Metatarsalgia

What is metatarsalgia?

Metatarsalgia is a general name given to pain in the front part of the foot under the heads of the metatarsal bones. This is the area on the sole of the foot sometimes called the ball of the foot. Metatarsalgia can be caused by a number of different conditions affecting the foot. It is really a symptom of other problems rather than a specific disease itself.

Anatomy of your foot

Hay muchos huesos en cada pie y estos se pueden dividir brevemente en los huesos tarsianos, los huesos metatarsianos y las falanges. (Vea la imagen en esta página.) Los huesos tarsianos son los huesos más grandes que forman la sección trasera del pie, siendo el hueso del talón (calcáneo) el más grande. Hay cinco huesos metatarsianos. El primer hueso metatarsiano es el más grande y es el hueso que se une al dedo gordo del pie. Cada dedo del pie tiene tres falanges, excepto el dedo gordo que solo tiene dos. Por lo tanto, hay tres articulaciones en la mayoría de los dedos del pie y dos articulaciones en el dedo gordo.

Metatarsalgia

There are also many muscles, tendons and ligaments within the foot. The bones, ligaments and tendons within the foot form the foot arches, called the longitudinal and transverse arches. It is the foot arches that allow your foot to hold up the weight of the body. Nerves provide sensation to the skin of the foot.

¿Qué causa la metatarsalgia?

La metatarsalgia puede ser causada por una serie de condiciones diferentes. Las causas comunes incluyen:

Uso excesivo

This is common in runners and athletes; overuse can cause some mild inflammation in the metatarsal heads and nearby joints. Other sports such as tennis or sports that involve jumping may also put extra stress on the metatarsal heads and lead to inflammation and pain.

Wearing high-heeled shoes

Esto puede ejercer una presión adicional sobre las cabezas metatarsianas. El calzado que no se ajusta bien o que es demasiado apretado también puede ser una causa.

Tener sobrepeso

Esto puede ejercer una presión adicional en los pies en general, pero particularmente en las cabezas metatarsianas.

Tener un tobillo rígido o tendón de Aquiles (el tendón en el talón)

Esto puede afectar la forma en que la presión se distribuye a lo largo del pie y puede llevar a un estrés adicional en las cabezas metatarsianas.

Neuroma de Morton

This is sometimes called Morton's metatarsalgia. It is a condition that affects one of the nerves that run between the metatarsal bones in the foot (the plantar digital nerves). Symptoms include pain, burning, numbness and tingling between two of the toes of the foot. Consulte el folleto separado llamado neuroma de Morton para más detalles.

Pie cavo (pes cavus)

In pes cavus, the foot has a very high arch which does not flatten when weight is put on the foot. It happens because of an imbalance in the muscles of the foot. Pes cavus can run in families but it can also happen out of the blue. Most people with pes cavus also have a neurological problem such as cerebral palsy, spina bifida, distrofia muscular or polio. Pes cavus can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.

Hammer toe or claw toe deformity

With a claw toe there is an abnormal position of all three of the joints in the toe. The joint with the metatarsal bone is bent upwards, the middle joint in the toe is bent downwards and the end joint in the toe may also be bent downwards. The toe resembles a claw. With a hammer toe, the toe is permanently bent at its middle joint so that it looks like a hammer. There are a number of conditions that can cause these toe deformities. These can include poorly fitted shoes, injury to the toes, bunions and rheumatoid arthritis. Hammer and claw toe can also occur in someone with pes cavus. They can also run in families. These toe deformities can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.

Bunion (hallux valgus)

A bunion is a deformity of the base joint of the big toe, causing the big toe to be angled towards the second toe. This causes a bump on the side of the foot at the base of the big toe. There is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful. Because of the bunion, extra stress is put on the ball of the foot and this can lead to metatarsalgia. See the separate leaflet called Bunions for more detail.

Hallux valgus

© Angela Simon, CC BY-SA 3.0, vía Wikimedia Commons

Previous surgery to the foot

This can include, for example, previous surgery for bunions.

Fisura por estrés (fractura) de un metatarsiano

A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as overuse injuries. A metatarsal stress fracture is a stress fracture in one of the metatarsal bones in the foot. See the separate leaflet called Metatarsal fractures for more detail, including metatarsal stress fractures.

