Plantarflexed Metatarsal

A plantarflexed metatarsal means simply that one of the long bones in the front of your foot is lower then the other four metatarsals. A catch all phrase for pain in this area of the foot is “metatarsalgia”.

Symptoms of a plantarflexed metatarsal is most commonly associated with a painful lesion. Many people mistake a painful callous on the bottom of there foot as a plantars wart. Any area of tough skin or lesion on the bottom of your foot should be seen by your Podiatrist to determine what it exactly is as they can be very similar. A porokeratosis may also be on the bottom of your foot and may resemble a callous caused by a plantarflexed metatarsal. Pain may occur only with heavy activity, or even at rest. There may be a large callous or no callous at all in the area of your pain. The callous may be present due to friction and extra pressure caused by metatarsal deformity. A bursa may also be felt as a soft lesion under the metatarsal head where pain exists.

Causes of a plantarflexed metatarsal are usually structural in nature. Many times this is the foot structure you were born with and other factors have now made it so that symptoms appear. All five metatarsal heads, commonly referred to as the “ball” of your foot, should be at the same level as your foot strikes the ground. This allows for even pressure to be applied to the metatarsal heads. If one metatarsal is lower than the others, uneven pressure and friction may result causing a callous to develop. This may also be due to a structural problem with the length of the metatarsal as it will cause early pressure on one metatarsal. Trauma or other surgery of your foot may predispose you to having the condition if your foot structure is altered. A fracture or stress fracture may cause misalignment of the bone causing it to lower in relation to other metatarsals.

Prevention of a plantarflexed metatarsal is very difficult as symptoms do not arise until the problem exists. Sometimes surgery is recommended for the condition. If the area is irritated with redness, swelling, and pain some ice and anti-inflammatory medications may be helpful. The best prevention may be to get advice from your podiatrist.

Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling or if a bursitis is present. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot, check for fractures and determine the cause. The podiatrist may see you to take care of any corns or callouses that develop due to the bone deformities. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure. Padding techniques may be used to bring all five metatarsal heads to the same plane. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgery to correct for a plantarflexed metatarsal is usually performed as an outpatient procedure at a hospital or surgery center. There are multiple procedures that can be used depending on your individual foot structure. There may be a surgical cut in the bone to raise the metatarsal or a piece of bone placed in or taken out to shorten or lengthen the bone as needed. Angular corrections may also be needed. The surgeon may place fixation in your foot as it heals which may include a screw, pin, or wires. A bone graft could be utilized if the bone needs to be lengthened.

The post-operative care and risks of a surgical correction of a plantarflexed metatarsal depends on the exact surgery done. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and an occasional ice pack placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. For some procedures you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks depending on procedure. Your surgeon may allow you to place some weight on the heel. With other procedures your surgeon may encourage weight on your foot so the metatarsals find the level needed while walking and healing of the bone. You may need crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing time is typically 6-8 weeks for all bone cuts. This is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If your bone heals real slow it may be a delayed union, or if not at all a non-union. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know.