Alternative to orthotics and surgery for dropped metatarsal and foot pain
Ross A. Hauser, M.D., Prolotherapy doctor

We recently saw a patient named Matt at the office who had been suffering with foot pain for a number of years. Unfortunately his medical history was all too common and one that we see frequently at Caring Medical. The consultation went something like this…

“Dr. Hauser, I have had horrible foot pain for several years. I went to see a podiatrist and he made these casts for me.You can tell I have a dropped first metatarsal bone. (See figures.)

The doctor then made me some orthotics which only slightly helped my foot pain. I then received a couple cortisone shots into my foot that did not help the pain at all. Now he is talking about surgery. I don’t want to have surgery. Will Prolotherapy help my foot pain?”

When Dr. Hauser examined Matt’s feet, his dropped metatarsal bone was obviously present, as well as a callous on the bottom of his foot proving that extra pressure was present in that area. From the physical examination, Matt actually experienced pain over other metatarsal areas, not just his first metatarsal, so a surgical procedure on his first metatarsal bone actually did not make a lot of sense, as this would likely not solve the problem.

Dr. Hauser explained to Matt that Prolotherapy was very successful in treating his condition, and needed to be done in combination with some exercises to get him back to walking pain free. His long term goals were also to play some basketball and be able to hike and walk long distances without pain. These were all reasonable goals. Sports medicine-minded Dr. Hauser assured Matt that he should be able to achieve those goals with Prolotherapy.

Metatarsalgia is one of the most common painful conditions seen by podiatrists (foot doctors). It involves pain in the metatarsal heads, often accompanied by a hard, painful callous under the dropped metatarsal head. The most common treatment of Metatarsalgia in a traditional setting is with the use of orthotics. Orthotics theoretically could reduce the pressure where the callous and dropped metatarsal head is located. If this doesn’t work, cortisone shots are usually tried next, followed by the surgery recommendation. Various surgeries might be tried including a metatarsal osteotomy. Being a conservative doctor, we say there is a better way and that way is Prolotherapy!

What causes metatarsal bone pain? A dropped metatarsal head is just one aspect of what is causing a patient’s foot pain. First of all, when a metatarsal bone drops, we always ask the question: why has it dropped? What structures are loose or weakened causing it to drop? What holds bones together? Yes, the correct answer is ligaments! What is the best treatment to strengthen and tighten stretched ligaments? Prolotherapy. Prolotherapy from this aspect makes a lot of sense. We typically use Prolotherapy to treat the painful areas, not just on the bottom, but also on the top of the metatarsal head(s) (dorsal and palmar surfaces of foot). This, however, is only one aspect of the problem.

When we see a patient with a dropped metatarsal head, the patient probably does not realize that he/she definitely has intrinsic foot muscle weakness, along with a narrowed space for the digital nerve that runs by that metatarsal bone to traverse. Since the space is narrowed, a neuroma may form. Thus a patient may develop the so-called “Morton’s Neuroma” and other foot neuromas. What is Caring Medical’s best treatment for a neuroma? We use Prolotherapy plus yoga toes and specific exercises to correct the intrinsic muscle problems of the foot. Dr. Hauser recommends that yoga toes are worn generally in the evening for 1-2 hours (may take some time to work up to that amount of time) to help spread out the toes so the toe anatomy (and thus metatarsal anatomy) gets back to a more normal, healthy spread out position, versus the very narrow abnormal foot. What causes this narrow foot? Shoes cause it, of course. Yes, long-term it would be best not to wear orthotics because they ultimately weaken the foot. Going barefoot and wearing less cushiony shoes will ultimately help strengthen your feet over time. You may be thinking to yourself, “that sounds awfully painful.” The Prolotherapy will get rid of that!

Effect of wearing shoes: When a person walks or for that matter, runs, weight bearing in the foot is supposed to be shared between the toes and the metatarsal joints. Shoes, including cushioned running shoes, cause the toes to do basically nothing. Ask any typical American to show you their toes. You will find they have basically almost no toe movement in their toes! Now take a dancer or someone who grew up in rural Philippines or some area of the world where they didn’t wear a lot of shoes. These people will have toes like fingers! They can move their toes much like most of us move our hands. Their intrinsic foot muscles are very developed. One time Steven Tyler (lead singer for Aerosmith and now an American Idol judge) was in the office and he said, “Doc, you haven’t seen a foot like this have you?” He had muscles upon muscles in his foot because he was a dancer. He was extremely nice and sent us this photo while on his world tour shortly after the visit!

Let’s make sure you understand this important point. When the foot is functioning properly, the weight borne by the forefoot is shared between the metatarsal heads and the toes, with, of course, the first and fifth metatarsal heads taking more of the load than the others. If the intrinsic muscles are functioning inefficiently the toes may cease to perform their share of the weight-bearing resulting in the load all being carried on the metatarsal heads. Guess what happens then? You guessed it, metatarsalgia. The increased pressure leads to pain, tenderness and callosity formation beneath the metatarsal heads and, of course, you can develop claw or hammer toes and/or Morton’s neuroma because of this. So what is a person like Matt to do?
 

We also prescribe specific toe exercises that are done while holding various toes in place. We also recommend one legged balance training to strengthen the foot/ankle, along with barefoot walking as much tolerated in order to strengthen the foot muscles.Typically 3-6 Prolotherapy visits, given monthly is what is needed to completely resolve the pain and disability.

Caring Medical and Rehabilitation Services
715 Lake Street Suite 600 Oak Park, IL 60301
708-848-7789 © 1999-2011 12 Years Online!

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As with any medical technique, Prolotherapy may not be effective for every individual and there are risks involved, these risks should be discussed with your physician. Results achieved with some may not be typical of all. Please consult a physician. Please read Prolotherapy Risks

There is no known cure for arthritis. Prolotherapy and nutritional supplements can help alleviate, reverse, or end arthritic pain by treating an underlying cause that contributes to degenerative disease, ligament laxity. Strengthening ligaments and other connective tissue can help prevent bone on bone arthritis from developing.

Caring Medical and Rehabilitation Services 715 Lake Street Suite 600 Oak Park IL, 60301