Abstract
Metatarsalgia (i.e. metatarsal pain) is one of the most common symptoms in patients with rheumatoid arthritis. It refers to painful difficulties localized in the forefoot region under the second through fifth metatarsal heads.
The pain is often accompanied by deformity of the first and fifth rays as well as of the toes. There is a wide scale of possible causes of metatarsalgia but all of them seem to be related to foot anatomy, weight-bearing during walking and foot and ankle deformity.
Most patients present with abnormalities of the metatarsophalangeal joints. In managing metatarsalgia, an individualized treatment protocol is required.
Nonsurgical management is usually sufficient to achieve satisfactory results. Surgical intervention must be reasonably indicated, precise, and all pain-producing deformities must be corrected.
Depending on the site of maximum impairment, we use either interventions leading to the restoration of the first ray function, metatarsal osteotomy or resection arthroplasty of first metatarsophalangeal joint. The aim of surgery is to make the patient able to use standard or custom made footwear and to ensure painless standing and walking.