Orthopedics-Online

Tendonitis in the metatarsus

definition

Tendonitis in the metatarsus is an acute or chronic inflammatory change in the tendons belonging to the foot muscles. For various reasons, this inflammation can impair the movement of the toes of the affected foot.

In addition to conservative treatment methods, surgical treatment measures are also available for exceptional cases.

causes

The causes of tendinitis in the metatarsus can be divided into acute and chronic causes.

Acute tendinitis of the metatarsus mainly occurs when the feet are overloaded. It can happen that after a long walk the pain in the metatarsus begins.

Even if e.g. Carrying heavy loads can lead to tendinitis of the metatarsus. The unfamiliar strain leads to strong friction in the area of the tendon attachment points on the bone, which causes the tendons to become inflamed.
Inflammation on the foot is usually painful when moving and rather painless when at rest. In the case of very severe and advanced tendinitis, pain at rest in the area of the metatarsus can also occur.

Long-term overuse of the metatarsus is one of the chronic causes of tendinitis of the metatarsus. For this reason, if the shoes are not properly fitted and at the same time full load is carried out, chronic tendinitis of the metatarsus can occur. Here, too, the symptoms initially only start when the patient is exerted, but can then also be present at rest if the inflammation is advanced.

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Symptoms

The first symptoms of tendinitis in the metatarsal area are pain when moving the foot and toes. Since the tendons belonging to the muscles move with it, calcifications lead to painful friction, which can lead to inflammation and thus further severe pain. Initially, the pain can only be felt when moving, because the muscle and tendon movement creates the greatest friction.

More about this topic can be found: Metatarsal pain

If the inflammation is advanced, pain occurs even at rest. Furthermore, there may be swelling of the back of the foot or the toes that is partially painful to pressure. Mobility restrictions sometimes also occur due to the swelling of the soft tissue.

More about this topic can be found: Inflammation in the foot

diagnosis

The diagnosis of tendinitis of the foot is made through the questioning of the patient and the examination by the doctor. The first question asked is when the pain occurred and how long it has existed.
Previously performed movements or loads are also asked for and the severity and type of complaints are examined in detail.

The examination relates to the mobility in the toe and ankle joints, which the examiner actively and passively tests.
If pulling the toes towards the body is particularly painful, this indicates a tendon problem in the area of the foot.
The reason for this is that when the toes move, the tendons of the associated muscles in the area of the foot move back and forth and, in the event of an inflammation, there is strong friction in this area.

During the examination, the patient is also asked to stand on tiptoe and on his heel. If he succeeds in doing this only with pain, this can also indicate tendinitis of the metatarsus.
In cases of doubt, imaging can still be performed for diagnostic purposes. In this case, the ultrasound examination is used, which can show calcifications and thickening of the muscle tendons.

If this examination does not provide any clear evidence of tendinitis, an MRI examination of the foot can also be performed.

Soft tissues can be visualized very well in this examination. Inflamed tendons of the foot would appear thickened or calcified, which would corroborate the suspicion of tendinitis.

Read more on the topic: MRI of the foot

Duration

Tendon infections often begin slowly. Caused by heavy exertion during sport without warming up beforehand or by repetitive one-sided movements, swelling, redness and pain occur in the affected area.

Limescale deposits can also appear after a long period of untreated treatment, which is noticeable by a grinding noise when moving. The duration of tendinitis depends very much on the immobilization of the affected tendon or the affected joint.

If this is consistently spared, the inflammation can subside after a few days.

If this is not the case, a chronic course can develop from it. It is important to avoid the triggering movements or to correct faulty movement sequences, for example during sports.

Preventive measures, such as physiotherapy exercises, also help to shorten or prevent tendinitis.

therapy

Mostly conservative treatment is used. The immobilization and cooling of the foot for a few days and the anti-inflammatory treatment lead in the vast majority of cases to an early improvement in the symptoms. Ibuprofen or diclofenac are used as anti-inflammatory drugs. Chronic and severe inflammations lead to tendons sticking together and severe mobility impairment. In this case it may be necessary that an operative solution of the tendons restores mobility.

Read also: Home remedies for tendinitis

Taping

Taping can help speed up regeneration of the inflamed tendon.

The tape increases the stability of the affected area, which on the one hand prevents consequential injuries and also avoids incorrect loading.

The vasodilator effect helps to reduce the inflammation process. The tape can also ensure that the affected tendon is relieved of pressure and thus not further irritated.

Home remedies

There are also some home remedies for tendinitis that can reduce the inflammatory reaction more quickly or at least alleviate the symptoms.

On the one hand, the quark wrap has proven itself, which has a pleasantly calming effect on the affected area with its cooling effect. To do this, it is sufficient to put quark on a cloth, which is placed on the inflamed area and replaced after a few minutes.
Cooling compresses are also useful for inflammation. It is important to note that the cooling element should never be placed directly on the skin, but always with a cloth in between to prevent the skin from freezing.
Tapes and bandages or splints are always useful to immobilize the affected part of the body in order to maintain the protection and to prevent further irritation of the tendon.
Anti-inflammatory gels or creams also help to speed up the healing process and curb excessive reactions from the body.

forecast

Depending on the severity of the inflammation, a treatment time of a few days up to 4 weeks may be necessary until the symptoms have completely subsided. It is also decisive to what extent the patient pays attention to the immobilization of the foot.

If the patient is overburdened during the healing phase, the inflammation can worsen or become chronic despite the administration of medication.

When can you do sports again?

If you have tendinitis, you should take it easy instead of exercising. Sport should be avoided for a few weeks.

During this time, the affected tendon should be spared and immobilized, for example with a special splint.

Individual exercises can then be performed slowly after a while in order to strengthen the surrounding muscles. However, the return to sport, especially if the sport triggered the tendinitis, should be carefully and carefully observed.

How can I tell the difference between a tendinitis in the metatarsus and a stress fracture?

Fatigue fractures are so-called stress fractures that occur particularly in people who practice high-intensity sports and / or have a congenital deformity and, as a result, an incorrect load on individual skeletal elements.

The bones are worn out, so to speak, by intense stress and then usually break spontaneously. Since the fragments are usually relatively cheap to each other, surgery is usually not necessary and immobilization is on the therapy plan.

What is dangerous is that a stress fracture with pain, redness and swelling of the affected area has symptoms similar to those of tendinitis.
Here you have to pay attention to whether the symptoms are temporally related to physical activity and how long they last.

From a duration of more than a week, imaging diagnostics should be carried out to rule out one of the two clinical pictures.