Enfermedad de Freiberg

Esta es una enfermedad rara caracterizada por la muerte de parte del hueso (osteonecrosis) en el segundo metatarsiano, que se observa más comúnmente en adolescentes.

Arthritis or gout

This can cause inflammation of the joints in the ball of the foot or of the big toe and can be a cause of metatarsalgia. Consulte el folleto separado llamado Gota and those on arthritis for more detail.

Diabetes

This can cause damage to the nerves in the feet and can be a cause of metatarsalgia, usually if diabetes has been present for years and the blood sugars are not well controlled. See the separate leaflet called Diabetes (Diabetes mellitus).

Síntomas de la metatarsalgia

Metatarsalgia causes pain in the ball of the foot that can be made worse by standing, walking or running. Some people describe the pain as feeling as though they are walking on pebbles. Others describe more of a general aching pain. The pain can occur in one or both feet. In some people the pain is felt under one or two metatarsal heads; in others it is felt under all of them.

Metatarsalgia usually comes on gradually over some weeks rather than suddenly. The affected area of the foot may also feel tender when pressed.

El neuroma de Morton tiene otros síntomas específicos y se explica más detalladamente en el folleto separado.

¿Necesito alguna investigación?

Un profesional médico puede ser capaz de identificar la causa solo escuchando, haciendo preguntas y examinando el pie. Sin embargo, también pueden sugerir una o más de las siguientes investigaciones:

• Análisis de sangre. Estos pueden verificar el control de la diabetes, la artritis y la gota.

• radiografía of the foot. This can show a problem with the bones or joints in the foot.

• Una ecografía puede utilizarse para detectar el neuroma de Morton.

• Other tests. Occasionally more detailed tests, such as a escaneo de resonancia magnética (IRM) of the foot, are needed. These would normally be organised by a physiotherapist or orthopaedic surgeon.

Tratamiento de la metatarsalgia

Las medidas básicas pueden ayudar a aliviar los síntomas de la metatarsalgia. Estas incluyen:

• Descansar con los pies elevados siempre que sea posible.

• Perder peso if overweight.

• Wearing shoes that are well fitted, low-heeled and have a wide toe area.

• La fisioterapia también puede ser útil. Esto puede incluir ejercicios para ayudar con un tobillo rígido o ejercicios para ayudar a estirar el tendón de Aquiles si estos son problemas para ti.

• Simple analgésicos como paracetamol y analgésicos antiinflamatorios no esteroides (AINEs) como ibuprofeno may help to relieve pain.

• Seeing a podiatrist can help to see if there is hard skin (callus) build-up which is altering weight bearing. Podiatrists can also identify other problems with the feet which may be causing the pain.

• Other treatment will depend on the underlying cause of the metatarsalgia. For example, if diabetes is the cause, it will be important to improve the control of the sugar levels. If gout or arthritis is the cause, treatment may be needed for these conditions.

• A veces se necesita cirugía para tratar la metatarsalgia si otros tratamientos han fallado. Esto dependerá de la causa subyacente, por ejemplo, el enderezamiento de los dedos en martillo o garra o la cirugía para el neuroma de Morton.

Padding for metatarsalgia

Metatarsal pads and orthotic inserts for the shoes may help to relieve pain in the foot by reducing the pressure placed on the heads of the metatarsal bones. These can be bought online or following advice from a podiatrist.

Immediate relief for metatarsalgia

There are not many ways of immediately getting rid of pains in the metatarsals. Simple painkillers such as paracetamol or ibuprofen may help. Ice packs help some people. Resting the foot with it elevated can help. Pads or arch supports in the shoes may help reduce pain quickly.

Cómo prevenir la metatarsalgia

Algunas de las causas de la metatarsalgia no se pueden prevenir, por ejemplo, la metatarsalgia debida al pie cavo (pes cavus). Sin embargo, hay algunas cosas que pueden ayudar a prevenir algunas de las otras causas. Estas incluyen:

• 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.

• Asegurarse de usar calzado bueno y bien ajustado al correr o practicar deportes con alto impacto en los pies.

• Losing weight if overweight.

• Good control of diabetes will reduce the chance of developing some foot problems.