Metatarsalgia and Lesser Metatarsal Surgery

Several authors have attempted to classify metatarsalgia. Helal classified metatarsalgia into primary, secondary, and unrelated to weight distribution. Primary metatarsalgia is defined as pain across the area of the metatarsophalangeal joints associated with plantar keratoses. It may be a result of functional problems such as wearing a high-heeled shoe or structural problems associated with, for example, a short first metatarsal, limb length discrepancies, or pes cavus. Also included by Helal as primary metatarsalgia were Freiberg's disease, hallux valgus, hallux rigidus, and problems of iatrogenic and traumatic origin. Secondary metatarsalgia was caused by systemic disease such as rheumatoid arthritis. Metatarsalgias attributed to tarsal tunnel and vascular insufficiency are those types of metatarsalgia unrelated to load distribution. Regnauld defined metatarsalgia into diffuse, localized, subcutaneous soft tissue, and cutaneous metatarsalgia. Diffuse metatarsalgia is an example of an acquired mechanical disorder, such as functional disorders, abnormalities of the ankle such as ankle equinus, overload of the metatarsals, and metatarsalgia from high-heeled shoes. Localized metatarsalgia results from an osseous disorder such as a long metatarsal, large metatarsal, or aplasia of a metatarsal. Subcutaneous soft metatarsalgia includes pain from intermetatarsal neuroma, articular synovial cysts, and bursa. Cutaneous metatarsalgia is a result of plantar calluses, verruca, or ulcerations of the skin. Viladot describes metatarsalgia in two categories: first, overload of anterior support as a result of high-heeled shoes, an equinus or cavus foot in which support is by the heel, and the metatarsal heads only, resulting in subluxation of the toes, a change in load, and change in cadence of gait. The second aspect of this classification is irregular distribution of mechanical load, as evidenced by the following symptoms: