Metatarsalgia can be a painful condition that might prevent you from taking part in your usual activities.
But the good news is that there are steps you can take towards improving your foot pain.
Understanding how to cure metatarsalgia could be the difference between being in pain and being pain-free.
We’re sharing information and offering advice in this guide to dealing with ball-of-foot pain.
What is Metatarsalgia?
Metatarsalgia is a “catch-all” phrase— the medical term— for the pain in the ball of the foot. There are five metatarsal bones in the foot and these not only connect the ankle bones to the toes, but they provide structure to the foot.
The metatarsal bones are essential to stand and walk, as they support your body weight. They are the last bones to leave the ground when we walk or run, as they propel us forward.
When experiencing pain in the forefoot—metatarsalgia—the pain can be in just one or two toes or one may feel pain across the ball of their foot. The ache can vary from mild to severe and it can interfere with daily activities.
Metatarsalgia develops over time and most often affects the base of the second toe. However, metatarsalgia can also affect the base of the third and fourth toes. You may find that one or both of your feet are affected by metatarsalgia and it can feel worse when standing, walking or when you flex your toes.
Symptoms
Tenderness or pain that extends across the forefoot pad—ball of the foot—and that can feel worse when pressure is placed on it or when walking, is often the main symptom of metatarsalgia.
The pain can be mild or severe. It could feel like a sharp, shooting pain, a dull ache or you may even experience a burning sensation in the ball of the foot.
You could also experience a tingling sensation or numbness in your toes. Some people may have swelling on the top of their foot going into the toes.
But with that being said, not everyone will have swelling. When wearing socks and shoes, there can be severe discomfort and you may feel as though there’s a pebble in your shoe or that the sock has bunched up under the ball of the foot.
You may notice that the pain increases when you need to walk, when you stand or when you’re taking part in physical activities that impact the forefoot, like running. Calluses may form on the ball of your foot.
Metatarsalgia pain develops over several months, rather than developing overnight.
Metatarsalgia Causes
The pain of metatarsalgia often occurs when the metatarsals are placed under constant, localized pressure.
This can be from uneven body weight distribution due to muscle imbalances, bone abnormalities, or the repetitive impact on the feet during high-impact sports.
It’s quite common for people to have a long second metatarsal bone—second toe—that extends past their big toe.
This can make you more prone to developing metatarsalgia. But metatarsalgia can also be caused by other foot conditions, such as hammer toes, bunions, or if you have prominent metatarsal heads.
People may be at a higher risk of developing metatarsalgia if they have high arches, tight Achilles tendons, hypermobile first ray, tight toe extensors, or weak toe flexors.
Our feet change shape as we age and we start to lose the protective, fatty layer in the ball of the foot. This can lead to the metatarsal heads being placed under constant pressure, which irritates the joints and causes inflammation and pain.
Metatarsalgia can be caused by wearing ill-fitting shoes, shoes that have a narrow toe box, or that don’t provide adequate support. These can all place the metatarsals under constant pressure and can cause you to shift your body weight, which then gets distributed unevenly.
Most often, women who wear high-heels shoes will develop metatarsalgia, as the heels shift your body weight onto the ball of the foot. Over time, the metatarsal becomes inflamed from the localized pressure that’s placed on the forefoot.
People who have excessive pronation are at risk of metatarsalgia and the transverse arch collapsing, as the pronation places the metatarsal under excessive pressure. This weakens the foot structure and will lead to pain in the forefoot.
Our feet are constantly under pressure and being overweight or obese can place excessive pressure on the metatarsals. This increases the risk of developing metatarsalgia.
Injuries from sports or accidents can cause stress fractures in the toes or metatarsals. This can cause you to shift your body weight and distribute it unevenly, which places the metatarsal under pressure.
You can develop metatarsalgia due to other health conditions such as gout, bursitis, rheumatoid arthritis, or Morton’s Neuroma.
Who’s at Risk?
People who spend a lot of time on their feet where the pressure is localized to their forefoot or who take part in high-impact sports such as running are more likely to experience metatarsalgia.
