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I hope this helps some of us. I found this a while ago, if anyone wishes the link please email me @ [email]20pearls@fkbnet.bm[/email]. It describes foot pains and can help determine a diagnosis.. I could not fit all the info in but here it goes.....

Good luck all..

thanks
CJ.

What is metatarsalgia?

Metatarsalgia is the name doctors give to describe pain in the ball of the foot. The word is derived from the fact that the metatarsal
bones make up the ball of the foot, and the suffix -algia added to the end of a word is the Greek word for pain. Hence, metatarsal + algia
= metatarsalgia (metatarsal pain).

What are the metatarsals?


Because the word metatarsalgia simply describes the general symptom of pain in the ball of the foot, regardless of its cause, it is not
really a diagnosis. The diagnosis is made after one figures out the cause of metatarsalgia. Thus, if you go into a medical office with a
complaint of pain in the ball of your foot, and come out told the diagnosis of metatarsalgia, you haven't really learned much about your
condition. All you now have is a Greek translation of the symptom you already knew you had.

What exactly is metatarsalgia?

There are many possible conditions that occur under the general heading of metatarsalgia, and they may not be easily differentiated. But
as each condition may have a different treatment and a large number of potential causes and associated factors, it is important to be
carefully examined by someone who treats a lot of feet.

We'll review some of the most common types and causes of metatarsalgia:

Capsulitis


The thickened soft-tissue covering surrounding a joint is termed "capsule". It
is a tough, cylindrically-shaped connective tissue that completely surrounds
both the metatarsal and toe bones as they come together to form the joint.


You can get a good idea of what capsule looks like the next time you see a turkey or chicken leg. Joint capsule is one of those thick, tough, white soft
tissues holding the bones together.

As we've mentioned before, the suffix -itis means inflammation, so it follows that adding it to the word capsule (forming the new word capsulitis)
refers to the inflammation of the joint covering.

Capsulitis is very common in the ball of the foot. Indeed, this is probably the most common cause of metatarsalgia. Unfortunately, it is
also one of the most overlooked diagnoses, which is too bad, because if your metatarsalgia is caused from capsulitis, it can usually be
resolved fairly quickly.

Symptoms include aching discomfort, but it is frequently experienced as a sharp pain with pressure and with movement of the toe. In
other words, if you bend the toe upwards or downwards, you may re-create the painful symptoms, because you're stretching the
capsule.

As the capsule surrounds all sides of the joint, pain may develop on either the top or bottom of the foot, or both. But most people find
the majority of their discomfort on the bottom of the foot.

Capsulitis is common when the bone in the ball of the foot is plantarflexed or "dropped," meaning relatively lower than the others. It is
common, too, when the inflamed metatarsal is excessively long. Trauma, too, whether of a gradual onset or a sudden onset, may create
the problem.

The presence of bunions, excessive mobility in adjacent joints and bones, connective tissue disorders, arthritis, (particularly rheumatoid
arthritis and osteoarthritis), equinus, sudden trauma, excessive weight, poor shoe choices (especially tight toe box and high heels),
repetitive irritation from weight bearing activities, age, gender (females get this condition more, especially if they've had children),
working or exercising on hard surfaces, and a host of other factors are associated with this condition.

When capsulitis involves the great toe joint, it is sometimes known as Turf Toe.

When the damage is severe enough, the capsule may even rupture, usually on the bottom of the foot, destabilizing the entire joint and
causing a dislocation of the joint, (discussed below)hammertoes (Contracted Toes).

There are several possible ways to treat the acute symptoms of capsulitis: rest, ice, anti-inflammatory medications, steroid injections,
massage, physiotherapy, shoe changes, and padding are just a few. Orthoses designed to redistribute weight away from a prominent
bone is likely best for chronic capsulitis.

Surgery to repair ruptured joint capsule, or to lift, shorten, or otherwise alter a prominent bone may be indicated at times.

Stress Fracture

When a bone bruise (see above) gets bad enough, a tiny crack (a break) may develop in the metatarsal bone. This is known as a "stress fracture."

Stress fractures usually occur over periods of overuse. Common with a sudden increase in activity, stress fractures are seen with people in
high-activity jobs, Christmas shoppers, individuals starting a new exercise regimen and army recruits in basic training. (In the military, these fractures
are often referred to as "March Fractures", as they can result from long marches common in the military.

Because stress fractures are just cracked and not completely broken and misaligned, diagnosis can be difficult. Podiatric physicians can often surmise a stress fracture is developing upon clinical examination, but definitive diagnosis may require X-rays or a bone scan.

Stress fractures sometimes look normal on X-ray, however, especially when early in the process. But they tend to become visible on X-ray when the bone begins to heal. The fracture may develop what
appears to be a cloud of "fluffy"-looking bone around the fracture site.

Bone scans are much more sensitive in showing this injury earlier than X-ray, but these tests are more invasive to the patient, and they're much more
expensive.

When the problem is acute, treatment for this condition is rest, ice, immobilization, padding and anti-inflammatory medications. After the condition has healed enough to return to more regular activity levels, shoe changes, padding and soft over-the-counter inserts may speed recovery.

If there is a biomechanical or structural problem, or when the problem is chronic, custom-made orthoses are helpful to redistribute weight away from
the painful region. Surgery is rarely indicated, unless the problem is a result of a misaligned or malformed bone that doesn't respond to conservative
treatments, or if the stress fracture progresses to a complete, displaced fracture.

Neuroma


A neuroma consists of scar tissue surrounding a nerve in the foot, as a result of chronic irritation. Usually this is caused from friction of the nerve between adjacent bones in the foot.

Symptoms usually consist of numbness to burning, electric pain that may shoot into the toe, or up the foot or leg. While neuromas are common, particularly between the third and fourth toes, many times this diagnosis is hastily made to describe any pain in the ball of the foot.

Tendinitis

Each toe has a lot more tendons attaching to it than you may think.

In most cases, there are two tendons to pull the toe up, two tendons to pull the toe down, not to mention the dorsal interosseous muscles, the plantar
interosseous muscles and lumbricale tendons, which exist primarily to stabilize the toe and help make the pull of the major tendons more efficient.

With so many tendons attaching into one relatively-small structure like the toe, it may seem rather surprising these structures don't get injured more
than they do. But tendons are strong and not easily injured.

Symptoms of tendonitis include pain with pressure, joint motion (particularly against resistance), and if chronic enough, misaligned toes may
develop.

Because tendons don't have great circulation, however, when they do get injured, they can be slow to heal.

Conservative treatment includes rest, ice, immobilization, physiotherapy, and massage. Surgical intervention is rare, unless the tendon has become
ruptured, in which case, it is better to fix the problem earlier, rather than later.





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