Metatarsalgia - Lesser Metatarsal Pain

Lesser metatarsalgia refers to pain in the ball of your foot other than the big toe joint. The pain under the ball of your foot could be due to a variety of causes. These might include:

Bony Prominence Fracture/Trauma to the bone/s
Damage to the tendons running around the joints
Damage to the joint capsule
Compression of the nerves in your foot (See Mortons Neuroma)
Arthritis in the joints
Soft tissue mass

Often the nature of the pain gives an indication as to the cause. Often a sharp pain suggests that a nerve might be compressed. A dull ache often suggests that a joint is overloaded. In some people the cause could be due to an overloaded or long metatarsal head.

Picture showing the relative length of the metatarsals. This affects force taken through the foot and is an important feature when planning surgery.

Investigations

These are aimed at finding out the cause of your pain. Several may be required and these depend on the presenting symptoms. In general the following tests are used to determine the cause of pain

X Ray
Ultrasound Scan
MRI

When combined with the clinical examination the cause of your pain is determined.

Treatment

This depends on the source and cause of pain. If a metatarsal is prominent or overloaded it may need to be shortened. If a thickened nerve is discovered this might respond to a steroid injection or possible surgical excision. I will discuss the pros and cons of each procedure so that we can arrive at a sensible and realistic treatment plan.

Neuroma Surgery
Lesser Metatarsel Surgery