Journal List > J Korean Foot Ankle Soc > v.21(3) > 1043449

Gwak and Ha: Cause of Metatarsalgia

Abstract

Metatarsalgia is one of the most common causes of patients complaining of pain in their feet. This pain is the plantar forefoot, including the second to fourth metatarsal heads and arises from either mechanical or iatrogenic causes. On the other hand, it is frequently accompanied by a deformity of the toes as well as of the first and fifth rays. The pain has a variety of causes, and sometimes the cause is difficult to distinguish. The variability of possible causative factors necessitates an individualized approach to treatment. To determine these causes, this paper presents an overview of the gait mechanics, plantar pressure, and the classification according to the etiology.

Figures and Tables

Figure 1

Event of three rocker phases of walking. The heel acts as the first rocker, beginning with initial heel strike. In the second rocker, the entire foot normally remains in contact with the ground. During the third rocker only the forefoot is in contact with the ground.

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Figure 2

An elevated first metatarsus pushes the whole load of the second rocker onto the second metatarsus, resulting in isolated keratosis underneath the second metatarsal head.

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Figure 3

This photo shows Morton's neuroma between 3rd~4th metatarsal heads.

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Figure 4

This photo shows benign tumor underneath the second metatarsal head.

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Table 1

Classification and Causes of Metatarsalgia

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Group Cause Etiology/pathology
Primary Excessive MT plantar flexion Neurologic, congenital
First ray insufficiency Hallux valgus deformity, flatfoot, hypermobility of the first metatarsocuneiform joint, brachymetatarsia
Forefoot equinus Congenital, cavus foot, contracture of the triceps surae
MT length discrepancy Congenital
MT head abnormality Arthritis, hereditary, congenital deformity, neoplasia, infection
Secondary MTP joint instability Long second MT, systemic arthritides, Keller-Brandes resection arthroplasty, plantar plate rupture
Freiberg infraction Malunion or nonunion of MT osteotomy or fusion of the first MTP joint
Neuropathic pain Interdigital neuroma, tarsal tunnel syndrome
Hallux rigidus Elevated first MT, hereditary, osteochondrosis, trauma
MT malalignment Trauma
Iatrogenic Failed forefoot surgery Malunion or nonunion of MT osteotomy or fusion of the first MTP joint

MT: metatarsal, MTP: metatarsophalangeal.

Notes

Financial support None.

Conflict of interest None.

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