| Metatarsalgia
(Capsulitis) is a general term used to denote
a painful foot condition in the metatarsal region
of the foot (the area just before the toes, more
commonly referred to as the ball-of-the-foot).
This is a common foot disorder that can affect
the bones and joints at the ball-of-the-foot.
Metatarsalgia (ball-of-foot-pain) is often located
under the 2nd, 3rd, and 4th metatarsal heads.
These joints have a capsule around them to hold
in the joint fluid and lubricate the joint for
motion. Excessive pressure to the joint can cause
inflammation of the joint and capsule. The patient
usually relates pain at the joint itself, and
states that it sometimes feels like their "sock
is bunched up" or it feels like their standing
on a "pea".
Cause.
With this condition one or more of the metatarsal
heads become painful and/or inflamed, usually
due to excessive pressure over a long period of
time. It is common to experience acute, recurrent,
or chronic pain with this common foot condition.
Ball-of-foot pain is often caused from improper
fitting footwear, most frequently in women’s dress
shoes and other restrictive footwear. Footwear
with a narrow toe box (toe area) causes the ball-of-foot
area to be forced into a minimal amount of space.
This can inhibit the walking process and lead
to extreme discomfort in the forefoot. Other factors
can cause excessive pressure in the ball-of-foot
area that can result in metatarsalgia. These include
shoes with heels that are too high or participating
in high impact activities without proper footwear
and/or orthotics. Also as we get older, the fat
pad in our foot tends to thin out, making us much
more susceptible to pain in the ball-of-the-foot.
Often times, the second metatarsal may be much
longer than the others, resulting in excessive
pressure on the joint as well.
Treatment
and Prevention.
The first step in treating metatarsalgia is to
determine the cause of the pain. If improper fitting
footwear is the cause of the pain, the footwear
must be changed. Footwear designed with a high,
wide toe box (toe area) and a rocker sole are
ideal for treating metatarsalgia. The high, wide
toe box allows the foot to spread out while the
rocker sole reduces stress on the ball-of-the-foot.
Unloading pressure to the ball-of-the-foot can
be accomplished with a variety of footcare products.
Orthotics designed to relieve ball-of-foot pain
usually feature a metatarsal pad. The orthotic
is constructed with the pad placed behind the
ball-of-the-foot to relieve pressure, and redistribute
weight from the painful area to more tolerant
areas. Other products often recommended include
gel metatarsal cushions and metatarsal bandages.
When these products are used with proper footwear,
you should experience significant relief.
Sometimes
off-loading of the joint does not eliminate the
pain. Surgery may be necessary to alleviate the
excessive pressures on the joint. The doctors
at Michigan Foot and
Ankle Center are well-trained in surgery
to correct metatarsalgia.
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