Metatarsalgia

Understanding biomechanics is essential to diagnosing and treating vague symptom descriptions such as metatarsalgia.

If you remember back to our discussion on pronation and supination - the foot first must pronate when loading then convert into a supinated, rigid lever for propulsion. This occurs when the body weight moves over the center of the foot, tightening posterior structures and placing them into position for maximal effect. When this system works properly, the Achilles tendon raises the hind foot and increases pressure on the forefoot. At the same time, supination is occurring. The peroneus longus tendon begins firing, causing forefoot load to transfer from the lateral forefoot to the first ray, our most important propulsive lever in the forefoot. If an imbalance exists in this chain - for example excessively tight Achilles, poorly functional peroneal complex, or first ray insufficiency due to elevation, shortening or stiffness, then more load occurs for longer in the lesser metatarsals. This sets up a variety of pathological processes, any of which may occur or more than one may happen at the same time.

Treatment should focus on mechanics first - how did the pathology occur? Functional problems are treated with functional support such as orthotics. Structure comes second. And when a structural concern exists often surgical intervention can be helpful. However surgery just to relieve pain will often fail if it does not address mechanical causes leading to the pain.

Key takeaways for practitioners:

• Metatarsalgia is a symptom, not a diagnosis
• The first ray is critical—ignore it and you’ll fail
• Callus tells you everything about pressure distribution
• Equinus is one of the most underappreciated contributors
• Orthotics work—when done correctly
• Surgery should correct mechanics, not just relieve pain

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.