Gait biomechanics in individuals with chronic metatarsalgia: A case-control study

Most treatments for chronic metatarsalgia (CM) focus on reducing forefoot plantar pressure. However, no study has yet identified a link between CM and metatarsal heads overload during level walking. Characterizing the differences in plantar pressure, and lower limb angles and moments in individuals with CM would help better understand the underlying biomechanical deficits associated with CM and developing a more deficit-targeted treatment. The main objectives were to determine whether individuals with CM exhibit greater pressure under the metatarsal heads, reduced ankle pronation, and increased midfoot dorsiflexion moments compared to controls during walking. A total of 23 individuals with CM and 23 individuals without lower limb pain (17 females and 6 males in each group) were recruited. Maximum within-mask pressure (nine foot regions), three-dimensional kinematics (midfoot, ankle, knee, and hip), and kinetics (internal joint moments in the sagittal, frontal, and transverse planes) were calculated during level walking and compared across groups with two-sample t-tests using statistical parametric mapping. Significantly greater maximum within-mask pressure under the lateral midfoot, 1st metatarsal head and the toes were observed during the stance phase for individuals with CM compared to controls. Ankle eversion, knee and hip flexion angles as well as ankle plantarflexion moments were significantly greater for individuals with CM compared to controls. These biomechanical differences in individuals with CM suggest potential compensatory mechanisms in response to pain under the forefoot. A comprehensive, individualized biomechanical and clinical assessment is essential to guide effective orthotic and therapeutic strategies for the treatment of CM.