In anterior metatarsalgia there is complaint of pain under the metatarsal heads. The condition is particularly common in middle-aged women and is also often associated with some splaying of the forefoot. Symptoms may be triggered by periods of excessive standing or an increase in weight, and there is often a concurrent flattening of the medial longitudinal arch. Weakness of the intrinsic muscles is usually present, so that there is a tendency to clawing of the toes; hyperextension of the toes at the MP joints leads to exposure of the plantar surfaces of the metatarsal heads, which give high spots of pressure against the underlying skin. In turn this produces pain and callus formation in the sole. This pathological process is by far the commonest cause of forefoot pain, but in every case March fracture, Freiberg's disease, plantar digital neuroma and verruca pedis should be excluded.
The majority of cases of anterior metatarsalgia respond to skilled chiropodial measures, which may include trimming of calluses and the provision of supports: these distribute the weightbearing loads more evenly under the metatarsal heads. Where there is much splaying of the forefoot and associated toe deformities, surgical shoes may be required. Where there is a marked hallux valgus deformity an MP joint fusion may improve the mechanics of the forefoot, with relief of pain.
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