Metatarsalgia (forefoot pain)

Common forefoot conditions include;

Bursitis

What is Bursitis?
Bursitis is a very common forefoot pathology and is caused by inflammation of the bursa, often seen in between the toes. Bursa are fluid filled sacs that are found all over the body near joints and act as shock absorbers to minimise the friction between ligaments, bones and tendons. Increased pressure
and loading from poor biomechanics, inappropriate footwear and/or trauma can cause the bursa to become inflamed and irritated, resulting in pain and burning on weight bearing.

What treatment is available?
Treatment for bursitis involves assessing footwear and if inappropriate, advising on better fitting shoes. Ultrasound therapy and taping are used initially when inflammation and pain are significant. A biomechanical assessment and fitting for orthotics with additional forefoot offloading may be required if poor biomechanics such as excessive pronation (rolling in) or joint restrictions are observed. Shockwave therapy is useful in improving range of motion and reducing forefoot overloading. Self management strategies such as stretching, icing and the use of anti inflammatories are also advised.


Morton’s Neuroma

What is Morton’s Neuroma?
A Morton’s neuroma is a thickening of the tissue around one of the nerves in the toes, most commonly affecting the third and fourth toes. Morton’s neuroma causes pain and discomfort including burning, stinging, tingling, pins and needles and or numbness.

What treatment is available?
Treatment for Morton’s neuroma is similar to bursitis and involves assessing footwear and if inappropriate, advising on better fitting shoes. Ultrasound therapy and taping are used initially when inflammation and pain are significant. A biomechanical assessment and fitting for orthotics with additional forefoot offloading may be required if poor biomechanics such as excessive pronation (rolling in) or joint restrictions are observed. Shockwave therapy is useful in improving range of motion and reducing forefoot overloading. Self management strategies such as stretching, icing and the use of anti inflammatories are also advised. If not responding to conservative therapy, cortisone injections and surgery may be advised.

Gout

What is Gout?
Gout is an inflammatory condition that affects approximately 70,000 Australians each year. It is more common in middle aged and elderly men but can also be seen in post menopausal women. Gout causes inflammation in the joints, most commonly in the big toe joint. It is the result of a build up of uric acid which forms small crystals in the joints. Medication prescribed by a GP for acute attacks will help relieve pain and inflammation but if regular attacks continue, irreversible damage to the joint can occur.

What treatment is available?
Regular podiatry visits for those who suffer with gout are recommended as pressure areas can develop if joints become mishapen. Routine visits may involve footwear assessments and advice, callous debridement and wound management if pressure areas result in ulceration. Offloading is a treatment priority and this may be through the use of orthotics and or accommodative padding in footwear.

Plantar Plate Tear

What is a plantar plate tear?
The plantar plate is small ligament type structure under the foot, attaching to each metatarsophalangeal joint in the ball of the foot. The plantar plate is designed as a shock absorber, protecting the forefoot from stress and preventing over extension, spreading and splaying of the toes. Due to poor biomechanics such as excessive pronation (rolling in) ,inappropriate footwear and or trauma, overloading of the forefoot can cause undue stress on the plantar plate resulting in a tear which initiates pain and inflammation. Plantar plate tears are most commonly seen in the second toe and symptoms may include pain and swelling under the ball of the foot, a burning sensation and a feeling of walking on the bones of the feet or having a stone in the shoe.

What treatment is available?

Treatment of plantar plate tears involves assessing footwear and if inappropriate, advising on better fitting shoes. Ultrasound therapy and taping are used initially when inflammation and pain are significant. A biomechanical assessment and fitting for orthotics with additional forefoot offloading
may be required if poor biomechanics such as excessive pronation (rolling in) or joint restrictions are observed. Self management strategies such as stretching, icing and the use of anti inflammatories are also recommended. Advising patients on plantar plate taping is very effective in reducing ongoing
symptoms. Immobilisation in a CAM boot (moon boot) may also be recommended for 4-6 weeks if not responding to treatment. Cortisone injections and surgery are considered when all conservative therapies have been exhausted. A similar course of treatment is offered for turf toe injuries.

Sesamoiditis

What is sesamoiditis?
The sesamoids are two small bones attached to the plantar surface of the big toe joint. They are attached by small tendons that run underneath the big toe and are used as levers to help control the movement in the toe. Through overuse and excessive force on the sesamoids, they can become fractured and the tendons which they are directly attached to can become inflamed and irritated. Pain is felt directly underneath the big toe joint.

What treatment is available?
Treatment of sesamoiditis involves resting and restriction from high intensity weightbearing exercises. Self management strategies such as stretching, icing and the use of anti inflammatories are also recommended. Ultrasound therapy and taping are used initially when inflammation and pain are significant. A biomechanical assessment for fitting of orthotics with additional forefoot offloading may be required if poor biomechanics such as excessive pronation (rolling in) or joint restrictions are observed and footwear alone is not sufficient offloading. Immobilisation in a CAM boot (moon boot) may also be recommended for 4-6 weeks if not responding to treatment or if a fracture of the sesamoids has been confirmed. Cortisone injections and surgery are considered when all conservative therapies have been exhausted. A similar course of treatment is offered for turf toe injuries.

Acute Fracture and Stress Fracture

What is a fracture?
A fracture is a break in bone which can either be an acute fracture (a sudden trauma to the foot resulting in a break in bone) or a stress fracture ( an overuse or repetitive trauma to the foot resulting in tiny cracks in the bone).When a fracture has been confirmed and diagnosed, often patients are placed in a CAM walker (moon boot) for an extended period, usually a minimum of 6-8 weeks.