Metatarsalgia Treatment

Metatarsalgia Treatment & Symptoms

What Part of the Foot Affects Metatarsalgia?

Metatarsalgia is a medical term used to describe pain in the ball of the foot. The condition is treated as more of a symptom rather than a disease itself.

In Metatarsalgia, the pain specifically occurs between the metatarsals and phalanges, usually in the 2nd -4th metatarsal joints. The implication of Metatarsalgia is it limits the individual’s independence and mobility in performing daily activities.

What are The Causes of Metatarsalgia?

The causes of Metatarsalgia are due to high-impact sports, personal activities, and other health conditions that put a great amount of force and pressure on the feet.

Common culprits of Metatarsalgia include high arched foot, poorly fitting footwear, stress fractures, poor quality insoles, bunions from tight-fitting shoes, high-impact, repetitive activities, diabetes, and arthritis amongst others.

What Type of Pain Comes from Metatarsalgia?

Pain in Metatarsalgia is described as gradual, sharp and burning. The onset is not abrupt and the pain is often chronic.

When to Seek Medical Help?

A doctor determines the problem by ascertaining a health history, doing a physical assessment and performing diagnostic exams or tests. It must be mentioned that foot pain is a somewhat normal experience for everyone after a series of some activities or sports.

However, if you notice that the pain lasts for several days or does not improve following some modifications in your lifestyle or taking some relief, it is best to see a podiatrist, a doctor who is a specialist in foot problems.

What are the Signs or Symptoms to Watch Out For?

The symptoms of Metatarsalgia can range from moderate to severe and it is always helpful to have a full and more comprehensive understanding of Metatarsalgia, but the following are the most common symptoms:

  • Pain in the ball of the foot
  • Pain increasing during weight-bearing
  • Tenderness on the affected part
  • Pain during toe flexion (when toes are bent downwards)
  • Pain radiating to the big toe and its adjacent toes
  • Excessive calluses
  • Pain during walking or running
  • Numbness sensation of the toes
  • Increased pain when walking barefoot

One condition that has a similar condition to that of Metatarsalgia is Morton’s neuroma. A differential diagnosis of Metatarsalgia, Morton’s neuroma is also due to irritation of nerves. In addition to foot pain, individuals affected with Morton’s neuroma will also feel a tingling sensation in the toes.

How to Diagnose Metatarsalgia?

X-Rays, USD (ultrasound), and MRI are radiologic exams that help visualize the foot. Blood tests are also performed to rule out any underlying problems like gout. Laboratory work-ups include CBC and erythrocyte sedimentation rate.

Causes: Faulty Foot Mechanics

Most of the conditions in the ball of the foot are due to faulty foot mechanics. The big toe joint is designed to carry much of the body’s weight during “push off” when walking. When the big toe joint does not carry this weight, the load is transferred to the lesser Metatarsal Phalangeal joints (MPJs).

During the gait cycle (walking cycle), the foot must transfer the weight from the heel to the forefoot. The calf muscle contracts and helps push the foot off the ground and propel the body forward. When the Achilles tendon and calf muscles are tight, this causes the heel to rise early and the foot to rotate out, which increases the abnormal stress through the midfoot and increases abnormal pronation.

These forces contribute to midfoot collapse, the elevation of the first ray, and the transfer of weight to the lesser metatarsal phalangal joints (MPJs). Mouse over the image to the left to see a demonstration of midfoot collapse, elevation of the first ray, and resultant pressure transfer to the lesser metatarsals.

1. Metatarsalgia

Metatarsalgia is used as a catch-all term for pain in the ball of the foot. Although faulty foot mechanics are considered the most common reason for the development of pain in this area, trauma, infection, repetitive stress, arthritis, and previous foot surgery could also contribute to pain.

Pain is generally deep and dull with walking and occurs at the 2nd, 3rd, and 4th Metatarsal Phalangeal joints (MPJs).

2. Hammertoes

Hammertoes can be associated with Metatarsalgia. There is a retrograde force from the hammertoe, which pushes back on the metatarsal phalangeal joint.

This causes excess pressure and pain, and inflammation in the area.

The most common area for this is the 2nd toe joint. Hammertoes can contribute to 2nd metatarsal overload syndrome.

For those with more flexible feet, when the weight is transferred to the ball of the foot, the 1st metatarsal elevates more than usual and places a tremendous amount of force on the 2nd MPJ, as seen in the illustration above. This excess stress can result in callus development under the 2nd MPJ and pain and inflammation in the joint. The image to the right shows a common area of callus development.

The pain is generally dull and achy when sitting or standing and can be dull or sharp when walking. It is generally sharper during propulsion, the puff-off phase of gait.

At this point during walking, the most force and pressure are on the ball of the foot, and for those with flexible feet and hypermobility of their first ray, the body’s weight is placed on the 2nd MPJ.

3. Plantar Plate Tears

The plantar plate is a thick, fibrous structure at the base of each joint in the ball of the foot. The fibrous band stabilizes the toe, preventing elevation and rotation. When a tear of the plantar plate occurs, it causes instability, deviation of the toe, and pain and inflammation around the joint.

This condition is most common in the 2nd metatarsal phalangeal joint and results from faulty foot mechanics, hypermobility of the 1st ray, and chronic 2nd metatarsal overload.

Chronic overload causes repetitive microtrauma to the joint and surrounding tissues, especially the plantar plate. Traumatic injuries can cause plantar plate tears, but they are not as common as chronic, repetitive stress due to abnormal foot mechanics.

4. Sesamoiditis

Sesamoiditis is the pain and inflammation of two small bones under the big toe joint. These bones act like ball bearings in the foot and allow the big toe to glide up and down smoothly. These two small bones carry a significant amount of weight. When overstressed, they can become inflamed and painful.

