Metatarsal tendonitis is an acute or chronic inflammatory change in the tendons belonging to the foot muscles. For various reasons, these inflammations can impair the movement of the toes of the affected foot.
In addition to conservative treatment methods, surgical treatment measures are also available in exceptional cases of emergency.
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Causes of the metatarsal tendonitis
The causes of inflammation of the tendon in the metatarsus can be divided into acute and chronic causes.
Acute tendonitis of the metatarsus occurs mainly due to the overloading of the feet. For example, it can happen that after a long walk, the pain in the metatarsus begins.
Even if, for example, heavy loads are carried, an inflammation of the tendon of the metatarsus can occur. The unaccustomed load leads to strong friction in the area of the tendon attachment points on the bone, which results in the tendons becoming inflamed.
Inflammation of the foot is usually painful when moving and is rather painless at rest. In the case of very severe and advanced tendon inflammation, pain at rest in the area of the metatarsus can also occur.
One of the chronic causes leading to inflammation of the tendon in the metatarsus is the long-term overloading of the metatarsus. If shoes are not correctly fitted and full weight-bearing is carried out at the same time, chronic tendonitis of the metatarsus can occur for this reason. Here too, the symptoms initially only start when the foot is loaded, but can then be present at rest when the inflammation is advanced.
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Symptoms of the metatarsal tendonitis
The first symptoms of tendonitis in the metatarsal area are a pain when moving the foot and toes. As the tendons belonging to the muscles move along with the foot, calcifications cause painful friction, which can lead to inflammation and thus, to further severe pain. The pain is initially only noticeable in motion because the most significant friction is caused by the movement of the muscles and tendons.
In the case of advanced inflammation, pain is also experienced at rest. Furthermore, swellings of the back of the foot or toes can also be painful due to pressure. Mobility restrictions sometimes also occur due to the swelling of the soft tissue.
The diagnosis of tendonitis of the foot is made by the patient interview and examination by the doctor. First of all, the patient is asked when the pain occurred and how long it has existed.
Previous movements or strains are also asked about, and the exact severity and type of pain are examined.
The examination refers to the mobility in the toe and foot joints, which the examiner actively and passively tests.
If, above all, the pulling of the toes towards the body is painful, this indicates a tendon problem in the area of the foot.
The reason for this is that when the toes are moved, the tendons of the associated muscles in the area of the foot move back and forth, and, in the event of an inflammation in this area, strong friction occurs.
During the examination, the patient is also asked to stand on the tips of the feet and on the heel. If he succeeds in doing so only under pain, this may also indicate an inflammation of the tendon of the metatarsus.
In cases of doubt, imaging can still be performed for diagnosis. In this case, an ultrasound examination is used, which can show calcifications and thickening of the muscle tendons.
If this examination also does not provide clear evidence of tendonitis, an MRI examination of the foot can also be performed.
Soft tissues can be depicted very well in this examination. Inflamed tendons of the foot would appear thickened or calcified, which would confirm the suspicion of tendonitis.
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Duration of the metatarsal tendonitis
Inflammations of the tendons often start insidiously. Caused by heavy strain during sports without warming up beforehand or by repetitive one-sided movements, swelling, redness, and pain occur in the affected area.
Calcification can also occur after a long period of untreated progression, which is noticeable by a crunching noise when moving. The duration of tendonitis depends very much on the immobilization of the affected tendon or joint.
If the tendon is consistently spared, the inflammation can subside after a few days.
If this is not the case, a chronic course can develop. It is important to avoid triggering movements or to correct incorrect movement sequences, for example, during sports.
Preventive measures, such as physiotherapy exercises, also help to shorten or prevent tendon inflammation.
In most cases, conservative treatment is used. The immobilization and cooling of the foot for a few days and the anti-inflammatory treatment leads in most cases to a new improvement of the symptoms. Ibuprofen or Diclofenac is used as an anti-inflammatory medication. Chronic and severe inflammations lead to a sticking of the tendons and to a substantial restriction of mobility. In this case, it may be necessary for a surgical solution of the tendons to restore mobility.
Taping can help to accelerate the regeneration of the inflamed tendon.
Taping increases the stability of the affected area, which, on the one hand, prevents secondary injuries and, on the other hand, avoids incorrect strain.
The vasodilating effect helps to accelerate the healing of the inflammation process. The tape can also ensure that the affected tendon is relieved of pressure, and thus no further irritation occurs.
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Home remedy of the metatarsal tendonitis
There are also some home remedies for tendonitis that can help the inflammatory reaction subside more quickly, or at least alleviate the symptoms.
On the one hand, the quark wrap has proven to be effective, which has a pleasantly calming effect on the affected area with its cooling effect. For this purpose, it is sufficient to put food quark on a cloth, which is placed on the inflamed area and replaced after a few minutes.
Cooling compresses are also useful for inflammations. Here it is essential to remember never to place the cooling element directly on the skin but always keep a cloth in between to prevent the skin from freezing.
Tapes and bandages or splints are always useful to immobilize the affected area of the body, to maintain the protection and prevent further irritation of the tendon.
Anti-inflammatory gels or creams also help to speed up the healing process and curb excessive reactions of the body.
Depending on the severity of the inflammation, treatment may take from a few days to 4 weeks until the symptoms have completely subsided. The extent to which the patient pays attention to the immobilization of the foot is also decisive.
If the foot is overstressed during the healing phase, the inflammation can worsen or become chronic despite the administration of medication.
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When may one do sport again
In the case of tendonitis, it is better to take it easy than to exercise. Sport should be avoided for a few weeks.
During this time, the affected tendon should be spared and immobilized with a special splint, for example.
Individual exercises can then be carried out slowly after some time to strengthen the surrounding muscles. However, the return to sport, mainly if the sport has caused the tendon inflammation, should be done carefully and attentively observed.
How can I distinguish an inflammation of the tendon of the metatarsus from a fatigue fracture?
Fatigue fractures are so-called stress fractures, which occur mainly in people who practice high-intensity sports or have a congenital malposition and thus incorrect loading of individual skeletal elements.
The bones are worn out, so to speak, by intense stress and then usually break spontaneously. Since the fragments are usually located relatively favorably to each other, surgery is usually not necessary, and immobilization is on the treatment plan.
Dangerous is that a fatigue fracture with pain, redness, and swelling of the affected area contains similar symptoms to tendonitis.
In this case, one must pay attention to whether the symptoms are temporally related to sporting activity and how long they last.
If it lasts longer than a week, imaging diagnostics should be performed to exclude one of the two clinical pictures.
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