Metatasalgia – sometimes called capsulitis is an inflamed joint at the base of the toes normally in the 2nd joint. Often caused by long standing or walking on hard surfaces, especially in high heel shoes. Resistant and very painful conditions may be relieved with padding directly applied to the skin or on an innersole. Very resistant cases respond very well to cortisone injections.
Metatarsal stress fracture – stress fractures occur at the weakest point in the bone after repeated stresses de-stabilise the internal structure. It is important to understand that no impact is recognised with this type of fracture and that plain x-ray does not usually show the fracture. In most cases it is sufficient to recognise these clinically and the treatment is often a below the knee walking cast for up to 6 weeks. Footwear changes and orthoses may also play an important role in prevention.
Neuromas – another common forefoot problem is the 'Mortons Neuroma'. This is a nerve enlargement normally seen at the junction of two branch nerves (lateral and medial plantar nerve). The most common site is between the 3rd and 4th metatarsal joints. The pain is often described as sharp shooting or burning pain, pins and needles or a numbness may occur on the inside edges of the 3rd and 4th toes. Treatment is best early with pads on the foot to spread the metatarsals apart or a similar support on either an innersole or orthotic. Other treatments are by cortisone and lastly by surgical removal.
Bunions – a bunion (from the Latin "bunion" meaning enlargement) is a protuberance of bone or tissue around the joint. The enlargement occurs either at the base of the great toe, on the outside of the foot or at the base of the little toe. This is called a "bunionette" or "tailor's bunion". Bunions at the base of the great toe usually begin when the big toe starts moving toward the smaller toes (as when tight, pointed shoes are worn). This crowding puts pressure on the joint, pushing it outward. The movement of the joint in this outward direction starts the formation of the bunion.
What causes a bunion? A bunion is most often a symptom of faulty mechanics of the foot. The deformity does run in families, however, it is the foot type that is hereditary, not the bunion. People with flat feet or low arches seem more prone to develop the problem than those with higher arches. Bunions may also be associated with various forms of arthritis. The arthritis can cause the joint's protective covering of cartilage to deteriorate, leaving the joint damaged with
Symptoms Pain from a bunion can be mild, moderate or severe making it difficult to walk in normal shoes, especially those with high heels. The skin and deeper tissues around the bunion may also be swollen or inflamed. The other toes can be affected by a bunion, as a result of pressure from the great toe pushing inward toward the lesser toes. Toenails may begin to grow into the sides of the nail bed; the smaller toes can develop corns and become hammer toes. Treatment – Resolve pressure from footwear, stabilise joint with a toe separator and or foot orthoses is usually successful. Operation should only be required in arthritic or neglected cases.
Sesamoiditis A painful inflammatory condition of one of two small bones that act as a fulcrum under the base of the big toe. Sesamoid bones are enveloped in a tendon, in this case the tendon of flexor hallucis longus. Once inflamed they can take some time to resolve, and should be treated as early as possible with soft accommodating supports or a below knee removable walking cast. Cortisone injection is used in recalcitrant cases.