Metatarsalgia on my 1st metatarsal head

hello, I’ve been dealing with this problem for over a year and a half now. I’m obviously not looking for a diagnosis as to the exact cause, but if you could give me some hints or ideas for what is going on I would appreciate it so much

It all started when I hit a curb with my big toe while walking. XRay and ultrasound scan showed nothing, but the 1st metatarsal head has been inflamed ever since. I think it’s due to the fact that I bear my weight mostly on my forefoot, so for this reason I was put on orthotics, which helped a lot the first months but lately have got pretty uncomfortable. I’ve already tried nsaids and physical therapy to no avail, so I’m getting a cortisone shot in a few days

I have a feeling that docs are downplaying the problem, as no-one has been interested in pinpointing the exact cause (I understand that metatarsalgia is a symptom), and proposed PT and nsaids without bothering too much

what part of my foot could the injury (hitting a curb while walking) have affected? is there anything that could have evaded x-rays and ultrasound scans? I’m asking because I’m guessing one would want to know where to inject the cortisone, the pain is in my metatarsal head but maybe that’s not sufficiently precise. Judging from the x-rays the sesamoid bones seem to be in place (though I can hear a strange clicking sound if I press on the side of my big toe, where the bulge is), and no pain is felt when I bend my toe. Range of motion is fine, but the whole tendon is a bit ‘heavy’ and with certain movements I get a burning sensation (ultrasound scan said it was slightly thickened, maybe it has something to do with that). Main problem though is the pain I feel under my metatarsal head if I try to walk orthotics-free. Have you ever dealt with anything similar?

thank you

9 Responses

  1. Foot-com

    another thing I’ve noticed is that my big toe deviates slightly towards the second toe, and I’ve read that this symptom can have something to do with the plantar plate. Also, contrary to what I wrote in my previous post, the pain may really be by the joint and plantar plate (I thought the joint coincided with the bulge I pointed out in the pic but maybe it’s a little bit further towards the toe).

  2. Foot-com

    hi again,
    at the moment I’m just wearing a gel insole with a little arch support and trying not to put pressure on the area when I walk. After some 5-6 months of orthotics the metatarsal pad started to be painful to the extent that even now that I’ve quit the orthotics since last summer I still have some discomfort in the forefoot, I don’t ‘feel’ it on the ground as the healthy one. I’ve bought a pair of T-shape metatarsal pads but haven’t tried them on yet as I’m afraid they’ll reproduce the same issue. I was wondering whether a forefoot gel pad (one of those enclosed in an elastic cotton bandage) could be a viable option, but maybe it wouldn’t differ too much from the gel insole.

    The sensation I feel when I’m on the toilet is entirely different from the one I get by pressing on the area (which is dull pain), it’s more of a burning sensation (not very strong, but enough to be unpleasant). Since I get it by simply pressing on the pelvis area I thought it could be some nerve, rather than something affecting the joint capsule (or maybe there’s a combo of the two, I don’t know). Also, as you can deduce from the pic I sent, the sore area is not exactly on the joint (which would roughly be halfway between the needle and the sore area, where the bulge on the outline is). I’m no expert on anatomy so I can’t tell if the supposedly inflamed capsule extends to that area; the shot was given right into the joint, not into the surrounding area.

    Another thing that could be diagnostically helpful is that one time, while I was having some ultrasounds done as part of a PT cycle, as the operator applied the hot rod (sorry I don’t know what it’s called) on the fingertip of my big toe, I felt a burning pain crossing my toe longitudinally from there for some 4 inches

    I’ve booked another appointment with my doc next week for the moment

    thank you very much for your help, as usual

  3. Foot-com

    Hello and thank you for your follow up.

    Based on your MRI results, descriptions and response to the injection I personally would have injected you in a different location. I would have focused more on the plantar plate of the great toe.

    Have you been doing any dancer’s pads or reverse Morton pads? As far as the description of the sitting on toilet and getting pain in the foot there are connections between the foot and pelvic floor so this doesn’t entirely surprise me. Is the pain you feel on the foot when going to the bathroom the same pain as what we are discussing or is it different?

