Dorset Foot & Ankle Clinic

Figure 1 – This patient has forefoot pain (mteatarsalgia) due to shortening of the big toe metatarsal following an operation to correct a bunion

Figure 2 – The pain is relieved by shortening the 4 long metatarsals with Weil osteotomoes. The screws may be required to be removed in the future to relieve toe stiffness

Metatarsalgia

Metatarsalgia describes the symptom of pain in the front of the foot beneath the metatarsal heads. This can occur in many different conditions such as rheumatoid arthritis (see Rheumatoid Foot), hammer and claw toe deformity (see Toe Deformity section), pes cavus (see Cavus Foot section), with Morton’s Neuroma (see Morton’s Neuroma section).

Treatment will be provided for the specific causes above. One other cause that is commonly seen in patients is due to imbalance between the lengths of the metatarsal bones in the foot.

In this condition some people have a relatively short big toe metatarsal bone and then relatively over-long second, third, fourth and fifth metatarsals. This means that the lesser metatarsals strike the floor before the big toe. This is a function that they are not well designed for, hence causing forefoot pain.

Surgical correction for this condition is complex. It may involve a procedure to shorten the metatarsal bones by removing segments of bone to equalise their lengths relative to the big toe metatarsals. This is usually done with an operation called a Weil osteotomy. In other cases procedures to remove bone from the metatarsal or toe joints, and realign the tendons may be used. Your consultant will discuss any operation with you and explain any potential complications or side effects.

These procedures are usually performed through two or three incisions on the top of the foot and require the metatarsals to be exposed by pushing aside the extending tendons to the lesser toes. A small screw or metal pin (K-wire) may be used to fix the bones until they heal and the patient is usually able to mobilise in either an orthopaedic shoe or a plaster cast shoe.

The main problem with Weil osteotomy is stiffness of the toes which occurs due to tethering of the tendons following surgery. It is often necessary to remove the screws from the bones very soon after the surgery and free up the tendons to try and get range of movement. The operation is successful for relieving the metatarsal pain in this particular condition but it may take some months to regain full toe movement.

With other procedures there may be a loss of full control of the toes due to the realignment of the tendons.