[Static metatarsalgia]

Abstract

Static metatarsalgia involves pain of non-inflammatory origin in the region of the metatarsal heads. It is caused by a functional disorder or anatomic derangement of the architecture over the ball of the foot, whether congenital or acquired, evident or not. Clinical examination, including of the shoe and of the plantar orthosis, distinguishes five types of anomalies: 1. horizontal malalignment of the metatarsal heads with insufficiency at the first metatarsal-phalangeal joint, dominated by hallux valgus, and involvement of the second metatarsal bone, sometimes favouring Freiberg's disease; 2. vertical malalignment, with a hollow anterior foot, sometimes complicated by Morton's neuroma; 3. a combination of these two anomalies, easily diagnosed but less easily treated; 4. possible enlargement of the first metatarsal-phalangeal joint (hallux rigidus, sesamoid pathology); 5. no patent architectural anomalies, but stress fractures or bone insufficiency fractures of the metatarsals. Only clinical examination can orient complementary strategy and examinations.