1. METATARSALGIA Fergus Ross Education and Training Salts Tech Step

2. DEFINITION Pain in the forefoot region is referred to as metatarsalgia and it can be caused by a number of underlying pathologies

3. Aetiology Articular Extra-articular CapsulitisFlexor Tendonopathy Capsular TearInter Digital Neuroma SynovitisMetatarsal Stress Fracture Arthritis Avascular Necrosis

4. Risk Factors ExtrinsicIntrinsic Running SurfaceFoot Function Running ShoesFoot Type Running StyleFoot Posture Index Plantar Pressure

5. Feel

6. Move

7. Specific Test Plantar Digital Neuroma

8. Decision Making

9. Treatment NSAIDs Running Shoes Foot Orthoses Night Splints Padding and Strapping Physical Therapies Steroid Injections Surgery

10. Case Study 48 year old male novice marathon runner was referred with pain in the forefoot of this left foot. The patient was otherwise healthy and participated in other sports Both the patient and the GP were unsure of the cause of the pain and he had been prescribed a course of NSAIDs and refererred for an examination and foot orthoses if appropriate

11. History A thorough medical history demonstrated no major illnesses, operations or a history of lower limb injuries No significant family medical history The most significant factor was the increase in running and purchasing new running shoes The foot was painful during activity and the patient noticed it was very uncomfortable on the hard tiled floor in the shower when he had forgotten his flip flops

12. Presenting Complaint The pain was under the second and third metatarsal heads but it was worse directly under the second metatarsal phalangeal joint The pain tended to occur during the warm up and then disappear. It would then return towards the end of the run sometimes causing the patient to stop. There was no swelling but the area was tender on palpation and when you extend the 2 nd MPJt

13. Differential Diagnosis Plantar Capsulitis Synovitis Flexor Hallucis Longus Tendinopathy Bursitis

14. CAD/CAM EVA Orthoses

15. Cushioning and Stability

16. References Yates B, Merrimans Assessment of the Lower Limb. Churchill Livingstone, 2009; pp422 – 424. Alexander IJ, The Foot Examination and Diagnosis. Churchill Livingstone, 1990