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Metatarsals are five long bones in the foot, found between the bones of the toes and the tarsal bones. Each metatarsal is attached to one of your toes. They are positioned side by side in the shape of an arch, which gives the foot its arch. They are important for maintaining balance when standing and walking.

Pathologies that metatarsals can suffer

The two most common conditions which can affect the metatarsals are:

Metatarsalgia – an injury which affects the sole of the foot near the beginning of the toes, in severe pain, limping and even being unable to walk. This is a very common problem, affecting women and sportspeople in particular, with the metatarsal of the second finger being the most affected.

Fifth metatarsal fracture – the fifth metatarsal is a bone located on the outer edge of the foot. It is of clinical importance because many fractures occur in this bone. Its fracture is very frequent in the sports field, especially in those sports that require jumping and changes in rhythm and direction (such as football and basketball). Fracture can occur because of prolonged exercise or because of a sudden movement.

Treatments for metatarsal pathologies

Metatarsalgia

Treatment for metatarsalgia depends on the cause. Some basic things you can do to aid the healing process are wearing suitable footwear, losing weight, or using custom insoles to reduce pressure on the injured area.

Conservative treatment to eliminate pain is recommended with physical therapy, with exercises such as:

• self-massage of the foot with a ball
• self-massage and separation of the toes from the foot
• widening of the forefoot arch
• twin and soleus stretching
• stretching of the anterior musculature of the foot and ankle
• self-massage and global mobilisation of the foot

Pharmacological therapy is recommended in the most acute phases of pain with the presence of inflammation. Hyaluronic acid injections are sometimes additionally performed to relieve pain and reduce inflammation.

Surgical treatment may be advisable in the case of metatarsalgia caused by a deformity of the foot to try to restore the ideal biomechanics of the forefoot:

• Open surgery: Shortening and/or elevation osteotomies of the metatarsals are performed by means of open surgery, placing and fixing them in the situation considered optimal.
• Percutaneous surgery: By making incisions of approximately 3 mm through the bone and soft tissues, the aim is to correct the deformity of the foot.

Stress fracture

Stress fracture of a metatarsal usually responds well to conservative treatment. Immobilisation with a cast or splint and crutches are usually applied to avoid loading the affected foot. It is also recommended to apply ice during the first 48 hours after the fracture to combat inflammation and pain.

Surgical treatment is indicated only in cases of comminuted fracture, complete fracture with displacement of the bone fragment or in cases where, after a period of immobilisation, the fracture has not been properly healed.

Specialist who treats pathologies of the metatarsals

Podiatrists specialise in the examination, assessment, and treatment of foot problems. If you see your GP about a foot problem and they are unable to make a diagnosis themselves they are likely to refer you to a podiatrist. In the UK podiatrists are also known as chiropodists.

Depending on the treatment recommended, you may also see a physiotherapist or orthopaedic surgeon.