• Plantar metatarsal phalangeal joint pain is usually the result of excessive pressure exerted by a metatarsal bone on the soft tissues below it. This can be caused by abnormal pronation of the rearfoot, abnormal position of neighboring metatarsals, shortness of neighboring metatarsals, excessive length of the bone with respect to other metatarsal bones, and/or hammering of the toes. Excessive pressure causes injury to the soft tissue structures that hold the toe to the metatarsal bone and cause dislocation of the joint.
  • The influence of pathomechanics and foot gear on the deformity was explained. Pronation of the rearfoot during walking causes instability at the base of the first metatarsal allowing it to move up and out of position. The big toe joint then becomes progressively more and more subluxed. Recommend use of sneakers and accommodative footgear including customized innersoles and orthotics. It was explained that orthotics address the biomechanical cause of problem, pronation of the rearfoot. Control of pronation reduces the deforming forces that make metatarsal pressure worse.

Treatments

  1. Immobilization and Protection
    This is the single most important treatment. You must protect the injury to give it a chance to heal and to lessen the chance of total rupture. A cam walker boot is used in more severe cases for the short term protection and functional foot orthotic devices are used for less severe injury and for long term treatment, to prevent harmful pronation of the foot during walking. Felt aperture padding can be directly applied to the foot to keep the weight off the metatarsal head.
  2. Steroid Injections and Non-Steroidal Medications
    Cortisone shots reduce pain temporarily. They do not heal the injury, and can cause rupture of the ligment. Cortisone shots are harmful and contra-indicated for this condition. Non-Steroidal Anti-Inflammatory Medications do not relieve inflammation in tendons and give a false sense of security which may prevent you from properly protecting the injury.
  3. Physical Therapy
    Can be mildly helpful to relieve symptoms temporarily but is not capable of stimulating healing of an injured tendon lying deep in the foot. Stretching of this structure by the therapist may be counterproductive and prolong the injury healing time.
  4. Heat vs Cold
    Ice is used only to stop bleeding. Although everyone recommends Ice for almost anything that hurts. This is wrong thinking. Use heat to increase the circulation. Increasing circulation washes out toxins and promotes healing. Use wet heat daily and consistently to promote healing.
  5. Shock Wave Therapy
    Pneumatic shock wave therapy will work like gravity does on bone and jump start the healing process. Treatment is given one time per week for six consecutive weeks. Healing usually takes 6-12 weeks. Shock wave is not covered by insurance. We charge $125 per week for 6 weeks.
  6. Cutting Edge Laser MLS Therapy
    Cutting Edge Laser Therapy is a focused therapeutic treatment given 3 to 5 times per week during the healing process. The laser beam shoots right through the skin and soft tissue and increases the circulation directly around the ligaments and bone washing out toxins and improving healing. It is not covered by insurance. We charge $10 per treatment.
  7. Topaz Surgical Repair of the Ligament
    This procedure is performed in the operating room. No incision is needed for this procedure. Through multiple puncture holes in the bottom of the foot over the ligament, burn holes are created in the ligament with the Topaz wand. The burn holes allow ingrowth of blood vessels into the ligament. Using a needle inserted into your heel bone, bone marrow containing stem cells is extracted and injected directly into the burn holes. It is believed the stem cells further encourage tendon healing and improve the outcome of the operation. The procedure temporarily weakens the ligament but eventually stimulates it to heal. Post operatively a cam walker boot must be worn for six weeks to give the ligament time to heal. All surgery carries risks and possible complications that will be discussed during surgical planning.

Recommendations
Combination therapy always works better. Each part contributes to healing in different ways.

  1. Immobilize and protect with orthotics in some cases cam walker boot.
  2. Stimulate healing with shockwave therapy.
  3. Increase circulation to the tendon with Cutting Edge Laser Therapy 3 times per week.

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