Are There Different Types Of Break
Breaks can be acute, or caused immediately by injury. They can also occur over a longer period of time, when they are called stress fractures.
An acute metatarsal fracture may be open or closed, and displaced or not displaced:
- Open or closed: an open fracture is one where the skin is broken over the fracture so that there is a route of possible infection from the outside into the broken bones. This is a more serious type of fracture, with more damage to the soft tissues around it making treatment and healing more complicated. Specialist assessment is needed.
- Displaced or not displaced: a displaced fracture is one where, following the break, the bones have slipped out of line. A displaced fracture needs specialist care, as the bones will need to be properly lined up and stabilised. This may involve an anaesthetic and some kind of metal pinning or plating to the bones.
Acute metatarsal fracture is usually caused by a sudden forceful injury to the foot, such as dropping a heavy object on to the foot, a fall, kicking against a hard object when tripping, or from a sporting injury.
Lifestyle And Home Remedies
To help ease your metatarsalgia pain, try these tips:
- Rest. Protect your foot from further injury by not stressing it. Elevate your foot after standing or walking. You might need to avoid your favorite sport for a while, but you can stay fit with low-impact exercises, such as swimming or cycling.
- Ice the affected area. Apply ice packs to the affected area for about 20 minutes at a time several times a day. To protect your skin, wrap the ice packs in a thin towel.
- Take an over-the-counter pain reliever. Try ibuprofen , naproxen sodium or aspirin to reduce pain and inflammation.
- Wear proper shoes. Avoid too-tight or too-loose shoes and limit your wearing of high heels. Wear shoes appropriate to the sports you play.
- Use metatarsal pads. These off-the-shelf pads are placed in your shoes just ahead of the metatarsal bone to help deflect stress from the painful area.
- Consider arch supports. If insoles don’t help, your doctor might recommend arch supports to minimize stress on the metatarsal bones and improve foot function. You can buy arch supports over-the-counter, or they can be custom fitted.
What Causes Plantar Plate Problems
- The metatarsal bones shape: a short first metatarsal combined with either a long second and third metatarsal or both heightens the chance of suffering plantar plate issues
- Placing too much weight on one of the metatarsals
- Being pigeon-toed
- Suffering from big toe arthritis or hallux valgus
- Having undergone steroid injections in the area previously
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Diagnosis For Metatarsalgia Forefoot Pain
Finding the correct diagnosis and hence cause of the metatarsalgia is essential to being able to advise the correct treatment. Sometimes more than one diagnosis is present.
Your orthopaedic surgeon will talk to you to gain clues from the history of your condition and will then examine you. X-rays and other investigations such as magnetic resonance imaging may also be required and the surgeon will discuss these with you. Only when a diagnosis has been made can treatment be initiated.
When To See A Healthcare Provider
Any new or worsening pain on the top of the foot should be examined by your healthcare provider as soon as possible. While at-home remedies may help alleviate your symptoms, this improvement may be temporary. In addition, some diagnoses like a stress fracture, gout, or peripheral neuropathy may progress or worsen if treated inappropriately.
Because of this, it is important to seek the care of a healthcare provider if you are experiencing any of the symptoms detailed above. This is especially important if you have other health conditions like diabetes, osteoporosis, kidney dysfunction, or vitamin or hormone deficiencies which can exacerbate some of the conditions that cause pain on the top of the foot.
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Are There Tests To Diagnose The Cause Of Top Of Foot Pain
Diagnosis of dorsal foot pain typically begins with a comprehensive evaluation by a physician. During this examination, several tests can help your healthcare provider discover the root cause of your issue:
- X-rays and MRIs:These tests are useful for visualizing bone and soft tissue conditions like midfoot arthritis, a stress fracture, a Lisfranc injury, or extensor tendonitis. This type of imaging may also be used for a ganglion cyst, though this is rarer.
- Blood Draws: Assessing your bodys uric acid levels using a blood draw may be necessary if gout is suspected.
- EMG:This test assesses how well the nerves in your leg and foot are functioning and can help diagnose peripheral neuropathy.
Can Metatarsalgia Be Prevented
Some of the causes of metatarsalgia cannot be prevented – for example, metatarsalgia due to claw foot . However, there are some things that may help to prevent some of the other causes. These include:
- Ensuring that shoes are well fitted, low-heeled and have a wide toe area. This may help to prevent some causes of metatarsalgia, including Morton’s neuroma.
- Ensuring that you wear good, properly fitted footwear when running or doing sports with high impact on the feet.
- Losing weight if you are overweight.
- If you have diabetes, good control of your diabetes may reduce your chance of developing foot problems.
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What Causes Ball Of Foot Pain
As we age, we generally lose the fat pad underneath the ball of the foot, causing abnormal pressure and shock to the area. Ball of foot pain, also known as metatarsalgia, can also be caused by:
- Certain foot abnormalities, such as hammertoes, which can cause incorrect pressure distribution and abnormal pressure to the ball of the foot
- Having high arches or having a second toe thats longer than the big toe, which can put more weight on the ball of your foot
- An increase in high-impact activities such as running, jumping, or long periods of standing
- Arthritis or joint inflammation in your feet, such as with rheumatoid arthritis or osteoarthritis
- Wearing shoes that dont fit well or provide adequate support.
