Metatarsal ‘Overload’
All metatarsals:
Can be overloaded in equinus foot types; high heel shoes; cavus feet.
Can be exacerbated with a lack of plantar fibro fatty padding.
Treatment:
Lower heel shoes; soft tissue supplements (eg Poron); adequate footwear; orthoses to redistribute weight; physical therapy
Surgical treatment of cavus foot.
Single metatarsal:
1) Plantarflexed first metatarsal:
If sufficient motion in first ray of midtarsal joint can dorsiflex cause compensatory problems elsewhere.
If insufficient motion to allow dorsiflexion overload of plantar metatarsal head structures ( eg hyperkeratosis; sesamoiditis)
2) Central metatarsal:
Plantarflexed lessor metatarsal overload of structures plantar to metatarsal head ( eg hyperkeratosis; capsulitis)
3) Second metatarsal head:
Pain in second MPJ secondary to abnormal biomechanics (eg first ray insufficiency) or overload due to hallux abducto valgus. Can develop flexor digitorum tendonitis, capsulitis and synovitis (second ray syndrome). Longer second metatarsal and equinus are common.
Treatment:
Accommodative padding; accommodative orthoses; functional foot orthoses; soft tissue supplements; physical therapy; surgical – dorsiflexory wedge osteotomy.
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