The term Metatarsalgia is derived from pain present around the metatarsal heads. More specifically, a sharp or shooting pain at the ball of the foot, and an aching or burning sensation. The toes may feel some numbness or tingling as well. The metatarsal heads are located just behind the toes where several nerves run between them. If the metatarsal bones get pinched together, the nerves become trapped in the middle, leading to pain and inflammation. Generally, Metatarsalgia has a slow onset of symptoms but it can also develop without warning.
Pain can often worsen from overuse, as the metatarsal heads withstand daily force when standing, walking, running or flexing the toes, especially on a hard surface. Patients often describe the feeling of Metatarsalgia as “walking on a pebble”.
There are several factors that can lead to Metatarsalgia. These include:
- Poorly fitting footwear: Shoes that fit too tight may squeeze the ball of the foot together, aggravating the nerves that lay between. For example, high heels force the forefoot into a tight space and expose the metatarsal heads.
- Increase in activity or high impact exercise: With a sudden increase in activity the foot is not used to the increased amounts of pressure, leading to Metatarsalgia. Regular high impact activities and repetitive force can be damaging to the foot.
- Excess weight: As we move, body weight gets shifted to the forefoot, and with extra weight there is further pressure put on the metatarsals.
- Foot shape: High arches can put added pressure on the metatarsals. If the second toe is longer than the big toe, more weight transfers to the second metatarsal head making it more susceptible to foot problems.
- Advanced age: As we age the protective fat pad at the ball of the foot gets thinner, increasing risk of Metatarsalgia.
- Stress fractures: Small breaks in the bones of the forefoot can change the way you walk due to pain.
- Medical conditions: Rheumatoid arthritis and diabetes can increase risk of developing Metatarsalgia.
- Morton’s Neuroma: Compression of a nerve between the third and fourth metatarsal heads causing symptoms similar to Metatarsalgia.
- Sesamoiditis: Tendons around the sesamoids become irritated or inflamed. Pain is usually felt under the first metatarsal and is most common in ballet dancers.
- Metatarsophalangeal (MTP) joint capsulitis: Inflammation of the plantar joint capsule, most commonly under second metatarsal head. Described as a “bruised feeling” or having the sensation of a “lump”.
Metatarsalgia is a treatable condition with a high rate of success. One way to relieve pain at the metatarsal heads include wearing properly fitted footwear with a wide enough toe box and a rocker sole. The wide toe box allows sufficient room for the foot to expand and the rocker sole decreases pressure on the ball of the foot. Another method to alleviate forefoot pain during exercise is to stretch before and after activity with a warm up and cool down period. Additionally, listen to your body and rest when necessary. Finally, custom orthotics can be designed to offload pressure at the metatarsal heads. Often a metatarsal pad is built into the orthotic to redistribute weight and help make putting weight on the forefoot more tolerable. If left untreated, the pain may worsen and other problems may occur such as hammer toes or low back pain from altered gait.
Daniel Gemmell C.Ped(C)