PODIATRIC SURGERY INFORMATION GUIDE METATARSALGIA

 PODIATRIC SURGERY INFORMATION GUIDE METATARSALGIA What is metatarsalgia? • Metatarsalgia is a term used to describe pain in the ball of the foot. • The term refers to the bones present in the ball of the foot, called metatarsals. • Pain in the ball of the foot can be caused by many different factors. These include the bones themselves, the joints, or soft tissues such as nerves around them. Who does metatarsalgia affect? • Anyone can get metatarsalgia, although it more commonly affects those who stand or walk for prolonged periods during the day. • Symptoms are worsened if walking on hard uneven surfaces, especially if in tight, high heeled shoes with thin hard soles. What causes metatarsalgia? 1. Arthritis • Wear and tear of the knuckle joints can give rise to joint pain and metatarsalgia. • In this instance, the cartilage which normally protects the joint surface becomes worn away, resulting in bone grinding against bone resulting in pain and stiffness. Normal Abnormal ‘wear and tear’ www.totalfootcaresolutions.co.uk
1
2. Abnormal weight distribution across the ball of the foot. • All the knuckle joints across the ball of the foot should take an even proportion of the body’s weight when walking and standing. • If one of these joints takes more weight than it should, it becomes irritated, inflamed and painful. Normal joint Inflamed joint •
Abnormal weight distribution across the ball of the foot can occur in many ways: o The cause can be directly related to the bone (such as in cases where it is too long, short or prominent on the underside of the foot). This leads to the bone / joint becoming overused and inflamed. o Another cause of overload pain is related to the way in which the foot works during walking. Abnormal ‘rolling-­‐in’ and flattening of the foot arch, known as over pronation; or high arched feet are associated with abnormal pressure distribution through the ball of the foot. o Pre existing foot conditions such as ‘bunions’, a stiff big toe, and / or abnormal positions of the smaller toes can also cause an abnormal painful overload of the knuckle joints. o Shoes which are tight fitting in the toe area and high heeled shoes will force more weight on to the ball of the foot and give rise to metatarsalgia. www.totalfootcaresolutions.co.uk
2
Overlong metatarsal Bunion 3. Nerve irritation • Sometimes the nerves that run between the metatarsal bones can become irritated and swollen causing sharp, painful shooting pain. • The nerves can be irritated by poor foot function with can result in the metatarsal bones ‘pinching’ the nerve. • The nerve may become permanently swollen and painful, known as a ‘Morton’s neuroma’ Normal nerve Swollen nerve, ‘Morton’s neuroma 4. Metatarsal stress fracture • Repeated trauma and overload of a metatarsal can sometimes lead to a hairline crack in the bone known as a stress fracture. TREATMENT OPTIONS: • Depending upon the degree of pain and length of time it has been present, there are several options: www.totalfootcaresolutions.co.uk
3
Non-­‐ surgical treatments: Prevention • Avoid long periods of standing, especially in thin soled shoes. • Wear as supportive, cushioning, roomy footwear is possible. • Use cushioning insoles within shoes. • Obtain custom made ‘orthotic’ insoles which can be custom made to fit your foot. These aim to improve foot function and distribute pressure more evenly across the ball of the foot. Non-­‐ surgical treatments: Treatment when acutely painful • As above plus: • Local anti-­‐inflammatory measures such as ice packs, ibuprofen gels, foot elevation and massage of the painful area. • Cortisone (steroid) injections into the painful joint or area. Cortisone is a potent anti-­‐inflammatory agent and a course of up to 3 injections may quickly reduce the pain of metatarsalgia. Surgical intervention •
•
•
If non-­‐surgical treatments fail to relieve pain, an operation may be needed to correct the problem. There are many different types of operations for metatarsalgia; the type of surgery recommended is based around you, the degree of pain suffering, type and cause of metatarsalgia, and lifestyle requirements after surgery. As a result not everybody is offered exactly the same surgery… the surgery is tailored to you as an individual. What might surgery involve? • The aim of surgery is to improve the pain of metatarsalgia. • Depending upon the cause, it may involve o Shortening an overlong metatarsal bone. o Elevating a dropped knuckle joint. o Straightening an associated abnormal toe position (such as a bunion or hammer toe). o Removing excessive arthritic overgrowth of bone. o Removing a swollen nerve (neurectomy). • Specific information sheets are available which describe relevant operations in more detail. Although surgery can be an effective form of intervention, unfortunately all operations carry a small risk of complications. www.totalfootcaresolutions.co.uk
4
If you are considering surgery, please be aware we do not advise patients to undertake air travel until at least 6 weeks post surgery. You should be aware that these complications are relatively uncommon. They mostly resolve without permanent disability or pain using medications, therapy and on occasions further surgery, but even allowing for these, sometimes you may not achieve the result that you want. For this reason we do NOT advise surgery purely for cosmetic reasons. We also advise against prophylactic surgery (which is preventative surgery to avoid problems that are not yet present). www.totalfootcaresolutions.co.uk
5