The metatarsal bones join the toes to the foot. Metatarsalgia affects the metatarsal heads, where the three middle toes meet the ball of the foot.
It most commonly affects the first metatarsal head, the ball of the foot just behind the big toe.
It is a common problem, especially among physically active people. High impact sports, such as running and jumping, increase the risk.
Sometimes, it can result from badly-fitting footwear or an underlying medical condition.
The severity of the pain can vary. It may affect just one or two toes, or sometimes the whole foot, or both feet.
Putting weight on the foot can worsen the pain, for example, when standing, walking, or running.
Signs and symptoms
Metatarsalgia causes pain at the ball of the foot.
Pain can range from mild to severe. It is usually more noticeable and unpleasant when the individual stands or moves.
There may be a burning or shooting pain, or a sharp aching, and there may be tingling or numbness in the toes. It can affect the area near the toes and the ball of the foot.
Pain may be worse on flexing the toes.
Symptoms usually develop slowly. However, they sometimes appear suddenly, especially if an increase in exercise puts strain on the feet, such as running or jumping.
Causes and risk factors
In the foot, there are small toe nerves between the metatarsal bones.
When the head of one metatarsal bone presses against another, the small nerve is caught between them and starts to become inflamed. This causes metatarsalgia.
Putting weight on the foot can worsen symptoms, because with each step the metatarsal bones rub together, increasing the inflammation of the nerve.
Causes include specific medical conditions and other factors, but it is only putting weigh on the food that causes the pain.
Factors that can contribute to metatarsalgia include:
- Footwear: Shoes that are too tight around the toes can cause pain, or high heels that add pressure to the ball of the foot as it is forced into a tight space.
- Being overweight: The excess weight can put strain on the foot.
- Age: The pad of fat that protects the foot can get thinner with age, leading to metatarsalgia.
- High impact exercise: Running or playing high impact sports increases the risk, as the feet absorb large amounts of force.
- Shape of the foot and toes: Having a high arch or a second toe that is longer than the big toe can add to the pressure.
- Stress fractures: Small breaks in the toe bones can cause pain when pressure is applied.
- Stiff ankle: This can add pressure to the metatarsal bones.
Some medical conditions that can cause metatarsalgia are:
- rheumatoid arthritis, with swollen joints in the foot, or gout
- diabetes if the small nerves in the foot can become irritated
- a buildup of fluid in the foot
A bunion is a painful, swollen, bump that occurs at the base of the big toe, weakening the toe, and increasing stress on the ball of the foot.
Bunions can develop if a person wears shoes that are too small, or they can be inherited. They are more common in women than men. This can lead to metatarsalgia.
Morton's neuroma is a growth of fibrous tissue around 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.
The patient may see a family doctor or go straight to an orthopedic surgeon or podiatrist, a specialist foot doctor.
The doctor will examine the patient's foot and ask the patient about:
- their medical history
- their lifestyle
- what type of footwear they use
- their hobbies
They will also ask about when the pain began, how often it occurs, when, and where, whether or not it is getting worse, and if there is pain elsewhere in the body.
The patient may be asked to walk on a treadmill or pressure plate to assess their gait. This can help identify which parts of the foot are receiving pressure.
There may also be tests.
Blood tests can detect possible underlying conditions such as gout, arthritis or diabetes.
Treatment will mainly focus on easing discomfort and pain.
This may include:
- applying ice to the area several times a day each time for 15 to 20 minutes. Ice should be wrapped to protect the skin
- using over-the-counter (OTC) anti-inflammatories, such as ibuprofen, will reduce inflammation and relieve the pain
- keeping pressure off the feet, and keeping the feet up when resting
Exercise strategies include:
- going swimming or cycling instead of doing high impact sports and exercise that puts pressure on the feet
- exercising the ankle and stretching the Achilles tendon
- using fitted insoles (orthotics), to reallocate pressure, improve foot function, and protect the ball of the foot
Strategies for supporting the foot include the use of metatarsal pads or a metatarsal bar to reduce pressure from the metatarsal bones, and shock-absorbing insoles or arch supports to relieve pressure when walking:
Wearing insoles can support the foot and reduce pain.
In more severe cases, a doctor may recommend:
- steroid injections to reduce pain and swelling
- surgery to reshape the metatarsal bones, relieve or remove a trapped or irritated nerve, or straighten a hammer toe, if there is one
Strategies to reduce the risk of developing metatarsalgia include wearing proper foot wear.
High-heeled shoes should be avoided. Shoes should not be too tight, and there should be adequate support and cushioning, preferably with a wide toe-box. Cushioned insoles can help prevent or relieve pain.
Maintaining a healthy bodyweight will reduce pressure on the feet.
People who are recovering from injuries should make sure they comply with doctor's recommendations regarding when to resume strenuous activity.
Not treating metatarsalgia, or returning too soon to activities, can lead to complications.
The pain can spread to other parts of the foot or elsewhere in the body, as the person adapts their gait to manage the pain.