Cause of Metatarsalgia

Heui Chul Gwak; Dong Jun Ha

doi:10.14193/jkfas.2017.21.3.79

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Gwak and Ha: Cause of Metatarsalgia

Review Article

Journal of Korean Foot and Ankle Society 2017; 21(3): 79-82.

Published online: 15 September 2017

DOI: https://doi.org/10.14193/jkfas.2017.21.3.79

Cause of Metatarsalgia

Heui Chul Gwak, Dong Jun Ha^*

Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

^*Department of Orthopedic Surgery, Pusan Medical Center, Busan, Korea.

Corresponding Author: Dong Jun Ha. Department of Orthopedic Surgery, Pusan Medical Center, 359 World Cup-daero, Yeonje-gu, Busan 47527, Korea. Tel: 82-51-507-3000, Fax: 82-51-501-3001, doctordj@paran.com

Received 21 July 2017 Revised 21 August 2017 Accepted 31 August 2017

Korean Foot and Ankle Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Metatarsalgia, Forefoot

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.

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.

Figure 3

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

Figure 4

This photo shows benign tumor underneath the second metatarsal head.

Table 1

Classification and Causes of Metatarsalgia

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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