From the Guidelines
Metatarsal pathology refers to conditions affecting the metatarsal bones in the foot, including deformities, ulcers, and other abnormalities.
Common Metatarsal Pathologies
- Metatarsal head resection: a surgical removal of part of a metatarsal head, often performed to manage infection, such as osteomyelitis or joint infection, or to surgically offload a prominent metatarsal head 1.
- Metatarsal osteotomy: a surgical procedure in which a bone is divided or a piece of bone is excised to correct a deformity 1.
- Prominent metatarsal heads: can cause increased plantar pressures, leading to ulcers, erythema, warmth, or calluses, and may require extra wide or deep shoes or custom-molded shoes 1.
Management of Metatarsal Pathology
- Offloading devices: such as total contact casts, removable walkers, or custom-made shoes, can be used to relieve mechanical stress from specific regions of the foot 1.
- Surgical interventions: such as metatarsal head resection or joint arthroplasty, may be necessary in some cases, particularly when non-surgical offloading interventions have failed 1.
- Footwear: well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure can be adequate for people with neuropathy or evidence of increased plantar pressures 1.
From the Research
Metatarsal Pathology
Metatarsal pathology refers to conditions affecting the metatarsal bones in the foot. These conditions can cause pain, disability, and limited mobility.
- Metatarsal fractures are relatively common and can be a source of pain and disability if not properly treated 2
- Metatarsal stress fractures, also known as "march fractures," often occur in the distal second and third metatarsals due to excessive overuse and repetitive motions 3
- Metatarsalgia, or metatarsal pain, is a common condition characterized by pain in the plantar forefoot, including the second through fourth metatarsal heads 4
Causes and Risk Factors
The causes and risk factors of metatarsal pathology include:
- Excessive overuse and repetitive motions, such as marching activities 3
- Abnormalities in gait mechanics, foot anatomy, and foot and ankle deformity 4
- Elements that have a detrimental effect on bone density, such as osteoporosis 3
- Deformity of the first and fifth rays, as well as toe deformities 4
Treatment Options
Treatment options for metatarsal pathology vary depending on the condition and severity:
- Nondisplaced fractures and fractures with displacement in the horizontal plane can be treated conservatively with protected weight bearing in a cast shoe for 4-6 weeks 2
- Displaced fractures may require closed reduction and internal fixation, such as percutaneous pinning or open reduction and plate fixation 2
- Metatarsal stress fractures are often treated nonoperatively with rest, ice, and nonweight bearing 3
- Metatarsalgia can be treated with modifications of shoe wear, metatarsal pads, and custom-made orthoses, as well as operative reconstructive procedures such as metatarsal osteotomies 4, 5