Conservative management of metatarsal and heel pain in the adult foot.

Abstract

The Louisiana State University (LSU) Affiliated Hospitals foot clinic has had good success in the treatment of metatarsal and heel pain using the following five modalities. Muscle strengthening and muscle stretching of the intrinsic muscles and the muscles about the ankle joint, especially the gastrocnemius-soleus complex. Contrast baths in the acute condition to decrease the edema and inflammatory process. Nonsteroidal agents with the acute condition to decrease the inflammatory response. Shoe modifications. Orthotic devices. Orthotic devices seem to be the most useful in the treatment of both conditions. It has been found necessary to prescribe orthotics in almost all cases of chronic problems to institute permanent relief. Opposition remains to multiple steroid injections into either area, although there is no great objection to one or possibly two injections into a particular area to decrease the inflammatory process. It has been observed that a general worsening of the condition occurs from multiple injections. After repeated steroid injections one sets the stage for increased atrophy of the fat pad, which results in a more prominent bony surface and increased pain. Cases have been documented on many occasions showing indented areas over the heel or metatarsals or complete loss of the metatarsal fat pad of patients who have received multiple injections of steroids.