Dr. Eduard Rabat is an Orthopedic Surgeon, Traumatologist and specialist in Foot and Ankle Surgery. He carries out his activity in his office at Hospital Quirón Barcelona and at the Centro Médico Áptima, in Terrassa.
Structure of the forefoot
From a study point of view, the foot is divided into three parts, the rearfoot, which is the part formed by the bones that we see in the heel and that together with the most distal part of the tibia form the ankle, the midfoot formed by a series of irregular and small bones tightly fitted between them and that form the plantar dome and finally the forefoot, formed by the five metatarsals and the corresponding toes.
It is a structure designed to resist the load at the end of the step, concentrating enormous pressures that are distributed through the 5 metatarsals but with the characteristic that the first toe and its metatarsal receives twice the load of each of the other four. This forms a biomechanical model that, if it does not work perfectly, gives rise to various pathologies, that is to say, to pain and suffering for the sufferer.
Pain in the forefoot and metatarsalgia
When the harmonic balance of the forefoot is broken, the loads, in the form of pressure, instead of being distributed, as we explained before, through the first toe and metatarsal, they do it through the metatarsals of the center, second third and fourth. These bones of the center of the forefoot do not have the capacity of cushioning of the first one and as much the skin as the soft parts of below react becoming thicker and becoming inflamed, with which the pain appears. Calluses appear on the skin as a reaction to this excess pressure.
The patient suffers a lot of pain, let us think that we cannot avoid putting the foot on the ground, and tries to avoid this painful area with which alters the posture of the foot. This leads to the appearance of pain not only in other areas of the foot but also in the leg, thigh and spine. This situation, chronically, leads to an imbalance of the entire skeleton and a significant decrease in quality of life. The patient, mostly women, comes to avoid any activity that involves walking, lives with a significant limitation and even suffers from mood swings. This is called “metatarsalgia”.
Frequency of metatarsalgia
This pathology is very frequent, pain in the forefoot has the sad honor of being among the three most frequent causes of pain in humans.
Function of footwear and relationship with metatarsalgia
The anatomical alterations that cause metatarsalgia are as frequent in men as in women, but women’s footwear is absolutely influenced by fashion. Fashion is the most fleeting thing that exists, remember the famous phrase of Coco Chanel “fashion is everything that goes out of fashion”.
We can say that not all feet resist all types of shoes, when a foot is more vulnerable a certain shoe can lead to the disease we are talking about. This is especially evident with summer shoes and with the increase in consultations due to metatarsalgia starting in September.
Basic standards that footwear must meet
Footwear should be a complement to the foot to help it overcome obstacles and difficulties in the terrain. In this sense a basic element is the cushioning, the sole and the inner insole, which should exist in any shoe must achieve this purpose by means of a thickness and suitable materials.
Support: the shoe must be attached to the foot, there is nothing worse than chasing the shoe, as is the example of certain flip-flops or some clogs.
And finally a logical height of the heel that we estimate between 3 to 4 centimeters of height of a width that allows the stability of the ankle. We must remember that completely flat shoes also cause pain not only in the foot but also in the lumbar region.
Treatment of metatarsalgia
If a patient presents an occasional metatarsalgia due to the use of an inadequate footwear during a special event, let’s put as a typical example a party or a wedding, we will use anti-inflammatory and we will recommend a footwear as cushioning as possible as far as the sole for a time, a pair of sneakers for example. If it is a chronic case, we will be forced to add insoles to the advice on footwear. Insoles are an excellent treatment for metatarsalgia and resolve approximately 90% of cases.
And finally, as always, in the most severe cases we must resort to surgery. Orthopedic surgeons who are dedicated to the foot operate many metatarsalgia despite this 90% success rate of conservative treatment. This can give us an idea of how frequent this disease is. Obviously this surgery should be performed by specialists in traumatology and orthopedics, and if possible with a great dedication to the foot. These are procedures that, if they are not successful, can cause new misalignments and sequelae. It requires a great deal of experience.