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Chiropractic Research Review

Manipulation May Be Effective Treatment for Primary Metatarsalgia

Metatarsalgia - generalized pain in the forefoot, under the area of the metatarsal heads - has been described as one of the most common sources of pain in the human body, particularly in the elderly population.

Current treatment options often include medication or surgery, although it has been suggested that nonoperative measures should be utilized initially to reduce or eliminate the pain.

This clinical trial investigated the potential effectiveness of chiropractic manipulative therapy (CMT) for the treatment of 40 subjects with primary metatarsalgia. All patients presented with a history of pain in the region of the metatarsal heads, related joint function, and two or more of the following involving the metatarsaophalangeal joints: pain on joint compression or distraction; pain on passive or active range of motion; pain on active resistance to flexors or extensors; and pain on palpation of surrounding soft tissues. Several objective outcomes measures were used to assess pain, tenderness and function in each subject before, during and after the trial.

Patients were randomly assigned to a group that received CMT to the foot and ankle of the fixated areas (using diversified technique), or a control group receiving detuned ultrasound machine treatments as placebo. The most commonly used manipulative techniques received by subjects in the experimental group were intermetatarsal glide or shear; long-axis distraction adjustments of the lesser metatarsophalangeal joints; mortise separation; and anterior-to- posterior (or dorsal-to-plantar) glide adjustments to the small tarsals.

Conclusion: Following eight treatments (two per week for four weeks) and four consultations to assess various pain parameters, patients "responded more rapidly to CMT than to placebo treatment in terms of subjective ... and objective measurements." Patients in the manipulation group had clinically and statistically greater levels of improvement compared to the placebo group. However, the authors note several study limitations and urge future trials to provide additional data on the efficacy of CMT for treating primary metatarsalgia.

Petersen SL, Brantingham JW, Kretzmann HM. Chiropractic manipulative therapy in the treatment of primary metatarsalgia: a prospective single-blind clinical trial. European Journal of Chiropractic 2003:49(3), pp267-79.
Information: ppederse@glam.ac.u

Chiropractic Research Review

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