DDx Metatarsalgia

Definition

 

Pain in the forefoot in the region of the MT heads

 

3 groups

 

1.  Localised

 

Morton's neuroma

Freiberg's

Stress fracture

Infection / tumour

Plantar Keratosis

Plantar Wart

 

2.  Systemic disease

 

RA

 

3.  Altered forefoot biomechanics / Transfer Metatarsalgia

- irregular Distribution of MT load

 

A  1st ray insufficiency syndrome

- splayed forefoot

- 1st ray unloaded

 

Metatarsalgia Splayed Foot

 

B.  Short 1st MT 

- > 2 cm back from 2nd MT

- varus 1st MT

- 1st ray unloaded

 

Metatarsalgia Short 1st Metatarsal

 

C.  Hyper-extended MTPJ with claw toe

 

D.  Iatrogenic

- bunion surgery

- excision of metatarsal head

 

E.  Lax soft tissues

- Lis franc injury

 

F.  Flatfoot

- supination, elevation of 1st metatarsal