This condition typically develops due to repetitive stress. It is common in dancers, sports with quick sprints, sports involving a squatting position (catchers in baseball), or sports with repetitive push on the ball of the foot, such as pitchers in softball. Individuals with high arch feet are more prone to developing this condition.

The pain is generally dull and achy when sitting and standing and sharp and sometimes stabbing when pushing off the great toe. Rest and ice tend to improve the pain, and walking, running, squatting, and pushing off aggravate the pain. Area of pain in sesamoiditis

5. Neuromas

A neuroma is an inflamed nerve that causes pain in the ball of the foot, which radiates to the third and fourth toes. The second and third toes are also commonly affected, which is called Morton’s Neuroma.

The pain is typically worst with standing and walking and relieved by rest. Walking in soft shoes, high-heeled shoes, narrow shoes, going up and down, and squatting will aggravate the condition.

Some will complain of deep achy pain, and others will complain of constant burning. It’s common to experience radiating pain, electrical pain, sharp shooting pain, or numbness. Some individuals feel as if they are walking on a lump, a ball, or a lamp cord; others complain of a “twang” in the ball of the foot.

Treatments for Ball of foot Pain

All of the foot conditions listed above have separate and specific treatments. But, some common treatments will benefit all people with pain in the ball of their foot.

1. Initial Treatment

When the foot injury is recent, the primary intervention for metatarsalgia is a cold compress or cold application. This is done for 15 minutes several times a day at intervals.

The cold application reduces swelling and inflammation in the area. Along with the cold application, there should be resting periods, not undertaking physical activities, and not putting so much weight on the foot. When relaxing or sleeping, it is best to elevate the affected area to reduce swelling formation.

2. Physical Therapy

Physical therapy is undertaken for restoration and recovery following a foot injury. Physical therapy will also strengthen the joints, muscles, and bones.

Other forms of conditioning and training during the process of healing should be encouraged such as swimming. Physical therapy may also entail the installation of orthotic devices to uphold normal muscle function.

3. Surgical Intervention

Surgery is the last resort for metatarsalgia and is only in the case of very serious foot problems where no relief can be found by simple methods. Nonetheless, when calluses or bunions have caused the injury, it is not obligatory to remove them entirely by means of surgery; scraping or debridement is the treatment of choice for them; however, to provide restoration of foot health, wearing supportive shoes with orthotics is a good consideration.

4. Medication

Taking medication, such as NSAIDs (Non-Steroidal Anti Inflammatory Drugs) can relieve any acute pain. Nevertheless, for chronic cases, steroid injections are given.

5. Wear Supportive Shoes

It is important to wear a rigid, supportive shoe with a wedge at the heel. This does not mean a “high heel” shoe, but a lift at the heel or wedge shoe about 1″ in height.

This helps distribute the pressure between the heel and the forefoot and decreases any stress on the calf muscles. Many of the foot problems listed above are worsened with soft, flexible shoes.

The shoe should only bend at the toe, not in the shoe’s middle. Hold the heel and place the toe area on the floor to test a shoe. Press down on the shoe. If it collapses, it is too flexible.

6. Calf Stretching

At first, it may not seem logical that stretching the calf muscles will help with pain in the ball of the foot, but after reading the information presented above, it should make more sense.

Stretching the calf will help decrease abnormal pronation, decrease the midfoot collapse and relieve the excess pressure on the ball of the foot. Calf stretching should be performed at least three times a day. Click here to view pictures of a daily sequence of calf stretches.

7. Padding

For Metatarsalgia and neuromas, metatarsal pads can be a very effective treatment. The pads help by distributing the pressure more evenly under the ball of the foot and taking pressure off the area of pain. One of the most common errors with this treatment is pad placement.

The pad is NOT placed under the area of pain. The pad is placed behind the ball of the foot, as seen in the picture of a HaPad Metatarsal Pad to the right. This is also helpful for neuromas because the pads spread the metatarsals, preventing rub and irritation of the inflamed nerve.

Padding can also be very effective for sesamoiditis—specific pads designed for off-loading the great toe joint help distribute pressure away from the 1st MPJ. The common pad designed for sesamoiditis is called a dancer’s pad. The pad obtained its name because sesamoiditis is common in dancers.

Dancers spend a tremendous amount of time on the ball of their feet and specifically their great toe joint. This pad can be fabricated out of felt or purchased. The pad can be placed on the foot, insert, or inside the shoe. Many podiatrists can design a removable and reusable dancer’s pad.

Preventative Measures

To put a stop to experiencing any foot injury, follow these simple preventive measures:

  • Choose footwear with the correct fit.
  • Wear footwear with adequate cushioning
  • Control weight
  • Avoid heels with very thin insoles

Any person who suffers metatarsalgia can find relief within weeks.

Nonetheless, overall recovery could still depend upon the duration and nature (or cause) of the injury. It must be stressed that before re-entering sports and strenuous activities, athletes should be completely healed and free from signs and symptoms.

Athletes must also be officially discharged by their physicians before returning to any type of sports activity.

Related read: How To Relieve Foot Pain From Standing All Day.

Summary

There is no “magic bullet” treatment for any of the conditions discussed here. Rest, ice, and anti-inflammatory medications may decrease pain and inflammation and may be appropriate treatments in addition to the solutions mentioned above. But, they are not addressing the cause of the problem.

Finding the cause of the problem by identifying the aggravating activity, poor quality shoes, and/or faulty foot mechanics and then addressing these problems will give better long-term results for problems in the ball of the foot.

If your symptoms do not improve within a few weeks, make sure to make an appointment with your podiatrist.