Metatarsalgia is sometimes thought to be a condition or an injury, but it is actually a group of symptoms. These symptoms usually include pain on the sole or ball of the foot. Sometimes the pain is coupled with bruising and inflammation (swelling). It most often appears within the metatarsal heads, where the second, third, and fourth (middle toes) meet the ball of the foot. Sometimes, however, it is isolated and affects the first metatarsal (big toe) only. It has the potential to affect the bones, muscles, and ligaments of the metatarsal bones, and it can cause immobility. Metatarsalgia is also known as “ball-of-foot pain,” and people between the ages of 30–80 are most affected. Without treatment, the foot joint may become less flexible and grow stiff.
Since metatarsalgia is a symptom itself, it’s important you understand what to look for:
- Localized pain in the ball of the foot
- Localized pain on the bottom of the foot
- Sharp or shooting pains in the toes
- Pain increases when toes are flexed
- Tingling or numbness in the toes
- A burning pain
- Pain that increases when walking barefoot
- Pain that increases when walking on hard surfaces
- Pain that increases when standing or moving around and decreases when immobile
- Skin lesions may be visible
Metatarsalgia pain can be acute, recurrent, or chronic. Some people describe it as like walking on small rocks, or like having rocks in their shoes. Metatarsalgia symptoms tend to progress slowly, but there may be sudden bursts of symptoms.
What Causes Metatarsalgia?
The main cause of metatarsalgia is simple: the foot is not functioning normally. When the foot stops working as usual, pressure increases on the ball of the foot, and the result is metatarsalgia. Podiatrists list the following factors that lead to dysfunction of the foot:
- Improper footwear
- Stress fractures of the metatarsal
- Irregular foot shape
- Claw toes
It’s important to know that sometimes this condition appears with no apparent cause. This can lead to frustration for the patient and doctor. Almost anyone is susceptible to metatarsalgia, but you’re putting yourself at a higher risk if you:
- Participate in high-impact sports or activities
- Wear shoes that do not fit properly
- Wear high heeled shoes
- Are obese
- Have structural problems with foot, such as high arches or unusually long metatarsal bones
- Suffer from a foot condition such as gout, hammertoe or arthritis
Diagnosing metatarsalgia can be tricky at times. Since it’s a symptom itself, many of the additional symptoms are similar to other foot conditions. For example, symptoms of neuroma also include numbness, tingling, burning sensations, and pain. Like metatarsalgia, neuroma can develop on any nerve in the body, but the most common place for it to show up is on the ball of the foot, at the base of the toes. One type of neuroma, called Morton’s neuroma, commonly forms between the third and fourth toes. Similarities like this can sometimes confuse doctors into thinking the patient has a condition other than metatarsalgia.
In order to come to the correct diagnosis, your doctor should perform a simple exam of your foot using his or her fingers to look for a lump or bruise in the ball of the foot. He or she will also examine your foot to look for deformities such as high or low arches, measure the length of the second toe, or to see if you have hammertoes. Your doctor will also inquire about your activities. If you spend a lot of time running or jumping, you may be more susceptible to metatarsalgia. Your doctor may perform additional tests in order to come to a proper diagnosis. X-rays are typically used to rule out things like bone fractures.
Treatment for Metatarsalgia
Fortunately, metatarsalgia can be treated with simple methods such as rest and ice. Most treatment options are self-care methods. The treatment you will receive will be based on the cause of the metatarsalgia. Often a simple change in footwear can resolve the problem. Over-the-counter medications such as ibuprofen can reduce pain and inflammation. Generally, you should avoid the activity that caused the metatarsalgia. For example, if you play basketball and develop this problem, your doctor may want you to switch to an alternate sport such as cycling or swimming, since these are easier on the feet.
If your shoes are good, your doctor may recommend a metatarsal pad to reduce pressure on the metatarsal bones. Shock-absorbing insoles and arch supports may also help. These can be bought over-the-counter or they can be custom-made for you. If simple steps like these do not work, your doctor may need to take another approach. For more serious cases, NSAIDs (Nonsteroidal anti-inflammatory drugs), steroid injections, physical therapy, or foot surgery may help reduce pain and swelling and correct the underlying condition causing the metatarsalgia. For example, if a hammertoe is causing the problem, you may need to have the hammertoe surgically corrected.
There are several things you can do to prevent metatarsalgia. Here are some tips to help you avoid this condition:
- Do simple stretches each day (See Plantar Fasciitis Exercises).
- Wear good shoes that fit properly and are appropriate for your activity.
- Lose excess weight if possible.
- Build your stamina slowly, especially with new exercises.
- Wear adhesive gel, felt, or foam padding around your toe area during exercises.
- Rest and elevate your feet whenever possible. Your feet should be at least one foot above your hearts level.
- Always follow your doctor’s instructions.
- Limit your activities until your symptoms improve.
- Switch activities daily. For example, swim one day and ride your bike the next.
- Do not ignore symptoms you are experiencing.
Talking to Your Doctor
Here are some questions you may want to ask your doctor about metatarsalgia:
- How long will it take for me to return to my normal activities?
- What additional non-surgical treatment methods can we try?
- What over-the-counter orthotics do you recommend for me?
- What changes do I need to make in my diet?
- What lifestyle changes do I need to make to improve my symptoms?
- What is the appropriate weight for my height?