Metatarsalgia

Repetitive microtrauma, improper loading, or high-impact athletic activities can cause pain at the ball of the foot. This condition is better known as metatarsalgia. Although it is generally benign, the pain can limit ambulation and affect other activities of daily.

What is metatarsalgia?

Metatarsalgia is pain coming from the long bones connecting the digits to the midfoot that is termed as metatarsals. It usually involves the second metatarsal head. Patients often describe the condition as a sharp pain in the ball of the foot that occurs insidiously. Some may describe a sensation of having a pebble in the shoe or wrinkle in the socks. A condition called Morton’s neurom affects the nerves between the forefoot bones and may present with the same symptoms. The main difference between metatarsalgia and Morton’s neuroma is the absence of radiating pain to the toes for the former.

What causes metatarsalgia?

1.) Type of footwear

Wearing high heels shifts the majority of body weight to the balls of the foot. Narrow toe boxes compress the metatarsals together to cause pain. Both can lead to chronic repetitive strain. Over time, this will develop to chronic pain in the balls of the feet and lead to metatarsalgia. Thin soles of shoes and flip-flops can increase impact on the ball of the foot.

2.) Obesity

Obesity causes metatarsalgia because the feet will have to bear more weight. The balls of the feet have to endure more force during propulsion while walking. When combined with habitual wearing of high heels, it will transmit the excess load unevenly to the ball of the foot.

3.) Athletic activities that load the ball of the foot

Activities that constitute more jumping and toe running make a person prone to developing metatarsalgia. These activities have a more concentrated transmission of body weight to the balls of the feet that will eventually lead to pain in the forefeet.

How to diagnose Metatarsalgia?

Diagnosis of metatarsalgia is purely clinical. A sound history and physical examination will lead a physician to diagnosis of metatarsalgia. An x-ray is only necessary if there is reason to believe that a fracture is present.  An MRI or bone scan is only warranted when sesamoid bone fracture (often with presentation of pain in the first metatarsal head) or stress fracture is entertained.

Treatment

• Correcting habits to relieve forefoot pressure

The mainstay of treatment is to unload the ball of the foot. Avoiding wearing shoes with elevated heels, narrow boxes, and thin soles can do this.  Correcting training patterns to decrease pressure on the forefoot should be done. Alternating running and swimming/biking on training days can rest the foot without compromising cardiovascular endurance. Losing weight should be advised for overweight and obese patients to decrease the load on the feet.

• Metatarsal (Forefoot bone) pads

A metatarsal gel pad insert or using premetatarsal pads is placed before the ball of the foot. Doing so takes pressure off the forefoot. This can facilitate rest and preserve functional daily activities for the patient.   The pads are placed just before the forefoot bones to relieve pressure.

• Orthoses

Custom-made foot orthoses can be prescribed when pain is recalcitrant to treatments number one and two. Orthoses can aid in distributing weight forces evenly along the foot; However, the main drawback of this treatment is expense when other options are available.

Surgery and steroid injections are not treatment options unlike in Morton’s neuroma.