The term metatarsalgia refers to pain at one of more of the metatarsal heads in the foot, which is commonly described as forefoot pain. It commonly presents in individuals following activities that place a high volume of stress on the metatarsals, such as intense training or sporting activities.
The main symptom of metatarsalgia is pain or tenderness in the distal end of the plantar metatarsal fat pad, what is commonly known as the forefoot. The pain typically extends across the surface of the metatarsal head and may affect one or both feet. In many cases, a callus also develops in the same area over time.
The intensity of the pain is usually aggravated during movement, particularly when the foot pushes against the ground to propel the body forward and in the mid-stance stage. Conversely, it tends to improve significantly with rest and avoiding activities that put significant stress on the feet. .
The pain may be described as:
- Uncomfortable feeling (like a stone in the shoe)
Mulder sign is a diagnostic indicator that involves a painful click of the toes then the metatarsal heads are compressed. However, this is not present in all patients with metatarsalgia.
Presentation of Symptoms
Most patients with metatarsalgia report chronic symptoms of pain in the feet that presented gradually over time, rather than in an acute situation following a specific injury. Often the symptoms may slowly worsen with continued activity or stress over an extended period of time (e.g. several months) until the individual feels the need to seek medical attention.
However, some individuals may report symptoms with a sudden onset. This is most likely to be associated with a recent increase in time or intensity of high-impact physical activity.
Symptoms for Differential Diagnosis
Morton neuroma is a health condition that has similar symptoms to metatarsalgia but arises from a different cause and requires a distinct treatment. Symptoms that are indicative of Morton neuroma include burning, tingling or numbness in between the toes due to damage to a nerve between the metatarsals.
It is important to check for signs and symptoms of pain or other neurological disturbances in the toes that occur in conjunction with the pain of the forefoot. This helps to make a differential diagnosis and allow the appropriate treatment to take place for individuals with nerve damage in addition to forefoot pain.
Therefore, when making a diagnosis of metatarsalgia, the reported pain should be present in the forefoot or generalized area of the foot but absent from the interdigital space between the toes. The metatarsal squeeze test can be used to check for the presence of interdigital neuroma that may be involved in causing the pain.