Metatarsalgia – To immobilise or not…

Zara asked The Guru for the following Physiotherapy Advice:

Hi Guru!

My bizzare injury came about whilst I was foam rolling my ITB a week and a half ago. I was on my left side when there was an almighty crack across the metatarsals in my supporting right foot as my weight shifted. For the days after there was some pain in the ball of my foot and slight tinging/burning sensation intermittently but nothing that made me worry. For the past couple of days it’s been a lot worse and I have been experiencing sharp pain on the underside of my foot centred on the 3rd/4th metatarsals on weight bearing which intensifies the further I walk etc. There is tenderness over the 3rd and 4th heads on the dorsal surface too. There is some discomfort on toe flexion and my toes have adopted a somewhat extended position at rest. I could convince myself that there is an increased gap between my 3rd and 4th toes. I have had to wear an air cast boot (acquired due to a previous injury) to mobilise today which eased pain significantly.

X rays have come back normal and was advised that it’s probably a ligamentous injury, rest, painkillers and avoid wearing the restrictive boot. The only problem is I’m on my feet for a lot of the day and rest isn’t much of an option! I’m prone to ankle stiffness due to torn lateral ligaments and I’m concerned that wearing the boot will further aggravate ankle symptoms/tighten calf etc. However I’m equally worried that not adequately supporting a plantar plate tear in the early stages, for example, will cause further problems down the line. Would you err on the side of caution and immobilise? Also, would you suggest going down the diagnostic ultrasound/MRI route or is it something that a bit of physio could sort out?

The guru’s advice would be much appreciated!

Many thanks in advance!