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Severe chronic metatarsalgia ? from flexor digitorum longus

Discussion in 'Ask your questions here' started by billph, Oct 20, 2013.

  1. billph

    billph New Member


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    I developed seronegative inflammatory arthritis 20 years ago. At the same time I developed very severe poorly localised metatarsalgia. The inflammatory component of my arthritis has settled with infliximab. Now I am well on etanercept. I am left with very severe metatarsalgia - worse with standing for more than a few minutes and walking more than a few hundred meters. (Strangely standing seems worse than walking). Plain X-rays MRI and US are normal. There are no neurological signs. I have bilateral tenderness over the midline of the plantar aspect of the 4th 3rd and 2nd toes ending at the insertion of flexor digitorum longus in the distal phalynx and reaching proximally over the metatarsal heads. I believe this pain is coming from the flexor digitorum tendon / tendon sheath. I would be very grateful for any experience anyone has had with similar cases and advice as to how to proceed. (I am a physician myself and have yet to meet any colleagues who have seen a similar problem).
     
  2. Craig Payne

    Craig Payne Active Member

    My experience with this is not that good. Generally it is the drugs like infliximab and etanercept that help. My experience with what I call 'local mechanical interventions' are that they just do not work that well.

    All I can suggest is that you try something like a metatarsal pad or forefoot cushioning to alter the weightbearing pattern - again, this tends to work not that well in inflammatory arthritis .... but can sometimes make walking a bit more comfortable.
     
    Last edited: Oct 20, 2013
  3. Anthony Short

    Anthony Short New Member

    I would agree with Craig about local mechanical interventions.

    I take care of quite a lot of people with inflammatory seronegative arthropathies. There is a predisposition towards pain, synovitis and joint deterioration towards the 'lesser' MTP joints.

    Although it sounds like you are concerned about the status of the tendon/sheaths, I would be more inclined to blame the actual joints themselves, with their associated inflamed synovium. Also, depending on your age, there could be substantial atrophy of the usual soft tissue fatty padding under the forefoot also.

    I would be looking towards offloading those joints with an orthotic or shoe modifications. I would be suprised to hear that after 20 years your x-rays and MRI are 'normal' - there must be deformity to some degree? - it may be worth considering surgical options such as pan metatarsal head resection if deformity and pain is severe.

    Tony
     
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