METATARSALGIA

Definition

These are the pains under the heads of the metatarsals. They are located on the sole of the foot, most often under the heads of the 2nd and 3rd metatarsals. These pains, like bar burns under the heads of the metatarsals, appear gradually when walking and are often worsened by wearing high heels. These pains can be isolated (in case of hollow foot for example) or associated with a hallux valgus most often.

Evolution

These pains gradually worsen and can become very disabling with increased calluses and extension to all the heads of the metatarsals and to the toes (claw deformity, dislocation) by rupture of the plantar ligaments.

Treatment

The first treatment is initiated by a podiatrist with the realization of insoles allowing to modify the supports and to remove the calluses on the level of the sole of the foot. The soles should be changed every 6 months to 1 year to remain effective. In the event of failure with persistence of pain despite wearing the soles for at least 3 months, surgical intervention may be proposed.

Surgical procedures and techniques

The intervention performed depends on the cause of the metatarsalgia.

In the event of isolated metatarsalgia, a section of the metatarsals (= osteotomy) is performed to modify the supports and relieve pain.

In case of metatarsalgia associated with a hallux valgus, it is necessary to operate both the hallux valgus (= the cause of the metatarsalgia) and the other toes according to the symptoms.

Operative suites

Full support on medical footwear is generally prescribed. There is postoperative edema for about 3 months requiring restraint (cohesive bands, compression socks).

Frequent question

Why operate on a painless hallux valgus when the pain is under the other toes?

In the event of advanced hallux valgus, there may be an impact on the other toes: the foot no longer presses under the big toe (although this is its role) but under the other toes (which are not made for this and which quickly develop calluses). The pain then sits under the 2^th and 3^th toes while there is little or no discomfort in the big toe. However, it is necessary to treat the cause of metatarsalgia and restore support under the big toe to relieve the other toes; this is why the treatment of hallux valgus is justified in these cases even if it is little or no symptomatic.