- High heels, which transfer your weight onto the front of your foot, can lead to ball of foot pain.
- Shoes that are too tight can also compress your toes and cause pain.
- Athletic or walking shoes that dont provide adequate support can put you at risk for ball of foot pain.
What Are The Risk Factors For Metatarsalgia
People who sustain this forefoot injury are often physically active. This includes runners, swimmers, walkers, and/or people who spend a lot of time on their feet. Those who weigh more are also at risk for developing metatarsalgia. Body weight transfers to the forefoot when we move and added weight puts more pressure on the foot bones.
Certain genetic conditions can also put a person at risk of developing this type of foot pain. Certain foot shapes, such as having a high arch or a hammertoe, can add pressure to foot and toe bones. Mortons neuroma, a noncancerous growth around a nerve in the toes, and inflammatory arthritis can cause symptoms similar to metatarsalgia and contribute to the pain.
In addition to lifestyle and genetic risk factors, ill-fitting footwear is a frequent cause of ball of foot pain, specifically high heels. These shoes transfer extra weight to the front of the foot. Shoes with a narrow tow box, or shoes that lack sufficient support and padding, can also cause metatarsalgia.
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What To Do For Metatarsalgia: Care & Treatment
With most cases of metatarsalgia, our podiatrists will assign simple treatments and care such as:
- Icing several times a day
- Taking Anti-inflammatories
- Using orthotics or arch supports
- Ankle & Achilles tendon stretches
In more serious stages of metatarsalgia we may recommend steroid injections to minimize pain and inflammation, or foot surgery if our other treatments were not effective.
In some cases our podiatrists may have an X-ray, MRI, or ultrasound scan done to check for bone fractures, or order blood work to test for other conditions often associated with metatarsalgia like arthritis, gout, and diabetes.
If you believe you are suffering from metatarsalgia or a similar ailment you should see one of our podiatric specialists right away.
Can Metatarsal Stress Fractures Be Prevented
There are a number of things that you can do to help prevent stress fractures:
- Exercise intensity and duration should be built up slowly and gradually.
- Rest time and recovery time need to be built in to any training schedule.
- Footwear should be well fitting and suit your running style. If changing – for example, from supportive training shoes to barefoot running shoes – you should be shown how to adapt your style. You should practise this gradually.
- You should be aware of the symptoms of stress fractures, and should not continue to run on a painful foot.
If stress fractures are recognised and treated quickly, this can reduce the amount of time that you need to stay away from activities.
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How Are Metatarsal Fractures Treated
This depends on:
- Which metatarsal bone is broken .
- Which part of the metatarsal bone is broken.
- How severe the damage is.
- Whether it is an acute fracture or a stress fracture.
It also depends on:
- Whether the fractured bone is displaced or non-displaced .
- Whether the tissues of the foot around the break are also badly injured causing the fracture to be an open fracture.
The basic principles of treating metatarsal fractures are as follows.
What Does Metatarsalgia Feel Like
Metatarsalgia is a term most often used to describe ball of foot pain or forefoot pain. Other symptoms can include:
- Pain in your toes : can be described as an aching, sharp, or burning pain.
- Increased pain when walking, running, standing for going barefoot
- Numbness or tingling in your toes
- A feeling like theres a pebble in your shoe that you are constantly stepping on.
- Stabbing pain in ball of foot
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How To Treat Metatarsalgia
Diagnosing the actual condition and cause of metatarsalgia is imperative when determining a treatment plan. Because there are many conditions that can cause pain and contribute to metatarsalgia, treatment plans vary, making proper diagnosis critical.
There are conservative measures that may help relieve metatarsalgia pain until you can visit a doctor. These include:
How Are Plantar Plate Problems Diagnosed
Your consultant will invite you to give a full explanation of your symptoms at your initial appointment and guide you towards the most appropriate course of treatment. It may be that X-rays are performed to assess the alignment and state of the foot bones, along with an ultrasound and/or MRI scan to establish if there has been a plantar plate tear.
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Take Over The Counter Pain Relievers
Popping a pill isnt fixing the root of the problem, but it can offer relief and help enable the balls of your feet to heal. Over-the-counter anti-inflammatories like ibuprofen, naproxen sodium or aspirin can curb the pain and bring down swelling associated with metatarsalgia.
If you are very active, pain relievers may be something to chat with your doctor or a certified podiatrist about for specific recommendations on when and how much to take for safe relief.
What Causes The Pain In The Ball Of The Foot
This pain is generally the result of excessive walking and running. Metatarsalgia is an overuse injury, and the condition is often due to abnormal weight distribution, persistent pressure on the area, and other musculoskeletal stressors. All causes result in excessive, localized pressure on the forefoot, which creates the pain in the ball of the foot.
