Painful metatarsalgia successfully treated with medication and ultrasound guided injections
History of Metatarsalgia
A lady was seen in the Pain Clinic complaining of pain in her feet, the left being worse than the right. The pain is worse on standing and she was aware of it after only 15 minutes on her feet. She was taking Tramadol 50 mg nocte, Ibuprofen as required and Thyroxine and Omeprazole.
Examination findings in Metatarsalgia
On examination, there was marked tenderness of 3 of the metatarsophalangeal joints on palpation. There was no evidence of allodynia or hyperalgesia in feet and power, tone and reflexes were all within normal limits for the lower limbs.
Diagnosis of Metatarsalgia
This lady was diagnosed with metatarsalgia, particularly in her left foot. We discussed the various treatment options including medication and adding Paracetamol to the Ibuprofen or Tramadol as required. We also discussed lighter duties at work and perhaps more desk based work, rather than being on her feet most of the day.
Ultrasound guided injections for Metatarsalgia
She was also put down for ultrasound guided injections of the small joints. These were performed approximately 2 months later by an interventional radiologist who was able to specifically localise the small joints of the foot which were giving her pain and a small amount of local anaesthetic and anti-inflammatory were instilled in each.
Succesful treatment of Metatarsalgia with ultrasound guided injections
The lady was reviewed at 5 months and she had been having significant benefit from these ultrasound guided procedures, with a drastic reduction in her analgesic requirements. However, she was starting to find that these were wearing off and she was therefore booked in for repeat of these. She will be reviewed in the clinic following this procedure.