Metatarsalgia
Milton J. Stern, DPM
Metatarsalgia
is a general term used to denote a painful foot condition in the metatarsal
region of the foot (the area just before the toes, more commonly referred to
as the ball-of-the-foot). This is a very common foot disorder that we see in
our practice. It can affect the bones and joints at the ball-of-the-foot.
Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and
4th metatarsal heads, or more isolated at the first metatarsal head (near
the big toe). The most common location is just the second metatarsal head.
The main symptom of metatarsalgia is pain in the ball of your foot — the
part of the sole just behind your toes. The pain may be sharp, aching or
burning, and you may feel it in the area around the second, third and fourth
toes or only near your big toe.
Other symptoms of
metatarsalgia include:
·
Pain that
gets worse when you stand, walk or run and that improves when you rest
·
Sharp or
shooting pain in your toes
·
Numbness or
tingling in your toes
·
Pain that
worsens when you flex your feet
·
A feeling in
your feet as if you're walking on pebbles or have a bruise from a stone
·
Increased
pain when you're walking barefoot, especially on a hard surface
Sometimes these symptoms
come on suddenly, especially if you've recently increased your usual amount
of running, jumping or other high-impact exercise, but problems are more
likely to develop over a period of months
With this common
foot condition, one or more of the metatarsal heads become painful and/or
inflamed, usually due to excessive pressure over a long period of time. It
is common to experience acute, recurrent, or chronic pain with
metatarsalgia. The most common complaint we hear all the time is that it
feels like walking on a small rock in the shoe. This happens when the
capsule around the joint gets inflamed and swollen and we walk on it.
Anything that
puts pressure or extra stress on the ball of our foot can cause this
condition. These include:
·
Being overweight
·
Wearing high heeled shoes
·
Digital deformities that create
retrograde pressure on the metatarsal head
·
Extremely high arched feet
·
An orthopedic condition where a
metatarsal is very long or declinated
·
Anterior ankle arthritis where
the foot can not be brought up into the ankle joint
·
Bunion deformities where big
toe is weakened and extra stress is put on ball of foot
·
Athletics where there is high
impact on the fore foot
·
Aging where the normal fat pad
on the bottom of the foot gets thinner
The first step in
treating metatarsalgia is to determine the cause of the pain. If it is
something obvious like improper fitting footwear, the footwear must be
changed. Footwear designed with a high, wide toe box (toe area) and a rocker
sole is ideal for treating metatarsalgia. The high, wide toe box allows the
foot to spread out while the rocker sole reduces stress on the
ball-of-the-foot.
Unloading
pressure to the ball-of-the-foot can be accomplished with a variety of
footcare products. Orthotics designed to relieve ball-of-foot pain usually
feature a metatarsal pad or a cut out under the affected metatarsal. The
orthotic is constructed with the pad placed behind the ball-of-the-foot to
relieve pressure and redistribute weight from the painful area to more
tolerant areas. Other products often recommended include gel metatarsal
cushions and metatarsal bandages.
Once we have
something in the shoe to try to prevent the excessive pressure and continual
injury then other modalities can be used concurrently. These include OTC
medications like Motrin of Aleve.
Sometimes a visit
to the podiatrist is indicated. X-rays can show if there is an orthopedic
condition causing the pain. They also show us if the joint has gone through
any changes. For the more painful joints sometimes a small steroid
injection can give relief. Most of the time (90%) conservative care can
give good long lasting relief. For the occasional chronic condition that
doesn’t get better with conservative care and is painful everyday, there are
some surgical options that are very successful.
Metatarsalgia is
a general term used to denote a painful foot condition in the metatarsal
region of the foot (the area just before the toes, more commonly referred to
as the ball-of-the-foot). This is a very common foot disorder that we see in
our practice. It can affect the bones and joints at the ball-of-the-foot.
Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and
4th metatarsal heads, or more isolated at the first metatarsal head (near
the big toe). The most common location is just the second metatarsal head.
The main symptom of metatarsalgia is pain in the ball of your foot — the
part of the sole just behind your toes. The pain may be sharp, aching or
burning, and you may feel it in the area around the second, third and fourth
toes or only near your big toe.
Other symptoms of
metatarsalgia include:
·
Pain that
gets worse when you stand, walk or run and that improves when you rest
·
Sharp or
shooting pain in your toes
·
Numbness or
tingling in your toes
·
Pain that
worsens when you flex your feet
·
A feeling in
your feet as if you're walking on pebbles or have a bruise from a stone
·
Increased
pain when you're walking barefoot, especially on a hard surface
Sometimes these symptoms
come on suddenly, especially if you've recently increased your usual amount
of running, jumping or other high-impact exercise, but problems are more
likely to develop over a period of months
With this common
foot condition, one or more of the metatarsal heads become painful and/or
inflamed, usually due to excessive pressure over a long period of time. It
is common to experience acute, recurrent, or chronic pain with
metatarsalgia. The most common complaint we hear all the time is that it
feels like walking on a small rock in the shoe. This happens when the
capsule around the joint gets inflamed and swollen and we walk on it.
Anything that
puts pressure or extra stress on the ball of our foot can cause this
condition. These include:
·
Being overweight
·
Wearing high heeled shoes
·
Digital deformities that create
retrograde pressure on the metatarsal head
·
Extremely high arched feet
·
An orthopedic condition where a
metatarsal is very long or declinated
·
Anterior ankle arthritis where
the foot can not be brought up into the ankle joint
·
Bunion deformities where big
toe is weakened and extra stress is put on ball of foot
·
Athletics where there is high
impact on the fore foot
·
Aging where the normal fat pad
on the bottom of the foot gets thinner
The first step in
treating metatarsalgia is to determine the cause of the pain. If it is
something obvious like improper fitting footwear, the footwear must be
changed. Footwear designed with a high, wide toe box (toe area) and a rocker
sole is ideal for treating metatarsalgia. The high, wide toe box allows the
foot to spread out while the rocker sole reduces stress on the
ball-of-the-foot.
Unloading
pressure to the ball-of-the-foot can be accomplished with a variety of
footcare products. Orthotics designed to relieve ball-of-foot pain usually
feature a metatarsal pad or a cut out under the affected metatarsal. The
orthotic is constructed with the pad placed behind the ball-of-the-foot to
relieve pressure and redistribute weight from the painful area to more
tolerant areas. Other products often recommended include gel metatarsal
cushions and metatarsal bandages.
Once we have
something in the shoe to try to prevent the excessive pressure and continual
injury then other modalities can be
used concurrently. These include OTC medications like Motrin of Aleve.
Sometimes a visit
to the podiatrist is indicated. X-rays can show if there is an orthopedic
condition causing the pain. They also
show us if the joint has gone through any changes. For the more painful
joints sometimes a small steroid injection can give relief. Most of the
time (90%) conservative care can give good long lasting relief. For the
occasional chronic condition that
doesn’t get better with conservative care and is painful everyday, there are
some surgical options that are very successful. |