Sharp pain in bottom of foot near toes. Clinical case

Bottom of foot near toes hurts

48-year-old woman. Complains of sharp pain in bottom of foot near toes when walking and aching at rest (especially at night, to sleep comfortably she took painkillers). Pain is localized in the area of metatarsal bones of 1-4 toes with maximum at the base of 2-3 toes. The problem has been bothering her for a very long time, acute pain for the last 3 years.

Objective examination: the foot is visually deformed (thumb is displaced laterally with severely enlarged metatarsophalangeal joint, transverse arch of the foot is absent). The second metatarsal bone is longer than the first and the callus is clearly localized under it - Morton's foot.
On palpation, the muscles, ligaments, and joints of this area are sharply painful. In addition, painfulness of the lower leg muscles stabilizing the foot.

Diagnosis: metatarsalgia, Morton's foot, myofascial pain syndrome of muscles of the foot and lower leg.

Treatment: mobilization with movement for the involved joints of the foot, progressive pressure increase technique for the affected muscles, myofascial release of the shin.

Results: after the first session a significant reduction of pain on exertion, complete disappearance of pain at rest (including at night). The patient was taught special exercises and self-massage. Recommendations on the use of special pads in insoles were given.

Sharp pain in bottom of foot near toes. Conclusions.

A case describing a fairly common, painful, but overlooked problem - Morton's foot (foot mechanics disorder as a result of excess length of the second metatarsal bone relative to the first). A problem that not only causes pain on the bottom of foot near toes, but also deforms the foot, violates the stability of walking, creates a huge load on the joints, muscles of the foot, shins, and knees.
The treatment I performed was pathogenetic in nature (I worked with the links of the problem, trying to improve the picture as a whole). But the most desirable and effective treatment is etiological - elimination of the cause of metatarsalgia of the foot. And the closest method to solving the problem is the use of a special pad under the pad of the big toe, which allows you to redistribute the load and stabilize the foot.
It is worth recalling that physical therapy, painkillers, anti-inflammatory and other medications are symptomatic treatments, affecting only the manifestation of the disease and can not solve the problem in principle.