    Sometimes over activation of the pelvic floor can lead to issues elsewhere in the body. Kindly provide additional information if at all possible.

    Thank you – Dr Emily

    Dr. Emily Splichal
    Please be advised: we do not provide medical advice, diagnosis or treatment.
    By law, we cannot give specific medical advice over the Internet.

  4. Foot-com

    I’m also starting to wonder whether the MRI scan got the diagnosis right. Ultrasound scan talked about tenosynovitis, MRI says it’s capsulitis and tendons are fine. Thing is, flexion of the hallux is fine so this should rule out tenosynovitis, but at the same time I get a strange burning sensation along the affected area on certain occasions and movements that have nothing to do with the joint itself. Could it be some sort of neuropathy instead? I apologize for the example I’m about to give but I really can’t describe it otherwise: I get this burning sensation on my bad foot whenever I’m on the toilet and have to press on my anus. (I haven’t been able to find a correlation between the two things on the internet so far, and I’ve yet to discuss it with my doctor as it’s a bit embarassing) maybe that would explain why the NSAIDs, physical therapy and lastly the cortisone shot never had any effect?

  5. Foot-com

    hi Emily sorry to bother you again with my questions (and to do so with a pic of my foot as well) I finally got my cortisone shot, but as 60 hours have passed and no effect (side effects included) whatsoever has been felt I’m beginning to wonder whether the shot was applied to the right spot. I was told the shot was applied to the joint (they even used ultrasound), but isn’t that a bit far from the joint? starting from the moment I felt the needle the whole process lasted no more than 5 secs, seems a bit strange to me

    thank you again

  6. Foot-com

    Hello and thank you for the follow up information. Based on your MRI, I would suggest the steroid injection. There are very few risks with steroid injections – especially after only one injection. The benefits of this injection far outweigh the risks.

    Good luck!

    Dr. Emily Splichal
    Please be advised: we do not provide medical advice, diagnosis or treatment.
    By law, we cannot give specific medical advice over the Internet.

  7. Foot-com

    just wanted to update you with what came out from the MRI scan: it says minimal thickening of the plantar plate with modest reactive capsulitis of the big toe joint. I’ve already booked an appointment with my doc for next monday. I’m not a fan of steroid shots but would it be advisable to have one? during this year and a half I’ve already tried several Nsaids creams and pills with no effect (diclofenac, ibuprofen, ketoprofen), I doubt they’d do anything if injected. My GP told me that something has to be done otherwise it could turn chronic

    thank you for your help

  8. Foot-com

    hi Emily and thank you very much for the suggestion, it’s the first time it has come up

    I did an MRI the other day so I’ll know for sure in a few days (I’ve postponed the steroid shot), but since I’m getting a bit anxious and I’ve been really stressed out for months would you be so kind to clarify a few more points?

    what puzzles me is that after a year and a half I don’t have any problem whatsoever in flexing my big toe, I don’t know if a certain degree of impairment is required for ostheocondrosis or FHL tendonitis (I forgot to add, the ultrasound scan technician stated there was FHL tendonitis, but a doc ruled that out as I hadn’t any problems in flexing my big toe; FHL tendonitis though can produce pain on the first metatarsal head area, or so I’ve read)

    The clicking sensation actually is not in the joint or on the painful site; I can feel a very faint clicking by pressing not the joint but the metatarsal head from the opposite side, towards the big toe. I can press it hard and not feel any discomfort. Does ostheocondrosis require this clicking to be right in the joint?

    again, thank you very much!

  9. Foot-com

    Hello and thank you for your question.

    If you have not had an MRI then I would suggest this diagnostic imaging. It may be possible you have an osteochondral injury to the cartilage of your 1st metatarsal head/joint. This will not necessarily show up on an x-ray. The treatment for this is immobilization with a surgical shoe, steroid injection to the 1st MPJ and/or surgery.

    Depending on the type of injury you can chip the cartilage on the 1st metatarsal head creating a clicking or catching sensation as you describe.

    I hope this helps!

    Dr. Emily Splichal
    Please be advised: we do not provide medical advice, diagnosis or treatment.
    By law, we cannot give specific medical advice over the Internet.

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