From the Guidelines
Low-dose naltrexone (LDN) may be considered as an adjunctive treatment for metatarsalgia, particularly when pain persists despite conventional treatments, due to its potential to reduce neuropathic pain as shown in a study on fibromyalgia patients where LDN 4.5 mg resulted in significant decrease of pain and improved satisfaction with life as compared to placebo 1. When considering LDN for metatarsalgia, it's essential to understand that the medication works by temporarily blocking opioid receptors, which paradoxically leads to increased endorphin production and reduced inflammation through modulation of glial cell activity, as noted in the study on neuropathic corneal pain management 1. Some key points to consider when using LDN for metatarsalgia include:
- A typical LDN regimen starts at 1.5mg taken orally at bedtime, gradually increasing to 4.5mg over 2-3 weeks as tolerated, as recommended for patients with neuropathic pain 1.
- The medication should be taken consistently each night, and patients should expect that it may take 2-3 months to experience maximum benefit.
- LDN should be used alongside primary treatments for metatarsalgia, including appropriate footwear with metatarsal pads, activity modification, weight management, and addressing any biomechanical issues.
- Potential side effects of LDN are generally mild and include vivid dreams, sleep disturbances, and headaches, which typically resolve within the first few weeks of treatment, as reported in the study on LDN use in patients with chronic neuropathic pain 1.
- LDN requires a prescription and must be obtained from a compounding pharmacy since commercial naltrexone is only available in 50mg tablets.
- Patients should continue their other pain management strategies while using LDN and maintain regular follow-up with their healthcare provider to monitor progress.
From the Research
Relationship Between Low Dose Naltrexone (LDN) and Metatarsalgia
There are no research papers to assist in answering this question, as none of the provided studies mention Low Dose Naltrexone (LDN) in relation to metatarsalgia.
Metatarsalgia Treatment Options
- Metatarsalgia can be treated with conservative methods such as stretching exercises, footwear modification, insoles, and lesion debridement 2
- Soft-tissue surgical procedures like gastrocnemius muscle recession, tendon transfer, and plantar plate repair can also be considered 2
- Ultrasound-guided pulsed radiofrequency may be beneficial for recalcitrant metatarsalgia 3
- Metatarsal pads can reduce plantar pressure under the metatarsal head and alleviate pain 4
- Simple insoles can be effective in reducing forefoot pain and functional limitation in patients with rheumatoid arthritis experiencing metatarsalgia 5