Many conditions and habits can lead to ball of foot pain, including high levels of activity, prominent metatarsal heads, weak toe flexor muscles, tight toe muscles, a tight Achilles tendon, ill-fitting footwear, and excessive pronation, which is the side-to-side movement of the foot when walking or running.
However, experiencing pain in the ball of the foot is not always the result of physical activity. Sometimes, inherited anatomical conditions may predispose people to metatarsalgia. This may include having a high arch, a Hammertoe deformity, a short first metatarsal bone, or a long second metatarsal bone. Any of these conditions can affect weight distribution across the foot.
This pressure and weight distribution causes inflammation, which in turn causes the foot pain. Blood vessels in the ball of the foot dilate, and blood flow increases to allow white blood cells to swarm the injured area. In some cases, the forefoot will become red or swollen.
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Do I Need Any Investigations
If you have metatarsalgia, your doctor will usually try to establish the cause for the pain. They may be able to identify the cause just by listening to you, asking you questions and examining your foot. However, they may also suggest one or more of the following investigations:
- Blood tests. These can check for diabetes, arthritis and gout.
- X-ray of your foot. This can show a problem with the bones or joints in your foot.
- An ultrasound scan may be used to detect Morton’s neuroma.
- Other tests. Occasionally more detailed tests, such as a magnetic resonance imaging scan of your foot, are needed.
Metatarsalgia Pain Relief Treatment
If an athlete has a competition and is experiencing the condition, ice can be applied to the forefoot along with the application of an ACE bandage for relief from metatarsalgia pain. If weight is kept off the foot for about a day, the inflammation can settle down and the pain can be somewhat relieved. Metatarsalgia treatment at The Foot Practice may include:
- Passive range of motion exercise to relieve the pain.
- Shockwave therapy treatment can be done to reduce the inflammation.
- Orthotic insoles can be prescribed to pad the area around the metatarsal bones.
- Footwear assessment to address shoe fit for better support of the forefoot and prevent further injury.
- A flexible corrective device can be placed in the shoe for better protection of the metatarsal bones.
- If a callus is present on the forefoot, it can be trimmed for temporary pain relief. Pads can be put over the trimmed area to prevent further callus formation.
Gradually, the foot is strengthened through physical therapy so the problem can be prevented. Its recommended to avoid activities that make the pain worse however, this may not be possible. In these instances a metatarsal bar can be inserted into the athletes shoe to protect the metatarsal bones.
For proper diagnosis of your foot pain and metatarsalgia treatment options, contact our podiatry clinic for a consultation and initial assessment of your condition.
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Who Gets Metatarsalgia
Anyone can get metatarsalgia, although runners and others who take part in high impact sports or spend more time on their forefoot have the condition more frequently than others.
People with high arches also have metatarsalgia more than others. High arches put extra pressure on the metatarsals and heels. People with a second toe longer than their big toe may also experience metatarsalgia more frequently.
People with foot deformities such as hammertoes and bunions may also experience more metatarsalgia.
When To See A Doctor
Not all foot problems need medical care. Sometimes your feet ache after a long day of standing or a punishing workout. But it’s best not to ignore foot pain that lasts more than a few days. Talk to your doctor if you have a burning pain in the ball of your foot that doesn’t improve after changing your shoes and modifying your activities.
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What Causes Mortons Neuroma
Mortons neuroma can occur when the nerve gets trapped between the ends of the foots metatarsal bones, causing inflammation.
- Middle-aged women suffer it more than most, and narrow footwear or high heels could be contributing factors
- Greater pressure on the toes when playing sport or running
- Flat feet, high arches, hammer toes or bunions increase the chances that you will suffer from Mortons neuroma
Treatment Of Metatarsal Pain
If left untreated, metatarsal pain can lead to other more serious foot and lower body joint problems, so it is important to consult a podiatrist or physiotherapist.
Treating metatarsal pain depends on the cause, but simple additions such as metatarsal pads to your shoes that help spread the weight will help ease the pain. In addition, orthotics will spread your weight more equally across the bottom of the foot and provide stability to the arch, relieving metatarsal pain.
Our Chartered Physiotherapists can assess your foot to determine which form of treatment would be most suitable for you. Good foot wear which suit your needs and a personalised stretching program can also help.
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How Is Sesamoiditis Treated
Frequently, resting, taking anti-inflammatory pain relief as directed by your doctor, using your foot as little as possible, together with keeping the foot iced can minimise pain. Comfortable, soft shoes are recommended, and an insole can help with cushioning a shoe or insole that reduces the load on your toe is particularly useful. Your consultant may advise you not to engage in activities that involve placing weight on the balls of the feet and also suggest you wear a leg brace for 4-6 weeks. A personally tailored course of physiotherapy may also be suggested. Should the pain persist, surgery to repair fractures or remove the troublesome sesamoid bone may be an option, allowing you to resume your usual activities.