Metatarsal Pain vs. Plantar Fasciitis: Treatment Options and Advice

Metatarsal pain and plantar fasciitis?

Are metatarsal pain and plantar fasciitis the same condition? Should I see an orthopedic doctor? I have previously consulted a traditional Chinese medicine practitioner and received acupuncture twice, but the bottom of my foot (the area under my toes) is still swollen and painful.
I have looked at some examples online and I'm worried that I might not be able to heal, especially since my job requires me to stand for long periods as a flight attendant.
What should I do to fully recover my foot? Is there a recommended orthopedic clinic or hospital in Kaohsiung, as I live in Kaohsiung City and would prefer to consult nearby? Do I need to see a doctor before purchasing specialized medical insoles?

Hoping to recover soon Joyce, 20~29 year old female. Ask Date: 2004/08/13

Dr. Shi Guozheng reply Orthopedics

Metatarsal fractures and plantar fasciitis are distinct conditions.
The metatarsals are located on the underside of the foot, consisting of five bones, and are typically caused by external trauma.
A fracture is defined as a disruption in the continuity of the bone, which results in immediate pain localized at the site of the fracture.

On the other hand, the plantar fascia is a fibrous structure located beneath the metatarsals, extending from the bottom of the calcaneus (heel bone) to the entire sole of the foot.
It helps maintain the arch of the foot, allowing for a certain degree of flexibility.
When standing, it prevents the entire foot's bones from making contact with the ground.
However, prolonged standing, excessive walking, walking on uneven surfaces, or over-massaging can lead to inflammation of the fascia, resulting in pain, which is known as plantar fasciitis.
Thus, the two conditions are quite different.
A fracture may require immobilization with a cast or surgical intervention, while plantar fasciitis can be managed by reducing standing time, limiting walking distances, avoiding uneven surfaces, wearing shoes with adequate heel support, using special silicone heel pads, applying heat, and taking anti-inflammatory pain medications.
If these measures are ineffective, corticosteroid injections may be considered at the most painful point on the plantar surface.
Surgical cases are very rare and can typically be avoided for the time being.

Reply Date: 2004/08/13

More Info

Metatarsal pain and plantar fasciitis are two distinct conditions, although they can sometimes present with similar symptoms, particularly in the context of foot pain. Understanding the differences between these two conditions is crucial for effective treatment and management.

Metatarsal Pain: This type of pain typically arises from issues affecting the metatarsal bones, which are the long bones in the foot that connect the toes to the midfoot. Common causes of metatarsal pain include stress fractures, inflammation of the metatarsal joints (metatarsalgia), or conditions like Morton’s neuroma, which involves thickening of the tissue around a nerve leading to the toes. Symptoms often include localized pain in the ball of the foot, swelling, and sometimes a burning sensation.

Plantar Fasciitis: This condition is characterized by inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot, connecting the heel bone to the toes. It is one of the most common causes of heel pain. Symptoms typically include sharp pain in the heel or along the arch of the foot, especially with the first steps in the morning or after prolonged periods of sitting or standing.

Given your situation as a flight attendant, where prolonged standing is a requirement, both conditions could be exacerbated by the repetitive stress and strain on your feet.

Treatment Options
1. Rest and Activity Modification: Reducing the amount of time spent standing or walking can help alleviate symptoms. If possible, alternate between standing and sitting to reduce pressure on your feet.

2. Ice Therapy: Applying ice to the affected area can help reduce inflammation and pain. Aim for 15-20 minutes of icing several times a day, especially after activities that exacerbate your pain.

3. Footwear: Proper footwear is crucial. Shoes with good arch support and cushioning can help alleviate pressure on the metatarsals and the plantar fascia. Avoid high heels or shoes with inadequate support.

4. Orthotic Inserts: Custom or over-the-counter orthotic inserts can provide additional support and cushioning. It’s advisable to consult with a healthcare professional, such as a podiatrist or orthopedic specialist, to determine the best type of insert for your specific condition.

5. Physical Therapy: A physical therapist can provide exercises to stretch and strengthen the muscles of the foot and lower leg, which can help alleviate pain and prevent future issues.

6. Medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.

7. Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation, particularly if conservative treatments fail.

8. Surgery: This is typically a last resort and is only considered if conservative treatments do not provide relief after several months.

Next Steps
Given that you have already seen a traditional Chinese medicine practitioner and undergone acupuncture without significant improvement, it may be beneficial to consult with an orthopedic specialist. They can perform a thorough evaluation, possibly including imaging studies like X-rays or MRIs, to determine the exact cause of your pain.
In terms of finding a specialist in Kaohsiung, I recommend looking for orthopedic clinics that specialize in foot and ankle conditions. You can check local hospital websites or ask for referrals from your primary care physician.
Regarding the use of medical shoe inserts, it is generally advisable to consult with a healthcare provider before purchasing them. They can assess your foot mechanics and recommend the most appropriate type of insert based on your specific needs.

In conclusion, while metatarsal pain and plantar fasciitis are different conditions, both can significantly impact your quality of life, especially in a profession that requires prolonged standing. A comprehensive approach involving rest, proper footwear, physical therapy, and possibly medical intervention will be key to your recovery.

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