Midfoot Pain and Treatment Options
Understanding metatarsalgia: causes, symptoms and treatment
Metatarsalgia is a common problem that affects people of all ages. It is often caused by overuse, injury or underlying medical conditions. The metatarsus, also known as the Lisfranc joint complex, plays a crucial role in foot function by distributing weight and providing stability during movement. Pain in this area can significantly affect daily life, athletic performance and quality of life.
This article discusses the causes, symptoms and treatment options for metatarsalgia, including conservative measures and surgical interventions. A better understanding of these issues will help patients make informed decisions about their healthcare and seek medical help when needed.
Causes of metatarsalgia
Overloading and repetitive strain
Repetitive strain on the metatarsus is a common cause of pain, especially in athletes and people with high levels of physical activity. Activities such as running, jumping and prolonged standing can lead to inflammation of the ligaments and tendons in the midfoot. In the long term, this can cause microtraumas that lead to chronic pain and discomfort.
Traumas and injuries
Direct injuries to the metatarsus, such as a fall, a car accident or a sports-related injury, can lead to fractures or ligament damage. One of the most well-known metatarsal injuries is the Lisfranc injury, in which the Lisfranc ligament is damaged. This injury can range from mild sprains to severe fractures that require surgical treatment.
Arthritis and degenerative diseases
Osteoarthritis and rheumatoid arthritis are common causes of metatarsalgia, especially in older adults. These conditions lead to the gradual breakdown of cartilage in the joints, causing pain, stiffness and limited mobility. Inflammatory arthritis, such as gout, can also contribute to severe metatarsal pain and swelling.
Flat feet and structural anomalies
People with flat feet (pes planus) often suffer from metatarsalgia due to abnormal foot mechanics. A missing arch puts undue stress on the structures of the midfoot, leading to pain and fatigue. Similarly, other structural abnormalities, such as high arches, can cause metatarsal pain by altering weight distribution.
Symptoms of metatarsalgia
The symptoms of metatarsalgia vary depending on the cause, but often include:
- Pain and tenderness in the middle of the foot
- Swelling and bruising (especially after trauma)
- Difficulty walking or putting weight on the foot
- Stiffness and limited mobility
- Pain that worsens with activity and improves at rest
Diagnosis of metatarsalgia
A thorough clinical examination is crucial to the diagnosis of metatarsalgia. A doctor will take the patient’s medical history, perform a physical examination and order imaging tests if necessary.
Diagnostic procedure
- X-ray: Shows fractures, dislocations and signs of arthritis.
- MRI (magnetic resonance imaging): Detailed images of soft tissues, including ligaments and tendons.
- CT scan (computed tomography): Used for complex fractures and to assess joint alignment.
- Ultrasound: Helps to assess soft tissue and detect inflammation.
Treatment options for metatarsalgia
Conservative treatments
Most cases of metatarsalgia can be treated without surgery:
Rest and adjustment of activity
Reducing physical activity and avoiding high-intensity exercise can relieve pain and prevent further injury.
Orthopaedic insoles and supportive footwear
Custom-made insoles or arch supports can promote correct foot alignment and reduce stress on the midfoot. Wearing supportive shoes with sufficient cushioning and arch support is essential.
Physiotherapy
A structured physical therapy program can improve strength, flexibility and overall foot function. Stretching and strengthening exercises for the foot and ankle help to relieve pain and prevent future injuries.
Pain management
Over-the-counter painkillers such as NSAIDs (ibuprofen, naproxen) can reduce inflammation and relieve discomfort. Cold therapy and elevation of the foot can also help.
Advanced and surgical treatments
Corticosteroid injections
In cases of severe inflammation, corticosteroid injections can reduce pain and swelling. However, these should be used with caution, as repeated injections can weaken the tissue.
Platelet-rich plasma (PRP) therapy
PRP therapy involves injecting the body’s own blood platelets into the affected area to promote healing and tissue regeneration.
Surgical options
Surgery may be necessary if conservative treatments are unsuccessful, especially in the following cases:
- Lisfranc injury repair: restoration of joint alignment and stabilization of fractures.
- Metatarsal fusion: Performed for severe arthritis to stabilize the joint and relieve pain.
- Tendon and ligament repair: treatment of soft tissue damage to restore function.
Recovery and rehabilitation
Recovery time varies depending on the severity of the condition and the treatment method chosen. Patients who receive conservative treatment may recover within a few weeks to months, while surgical treatment may require several months of rehabilitation. A customized rehabilitation plan with physical therapy and a gradual return to activity is crucial for optimal recovery.
Frequently asked questions
Supportive shoes with good arch support, cushioning and a firm sole can alleviate metatarsal pain. Custom-made insoles provide additional relief.
If there is severe pain, swelling, bruising or difficulty walking, medical help should be sought immediately.
Mild cases often improve with rest, ice treatment and suitable footwear. However, chronic or untreated injuries can worsen.
Stretching exercises for the plantar fascia, Achilles tendon and arch of the foot as well as strengthening exercises for the foot muscles improve stability and relieve pain.
Conclusion
Metatarsalgia can have a significant impact on everyday life, but with the right diagnosis and treatment, relief is possible. Don’t hesitate to contact an expert to find the best treatment for your symptoms.
