In looking over the literature I can find but one operation recommended for the relief of metatarsalgia—the excision of the head of the metatarsal as advised by Morton. Various palliative measures have been used with some success.
Several theories have been offered to explain the etiology. Whitman's explanation of lateral pressure by tight shoes on the depressed transverse arch is no doubt the correct one. In the two cases reported the depression of the arch was caused by pressure of the shoe against the second toe joint, forcing the first phalanx downward against the metatarsal bone. The factors which may tend to hold the first phalanx in this undesirable position are: 1, Displacement of the toe upward by hallux valgus; 2, hammer toe; 3, contracted tendons; 4, jamming backward of the toe by a short shoe. Hence the shoe which causes metatarsalgia is the one which squeezes laterally and at