(i) Metatarsalgia: a symptom, not a diagnosis

Abstract

Metatarsalgia can be a debilitating disorder leading to painful ambulation and the loss of ability to participate in recreational activities. Forefoot pain is a symptom, not a diagnosis and must be analysed successfully in order to make a correct diagnosis. The accompanying algorithm (Fig. 1) may prove useful in determining the diagnosis in patients with metatarsalgia. The most important objective is to determine the exact location of pain. Other important factors to be analysed are associated neuritic symptoms, enlarged exostoses, and/or soft tissue inflammation. The presence of a callosity overlying an area of pain is important in determining the diagnosis. A bunionette is characterized by a callus overlying the fifth metatarsal head while with an intractable plantar keratosis (IPK), a callus is located on the plantar surface. A dorsal callus overlies a flexion deformity of the distal interphalangeal (DIP) joint and occurs with a mallet toe while a similar callus associated with a contracture of the proximal interphalangeal (PIP) joint occurs with a hammer toe. A claw toe develops with hyperextension of the MTP joint and flexion of the PIP joint. Often with a claw toe, a callus may develop beneath the metatarsal head as well as one which overlies the PIP joint. A callus which lies between the lesser toes may be associated with a soft corn but when localized to the lateral aspect of the fifth toe, it may indicate a hard corn. With complaints of metatarsalgia in the absence of any callosity, a patient should be carefully evaluated for the presence of neuritic symptoms consistent with