Metatarsalgia, also known as stone bruise, is a type of pain and inflammation that occurs in a part of the foot known as the metatarsal (ball of foot). It often occurs in the metatarsal heads - where the three middle toes meet the ball of the foot. It is a common problem which can affect the bones and joints of the metatarsals.
Most commonly, the first metatarsal head is affected - the ball of the foot just behind the big toe.
A lot of physically active people suffer from this condition as it can be caused by high impact of the foot which is a product of running, jumping etc. Sometimes, the condition can be caused by badly-fitting footwear, or even an underlying medical condition.
The severity of the pain can vary and may affect just one or two toes - sometimes the whole foot or even both feet might be affected. Metatarsalgia can worsen when weight is put on the foot, as may be the case when standing, walking, or running.
Metatarsalgia can affect males and females of all ages, but is most common in middle aged females.
Although the condition is not considered as serious or life-threatening in any way, the patient may be sidelined by it. Fortunately, symptoms usually respond well to plenty of rest, the application of ice, and some other conservative treatments.
What causes metatarsalgia?
Metatarsal bones are a group of five longer bones in the foot.
In the foot there are small toe nerves between the metatarsal bones. When the head of one metatarsal bone is pressed against another, the small nerve is caught between them and starts to become inflamed, thus causing metatarsalgia.
The condition can worsen as weight is put on the foot, because with each step the metatarsal bones rub together more and more, which causes the inflammation of the nerve to increase.
There are many things that can cause metatarsalgia, such as particular medical conditions; however, the pain can be brought on by anything that puts too much stress on the ball of the foot.
Any of the below can cause metatarsalgia or contribute towards it:
- Footwear that doesn't fit properly - footwear that is tight around the toes or has high heels that can add pressure on the ball of the foot as it is forced into a tight space.
- Being overweight - overweight people may suffer this pain as the excess weight can put strain on the foot.
- Age - the pad of fat that protects the foot can get thinner as a person ages; metatarsalgia can subsequently develop as the foot has less protection from the strain of impact and load.
- High impact exercise - people who run or play high impact sports are at risk of metatarsalgia. When we are running our feet absorb large amounts of force.
- Shape of the foot and toes - having a high arch in your foot or a second toe longer than the big toe can add to the pressure on the metatarsals.
- Stress fractures - these are small breaks in the toe bones or metatarsals. They can cause pain when weight is put on the foot - the individual compensates by changing the way they put weight on his/her foot.
Medical conditions that can cause Metatarsalgia:
- Bunion - this is a painful swollen bump that occurs at the base of the big toe. It weakens the big toe, which results in increased stress on the ball of the foot. This condition can be caused by wearing shoes that are too small, or can be inherited. It is more common in women than men.
- Rheumatoid Arthritis - swelled joints in the foot, or gout can cause Metatarsalgia.
- Build up of fluid in the foot.
- Morton's neuroma - this is a growth of fibrous tissue of one of the nerves between the metatarsal heads. Morton's neuroma has very similar symptoms to Metatarsalgia and can cause further stress to the metatarsals.
- Diabetes - the small nerves in the foot can become irritated, thus causing Metatarsalgia.
Signs and symptoms of metatarsalgia
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
Symptoms of pain can range from mild to severe, and usually become more noticeable and unpleasant when the individual stands of moves. Some describe it as a burning sensation, while others complain of shooting pain, tingling or numbness in their toes. "It is like walking on pebbles."
Common symptoms of metatarsalgia:
- A burning pain
- Sharp aching
- Pain in the ball of the foot, this is the metatarsal region, which is just behind the toes
- Pain that can occur near the toes
- Pain that increases when walking in bare feet, and even more so when walking on a hard surface
- Pain that worsens when standing or moving around but decreases when the weight is taken off the feet.
- Shooting pain in the toes
- Tingling sensation in the toes
These symptoms usually develop slowly, however they may sometimes develop abruptly. Especially if there is an increase in exercise that may put strain on the feet, such as running or jumping.
Who is most at risk of developing metatarsalgia?
- People who wear high heels or shoes that don't fit properly
- Individuals with foot problems
- Obese or overweight patients
- Athletes or people who partake in high impact sports
Complications of metatarsalgia
If left untreated Metatarsalgia can cause:
- The pain to spread to other parts of the foot or even the other foot.
- Pain somewhere else on the body due to limping caused by the foot pain.
On the next page we look at how metatarsalgia is diagnosed, how it can be prevented and the treatment options for metatarsalgia.