The metatarsals are the five long bones which run from the arch area through the beginning of the toes. Their heads and the tuberosity (bump) of the heel receive the most pressure upon the foot, and, as a consequence, involve the highest rate of the pathology. Straining of the metatarsals can result in metatarsalgia. This term describes the pain and inflammation as a symptom in the plantar surface of the forefoot, especially in the area under the metatarsal heads.
One of the causes of metatarsalgia is the dropped metatarsals, when one of the bones rests upon the ground with more pressure (the second one is considered more “sensitive”). Patients describe the pain as deep and consistent, which becomes “activated” when walking or running, while they also report a burning sensation. The effect of the pressure is the appearance of thickenings and keratoses on the skin, while, in chronic cases, it is probable that a deformity of the toe which is articulated to the “problematic” metatarsal, also exists.

Symptoms appear over time, and depend on factors such as the extent of standing, body weight, and type of shoes (high heels which are worn for too many hours are considered “guilty”). Even the ground which one walks on, plays its own role. Athletes, especially runners, jumpers, tennis players and footballers, as well as the elderly, are also included in the high-risk groups, due to the atrophy of the fat padding of the metatarsal heads and due to the degeneration and imbalance of the forefoot muscles.
A secondary stage of the dropped metatarsals is the Morton’s neuroma. It is a syndrome that leads to nerve hypertrophy between two toes, resulting in pain, numbness and a burning sensation. In addition, those who have short Achilles tendons, pes cavus, or a deformity of their toes – generally, anything that changes the articulation architecture, can lead to metatarsalgia – qualify as “candidates”.

The diagnosis is performed by the orthopaedist, through the obtaining of a complete history, focusing on the patient’s activities and whether diabetes mellitus or a neurological problem is present. Additionally, the clinical examination shall indicate the general condition of the foot, while blood tests and radiological examinations are considered necessary.
Conservative treatment includes rest, ice, analgesics, cortisone, use of personalized orthotic insoles for the distribution of loads during walking, special stretching exercises and physical therapies. However, in persistent situations, surgical treatment of the problem is recommended. Through the minimally invasive technique currently in use, the procedure is easy and fast, and no hospital admission is required. It is performed under local anesthesia.
Through small holes, and with the help of special surgical instruments, the orthopaedist performs a shortening and lifting of the head, thus correcting the wrong position of the metatarsal. A screw or a different material may be used to hold the osteotomy. Postoperatively, the patient is soon able to walk, with the help of a special shoe.

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