Treating 5th metatarsalgia with lateral sole wedges
I saw a 14 y/o young lady today with symptoms of pain specific to the right 5th metatarsal. She said that the pain had begun several weeks into training for basketball season. She described no injury but stated that whenever she 'pushed it' the pain in the outside of the foot increased. She said that basketball was her life and that I really needed to find a solution.
The patient had palpable pain specific to the 5th metatarsal. Pain was focused at the base of the metatarsal but also found in the mid-shaft. She described no increase in pain with weight-bearing or with toe raises. X-rays were negative for a stress fracture or for spurring of the base of the metatarsal (styloid process). Primary diagnosis was metatarsalgia of the 5th metatarsal with a differential diagnosis of peroneus brevis tendonitis.
We talked about treatment options and initiated care with the use of a lateral sole wedge. The lateral sole wedge is intended to inhibit rolling to the outside of the sole. By doing so, many cases of 5th metatarsalgia will resolve. We also looked at this athlete's shoes. At the onset of this pain, she had switched to a pair of shoes that had a curved last. A curved last differs from a straight last in that the curvature of the shoe is intended to match the curvature of the foot. In this patient's case, I think the curved last was actually throwing weight-bearing to the lateral aspect of the foot, thereby increasing load to the 5th metatarsal resulting in metatarsalgia. We also suggested a new pair of shoes with a straight last.
I don't think we'll see any change in this young athlete's play patterns with the use of a lateral sole wedge. She'll keep playing due to her love of the game. But I have my fingers crossed that the lateral sole wedges are going to be enough of a mechanical change to decrease the symptoms of metatarsalgia.
Jeffrey A. Oster, DPM