Metatarsalgia

Metatarsalgia is the name for pain in the ball of your foot. It is typically associated with inflammation along the metatarsal bones which run along the length of your feet towards your toes. This is a common condition and may be experienced when you walk, jump or exercise which can exert excess pressure on the foot. Metatarsalgia is a symptom and not a diagnosis, so your specialist will need to assess you to identify the cause before treatment can be recommended.

Risk factors for metatarsalgia

• Intense activity: This can be a common condition among long-distance runners, due to the constant stress put through the balls of the feet.
• Ill-fitting footwear: Shoes that push your toes together may cause pain. High-heeled shoes also put extra pressure on the balls of your feet.
• Foot shape: High foot arches and irregular-length toes can make people more likely to experience metatarsalgia.
• Excess weight: Carrying extra weight adds to the pressure that goes through your feet.

Causes of metatarsalgia

The causes of metatarsalgia are typically split into two categories.

Primary metatarsalgia

This is when an issue with the metatarsals in your foot is directly causing you discomfort. Some common examples of primary metatarsalgia are:

• Calluses: If hard skin forms on your feet, it can result in pain and affect the way you walk. If this adds pressure to the balls of your feet, metatarsalgia may develop.
• Bunions: A bunion is a lump of bone that forms at the bottom of your big toe, often as a result of long-term pressure moving it towards the rest of your toes. As your toes move out of alignment, the pressure can cause pain across the balls of your feet.
• Foot shape: High foot arches can result in added pressure on the balls of your feet, while having a second toe bigger than your first toe also may create an imbalance across your metatarsals.
• Hammertoes: A deformity of the toes where they are rigidly bent. This may cause your metatarsals to move closer to the bottom of your foot, resulting in pain and discomfort.

Secondary metatarsalgia

Secondary metatarsalgia refers to pain and discomfort that is caused as a result of an underlying condition or trauma.

• Injury: Inflammation of the metatarsals may happen as a result of extended strenuous activity such as running or jumping.
• Diseases: Diabetes can result in nerve damage in the feet and cause conditions such as metatarsalgia. 
• Conditions: 

o Obesity is a condition that can be an underlying cause of foot conditions as increased body mass puts extra strain on the feet. 

o Rheumatoid arthritis can cause swelling and pain in your feet. 

o Morton's neuroma is an inflammatory condition of the nerves between toes that can cause metatarsalgia.

Metatarsalgia diagnosis

Metatarsalgia is typically diagnosed following a physical exam of your affected foot. Your consultant will discuss your symptoms with you to help make a diagnosis. They will take a history of your activity levels and look at your biomechanical alignment as well as your shoe wear.

You may be offered an X-ray, an Ultrasound scan or an MRI scan to get to the bottom of your issue if clinical tests are inconclusive, or to rule out certain conditions such as stress fractures or bone spurs that could cause similar discomfort.

Common diagnoses that follow metatarsalgia

• Sprains and strains: Stretching or tearing the ligaments, tendons or muscles in your foot.
• Bursitis: This is when small fluid-filled sacs near ligaments called bursae swell and increase the pressure in the surrounding area.
• Arthritis: Damage to the cartilage in the joints of your foot, either due to wear and tear (osteoarthritis) or chronic disease (rheumatoid arthritis).
• Morton's neuroma: Nerves between your toes can become irritated and inflamed. This condition is often treated with Morton's neuroma surgery.
• Bunions: A deformity of the big toe that pushes it towards the other toes and a bony lump appears on the outside of your foot.
• Stress fractures: Small breakages in bones can alter your walking style, putting excess pressure on areas of the foot.

Metatarsalgia treatment options

Metatarsal pain relief is usually achievable with anti-inflammatory medication such as ibuprofen and aspirin or by resting and applying ice to the affected area.

Certain exercises like calf stretches and ankle extensions can help, as can wearing shoes with more room for your feet, a lower heel or foot inserts for metatarsalgia added. 

Although rare, you may be recommended to undergo foot surgery for metatarsalgia if conservative treatment does not help or you have an underlying condition.

An osteotomy could relieve symptoms if your metatarsals' alignment is irregular. This involves cutting part of your bone to reshape and realign them before they are held in place with screws.

Morton's neuroma surgery or bunion surgery may be suggested to treat their related conditions and ease metatarsalgia as a result.

Preventing Metatarsalgia

It may be possible to stop some cases of metatarsalgia developing or preventing symptoms from becoming severe.

• Wearing sturdy shoes with extra room for your toes stops them from being pushed into unnatural positions. Low heels or special insoles can also provide additional support.
• If long-distance running is part of your fitness routine, taking time to rest and letting your feet recover may limit inflammation.
• Calluses can be caused by metatarsalgia, but removing them may make walking more comfortable.
• Maintaining a healthy weight means putting less pressure through the balls of your feet as you walk.