Case History:
53 year old woman with right foot pain
Contributed By:
Robert D. Schwer, DC
Case Presentation: Page 4 of 4
A final diagnosis of metatarsalgia was made. This patient demonstrated an acute reaction to chronic mechanical problems in her foot. Her pes planus with chronic over pronation was the primary underlying cause. This is thought to produce metatarsalgia in the following way. The transverse metatarsal arch of the over pronated foot is splayed placing abnormal strain on the transverse metatarsal ligaments. The transfer of weight from the heel to the push off point during gait is not shared by the outer borders of the foot but rather is directed immediately to the middle metatarsal heads (2,3,4). Because the intrinsic flexors are often weak push off is made from the metatarsal heads without any assistance from the toes and causing chronic irritation of the metatarsals and plantar fascia.
Treatment in this case was made with manipulation of the foot, ultrasound and home icing instructions. Swelling was gone within 72 hours and within 2 weeks she was asymptomatic. At this point the patient was casted for orthotics to address the chronic over pronation. The orthotics were made with a metatarsal pad for the right second metatarsal to prevent recurrent inferior subluxation.
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