Metatarsalgia: Symptoms, Causes, Diagnosis, Treatment
Metatarsalgia Symptoms
The primary symptom of metatarsalgia is pain in the ball of the foot, near the toes. This pain may feel sharp, dull, or burning. It can also create a sensation like stepping on a pebble and often worsens with walking or running. Tingling or numbness in the toes may also occur. Athletes engaged in high-impact activities, especially those with inflammatory conditions like bursitis, may experience more widespread pain in the ball and middle of the foot. Typically, the pain develops gradually over several months.
Causes of Metatarsalgia
Metatarsalgia pain results from excessive pressure on a specific area of the foot. This is often caused by the impact from high-impact sports, but unique bone or muscle structures affecting pressure distribution can also contribute, including:
- A short first metatarsal or long second metatarsal
- Prominent metatarsal heads
- Tight toe extensor muscles or weak toe flexors
- Hammertoe deformity
- Hypermobile first foot bone
- Tight Achilles tendon
Other causes include:
- Excessive pronation (side-to-side foot motion)
- Ill-fitting shoes
- Excess weight
- Stress fractures
- Bunions
- Torn ligaments
- Morton’s neuroma, which involves tissue buildup around a nerve, typically between the third and fourth toes, causing pain and numbness in the forefoot.
Metatarsalgia Risk Factors
In the U.S., forefoot injuries like metatarsalgia are common in athletes who engage in sports involving running or jumping. High-risk groups include track runners and other athletes like tennis, soccer, baseball, and football players. Other risk factors include:
- High arches
- Wearing high heels
- Conditions that cause joint inflammation, such as osteoarthritis, rheumatoid arthritis, or gout
- Age, as the foot’s fat pad thins over time
Diagnosing Metatarsalgia
To diagnose metatarsalgia, X-rays may be used to exclude other sources of foot pain. A bone scan can identify inflammation spots, and ultrasound can detect issues like bursitis or Morton’s neuroma. An MRI may also be needed to assess trauma, circulatory problems, arthritis, nerve issues, or biomechanical imbalances.
Treating Metatarsalgia
There are several options for treating metatarsalgia.
Medical Treatment
To alleviate pain, doctors may recommend:
- Staying off the foot and avoiding high-impact activities temporarily
- Applying ice to the affected area (try rolling the foot over a frozen water bottle)
- Using a pressure bandage
- Wearing cushioned pads, arch supports, or other orthotics
- Doing gentle stretching and strengthening exercises
- Removing any callus buildup on the painful spot to reduce pressure
Surgery may be required for bone issues or to relieve a pinched nerve.
Medication
Over-the-counter NSAIDs like ibuprofen or naproxen may provide short-term pain relief. If a pinched nerve is involved, a nerve block combined with steroids might be used.
Recovery
Once pain subsides, gradually increase stretching and strengthening exercises. Reintroduce low-impact activities first, such as swimming.
Complications of Metatarsalgia
Untreated metatarsalgia can lead to altered walking patterns to avoid pressure on the painful area, potentially causing pain elsewhere in the foot, other foot, lower back, or hips, and may even lead to hammertoe.
Metatarsalgia Prognosis
Most individuals recover fully from metatarsalgia with treatment, but it’s essential to understand the cause and take preventive steps to avoid recurrence.
Preventing Re-injury
Caring for your feet can help prevent future metatarsalgia episodes:
- Wear properly fitting shoes, and replace athletic shoes frequently.
- Avoid high heels.
- Use pads, arch supports, or other orthotics as recommended.
- Prevent callus buildup by soaking your feet and gently rubbing them with a pumice stone.
- Maintain a healthy weight.
- Gradually increase the intensity of athletic activities.
- Always stretch and warm up before exercise.
