption materials, and eventually local corticosteroid injections. Depending on the intensity of your symptoms and your response to conservative treatment, it will be determined if the treatment has to be modified or a surgical alternative should be undertaken.
Surgery
The surgery will include soft tissue and bony procedures to correct and alleviate your pain. Your orthopedic surgeon will explain the surgical details to you, postoperative rehabilitation and possible complications.
-Clinica Alemana has foot and ankle surgeons trained in the U.S. and in Europe, which will offer you the best treatment and care for your condition.
-Brochure prepared by the Foot and Ankle team of the Orthopedics and Traumatology Department of Clinica Alemana.