Links to clinical resources on metatarsagia from Rural Nurse Organization

"Metatarsalgia" is an ill-defined condition. Scranton defined it as "pain in the fore part of the foot", but other definitions would be more precise in terms of nature and location of discomfort. Pain in the first ray is generally understood to be excluded.
Metatarsalgia should be understood as a symptom rather than a diagnosis. It is a diagnostic challenge and a good example of the importance of careful history taking and examination in the foot, as it has many causes and often more than one is present.

Author: Britt A Durham, MD
Metatarsalgia is a common overuse injury described as pain in the forefoot associated with increased stress over the metatarsal head region. Metatarsalgia often is referred to as a symptom, rather than as a specific disease. Common causes of metatarsalgia include interdigital neuroma, metatarsophalangeal synovitis, avascular necrosis, sesamoiditis, and inflammatory arthritis; however, these causes often are diagnosed separately.
Synonyms and related keywords: overuse injury, pain in the forefoot, forefoot injuries, interdigital neuroma, metatarsophalangeal synovitis, avascular necrosis, sesamoiditis, inflammatory arthritis

GUIDELINE TITLE Metatarsalgia/intractable plantar keratosis/Tailor's bunion. BIBLIOGRAPHIC SOURCE(S) * Academy of Ambulatory Foot and Ankle Surgery. Metatarsalgia/intractable plantar keratosis/Tailor's bunion. Philadelphia (PA): Academy of Ambulatory Foot and Ankle Surgery; 2003. 6 p. [26 references]
INTENDED USERS Podiatrists
GUIDELINE OBJECTIVE(S) To provide recommendations for the diagnosis and treatment of metatarsalgia, intractable plantar keratosis, and Tailor's bunion

Metatarsalgia is a general term for pain in the area of the metatarsophalangeal joints (ball of the foot). Most common causes include interdigital nerve pain (Morton's neuroma), metatarsophalangeal joint pain, and sesamoiditis.

DIFFERENTIAL DIAGNOSIS
Stress fracture
Interdigital neuroma
MTP joint synovitis
Plantar wart
Plantar keratosis
Orthopaedic & Sports Medicine Physicians

Metatarsalgia Patient/Family Resources from Rural Nurse Organization

Madigan Army Medical Center Referral Guidelines

Wheeless' Textbook of Orthopaedics
in the normal foot, metatarsal heads bear one half of a person's body wt, when the foot is plantigrade;
- the first metatarsal normally bears half the wt of the forefoot;
- long 2nd metatarsal can contribute to pressure under metatarsal head;
- limitation of dorsiflexion (from heel cord contracture or ankle impingement can contribute to diffuse metatarsalgia

Orthotic treatment for metatarsagia