Metatarsalgia

Metatarsalgia is one of the most common disorders seen in foot and ankle consultation, with patients complaining of pain across the plantar aspect of the forefoot, frequently associated with toe deformities, especially hallux valgus deformity. There are no solid statistical data on the true prevalence of metatarsalgia. Clinical examination and radiological findings will allow the identification of the type of metatarsalgia. Overall, metatarsalgia can be classified into two subtypes based on patho-mechanics. Nonpropulsive/second-rocker metatarsalgia is related to an abnormal inclination of a metatarsal in the sagittal plane, either anatomical or functional (equinus), and requires metatarsal elevation/dorsiflexion and gastrocnemius release. Propulsive/third rocker metatarsalgia is related to an abnormal length of a certain metatarsal with respect to the neighboring metatarsals and is dealt by shortening metatarsal osteotomies. Floating toes are the most common complications following surgery. Delayed union, nonunion and malunion are apparently more frequently found after mini-invasive metatarsal osteotomies. When dealing with metatarsal osteotomies, the most important complication would arise from a suboptimal displacement and/or fixation ending up in a non-harmonical metatarsal parabola in any of the planes.