Metatarsalgia is a generalized term for pain at the ball of the foot. Several different conditions can produce pain in this area, including structural problems with the toes or metatarsal bones, stress fractures, as well as a pinched nerve at the ball of the foot. The development of “hammertoes” will typically lead to increased retrograde pressure at the ball of the foot. An excessively long or short metatarsal can increase the weight distribution in certain areas at the ball of the foot and cause focal pain. A tight Achilles tendon and wearing high heels will increase pressure at the ball of the foot and contribute to the development of pain and overuse injuries. A careful history, thorough examination and x-rays can help identify most of the causes of pain at the ball of the foot.
Treatment of many of the causes of pain at the ball of the foot includes alleviating pressure in the area with stretching exercises, shoe changes, custom orthotics, padding, or toe strapping. Increased cushion at the ball of the foot can help some conditions. Stress fractures usually require a period of immobilization; identifying them early will speed the overall recovery as early stress fractures respond much more quickly than those which have progressed to a more complicated fracture.
In cases of a pinched nerve, or a “Morton’s Neuroma”, cortisone injections, orthotics, shoe changes, and padding can alleviate pain. A newer technique for neuromas includes a series of sclerosing injections that help “deaden” the nerve; it has proven to be very successful in relieving pain and avoiding the need for surgery. Cryotherapy of the damaged nerve is another alternative non-surgical treatment. If surgery is required, there are two approaches; the first is to release and decompress the nerve, and the second involves removing a section of the nerve. Our preference in many cases is to perform a simpler nerve decompression, avoiding the long-term numbness that usually follows nerve excision.
For more information, please call 661-260-1180.