Most of us don’t realize how many steps we take in a day until we experience foot pain. And when every step hurts, you may feel like you have to put your fitness goals, your favorite activities, and even your daily tasks on hold.
Pain that occurs in the ball of the foot, the area where the toes meet the arch (also called the ball of the foot), is known as metatarsalgia. Metatarsalgia, named after the metatarsal bones of the foot, is most commonly an overuse injury related to physical activity. It is often a sign that too much pressure is being applied to the forefoot, causing inflammation in one or more of the metatarsal bones.
Below, we’ll guide you through the characteristic signs and symptoms of metatarsalgia, how to treat it if you have it, and how to prevent it once and for all.
The main symptom of metatarsalgia is pain in the forefoot.
At the front of the foot, the metatarsal bones fan out and connect to each of the bones of the first toe (called phalanges). When too much pressure is applied to one or more metatarsal bones for too long, the bone can become painful and swollen. This is metatarsalgia. Symptoms of metatarsalgia may include:
- Burning, aching, or stabbing pain concentrated in and around the ball of the foot, which worsens when standing, walking, barefoot, or squatting.
- Tingling and loss of sensation in the finger or toes.
- Inflammation and swelling in the forefoot area.
Metatarsalgia can feel like a stone in your shoe
In addition to pain in the forefoot, metatarsalgia can cause a different sensation in the foot. When you have metatarsalgia, you may feel as if you are walking with a pebble or marble in your shoe. You may also feel like you have a deep bruise on your ball of foot; Metatarsalgia is sometimes called “stone bruise.”
What does metatarsalgia look like?
The inflammation of metatarsalgia occurs inside the foot, so at first metatarsalgia will not show any apparent signs. If the condition worsens, the forefoot area may begin to look swollen, swollen, or red.
The causes of metatarsalgia fall into three categories.
Podiatrists, or doctors specialized in foot and ankle care, classify the causes of metatarsalgia into three groups: primary, secondary and iatrogenic.
primary metatarsalgia
If metatarsalgia is caused by a structural abnormality of the foot, then it is considered primary metatarsalgia. These problems directly affect the metatarsal bones and include:
Secondary metatarsalgia means that your metatarsalgia is caused by other health conditions you have or are related to the activities you do. Common causes of secondary metatarsalgia may include:
- morton neuroma – This is a thickening of the tissue surrounding the nerves (known as the common digital plantar nerves) that branch towards the toes and cause pain.
- Conditions that make walking painful – Rheumatoid arthritis, gout, diabetes, and plantar warts can affect the joints, nerves, and soles of our feet, making our normal way of walking (our “gait”) painful. As we adjust our gait to avoid pain, this can put more pressure on the metatarsals.
- Wearing high heels or ill-fitting shoes – Shoes like high heels, narrow styles, and flats can squeeze your toes, aggravate high arches, and put extra pressure on the ball of your foot.
- Running, jumping or other high-impact physical activities. – There’s nothing wrong with an intense workout, but make sure you have the right shoes and alternate between hard and soft surfaces (running on grass instead of pavement for a mile or two, for example) to avoid secondary metatarsalgia.
- Stress fractures – Your metatarsalgia may be a sign that one or more of your metatarsals have suffered a stress fracture. Stress fractures are usually the result of intense, repeated movements or a symptom of osteoporosis.
iatrogenic metatarsalgia
“Iatrogenic” describes an illness, injury, or other condition caused by a medical intervention. In the case of iatrogenic metatarsalgia, this means that it developed as a complication of foot surgery (such as bunion surgery) or as a result of broken bones in the foot that healed incorrectly. Iatrogenic metatarsalgia can also be caused by avascular necrosis, when the bones of the foot are temporarily or permanently deprived of their blood supply, but this is rare.
Treatment for metatarsalgia begins at home
You should be able to self-diagnose metatarsalgia and, depending on its cause, treat it relatively well at home with the following:
Select shoes with metatarsal support.
Shoes with arch support, forefoot cushioning, a wide toe box, and a low heel can relieve metatarsalgia pain. Consider shopping at a sporting goods store with specialists who can help you select the right shoe for your needs.
Orthosis for metatarsalgia (pads and insoles)
They can be added to existing shoes with custom or over-the-counter orthotics that support high arches and provide more cushioning in the forefoot area and relieve pressure on the metatarsal bones.
Other treatments at home
- RICE – Rest, ice, compression and elevation can provide immediate pain relief.
- Over-the-counter anti-inflammatories – NSAIDs can be taken as needed, but they are not a permanent solution for metatarsalgia.
- Metatarsal exercises – Foot, ankle and calf stretches keep the muscles and ligaments that surround the metatarsal bones (and those that contribute to the way we walk) flexible and strong. These exercises and stretches can also relieve pain and prevent metatarsalgia.
How to prevent metatarsalgia
Not all cases of metatarsalgia can be prevented. But many of the ways metatarsalgia is treated are also ways to prevent it in the first place, or keep it from coming back. These include:
- Wear appropriate footwear
- File calluses
- Maintain a healthy weight
When to see a doctor for metatarsalgia treatment
Sore feet after a long day of exercise or work can be normal. However, once you put your feet up and rest, perhaps even with ice, the pain should go away. If foot pain persists, it could be a sign of something more serious, including metatarsalgia. Consult a podiatrist if:
- Foot pain lasts more than two weeks or keeps coming back, despite home treatments
- The tingling and numbness extends from the toes to the rest of the foot.
- Do you have diabetes
- The pain is so intense that you can’t walk.
A podiatrist may give you corticosteroid injections to relieve inflammation, as well as refer you to physical therapy or recommend surgery.
Physiotherapy
Physical therapy can be an excellent option for treating persistent metatarsalgia without the need for surgery.
A physical therapist can guide you through exercises and stretches that relieve pressure on the bottom of your foot, as well as provide prevention strategies. They can also help you adapt your favorite activities to do them without pain.
They may perform interferential electrical current therapy (IECT), a procedure in which electrical currents are sent to tissue in the foot to reduce pain and inflammation.
Surgeries for metatarsalgia
Depending on your particular case, surgical treatment for metatarsalgia is often reserved as a last resort. Surgeries performed for metatarsalgia will seek to correct abnormalities in the structure of the foot.
- Metatarsal osteotomy – In this procedure, a foot surgeon cuts the metatarsal bone and repositions it to correct the alignment with the big toe bone.
- Hammertoe repair – Hammertoe describes a toe with the middle joint stuck in a bent position. Because hammertoe can be a cause of metatarsalgia, metatarsalgia can be resolved through surgical repair of the hammertoe. A foot surgeon may lengthen the tendon of the affected toe or remove and reposition the metatarsal and phalanx bones.
- bunion surgery – A bunion is a growth of bone or tissue most commonly in the joint of the big toe, caused by repeated stress or pressure on that area. To repair a bunion, a foot surgeon will remove the growth and realign the bones and ligaments.
Don’t ignore forefoot pain
Going for a walk with your dog, training for a 5K race, or gardening with your grandchild doesn’t have to be accompanied by an annoying itch or pain in the ball of your foot. Addressing foot pain due to metatarsalgia can make a big difference in your enjoyment of your favorite activities and your overall quality of life.