If you have a foot condition such as hammer toes, bunions, high arches, or where the second toe is longer than the big toe, you are at a higher risk of developing metatarsalgia. Those who suffer from medical conditions such as gout or rheumatoid arthritis may experience metatarsalgia more frequently.
People who are overweight or obese have a high risk of od developing and experiencing metatarsalgia, due to the amount of pressure placed on the metatarsals.
If you wear high-heel shoes or ill-fitting shoes—shoes with a narrow toe box—this can increase your risk of developing metatarsalgia.
Metatarsalgia Diagnosis
Your doctor will examine your foot, either while you sit or stand, and they’ll ask detailed questions about your activity level, prior injuries to the foot, and your lifestyle.
They may recommend an x-ray so that they can rule out stress fractures or other conditions that may be causing the pain.
An ultrasound can be done on the foot, as this would help to rule out conditions such as Morton’s Neuroma, bursitis, and sesamoiditis, which can cause inflammation in the foot and cause pain in the forefoot.
Your doctor may even recommend an MRI to rule out circulatory conditions, neuropathy, arthritis, and other possible conditions that could cause imbalances.
Metatarsalgia Prevention
Fortunately, there are steps you can take to prevent metatarsalgia. One of the first steps you can take is to look at the type of shoes you’re wearing.
Make sure that you get shoes for metatarsalgia that fit your foot and have at least a thumb’s width of space between your longest toe and the front of the shoe. The shoes should have a wide toe box so that your toes can splay naturally and there should be a low heel.
Try to avoid wearing high heels. This will prevent your foot from shifting in the shoe and placing pressure on the ball of your foot.
If you run often, then make sure that you swap out your running shoes. When you start to feel that the shock absorbing cushioning of the shoe is no longer responsive or it feels flat, it’s time for new shoes.
If you are outside in warm weather, make sure you wear sandals for metatarsalgia that are cushioned and supportive. In contrast, good socks can help in cold weather and indoor slippers for metatarsalgia.
By using shoes that don’t adequately support your foot, you’re opening yourself up to injuries, metatarsalgia, and other foot conditions.
Look at using orthotic products to support your feet, such as met pads, prescribed orthotics, arch supports, even orthotic sandals.
You can also look at using shock-absorbing insoles that provide additional padding for the foot and that reduces the impact on your foot. Most insoles will have arch support and this will help realign the foot and distribute your body weight evenly.
If you don’t like the idea of using insoles, then you could try metatarsal pads—also known as met domes. These are smaller and are placed in the transverse arch—just behind the ball of your foot—where they can support and reduce the amount of pressure on the metatarsal heads.
At night, you could try using bunion splints as these wrap around your foot to align your toes to their natural position. This can provide support overnight—they can’t be worn with shoes—which can help to reduce or alleviate metatarsalgia.
If you have flat arches or high arches, try using arch supports that fit the shape of your foot. This will encourage a healthy gait, allow your foot to move in a natural way and evenly distribute your weight, which will reduce the pressure on the metatarsals.
You may have to make some lifestyle changes to prevent metatarsalgia. If you are overweight, then shedding some of those excess pounds will help reduce the amount of pressure that’s placed on your joints, as well as your feet.
Make sure that you warm-up and stretch before doing any physical or athletic activity. Gradually increase the amount of time and intensity of your workouts. This will allow you to pay attention to how your body feels and reacts to the activity, which can reduce the risk of injury as well.
If you’ve noticed calluses on the ball of your foot, try soaking your feet and then using a pumice stone to remove them.
You should avoid walking barefoot, especially over hard surfaces like tiles. Instead, use slippers around the house. This will protect your feet, especially if you have prominent metatarsal heads. Make sure to buy the right size, especially if you have narrow feet.
To help manage and alleviate the pain of metatarsalgia, nonsteroidal anti-inflammatory drugs such as ibuprofen—Motrin, Nuprin or Advil—or naproxen—Aleve or Naprosyn can be used.
Recovery
Once the pain of metatarsalgia has gone and you’re able to put pressure on your foot without any symptoms, then you can gradually get back to your normal activity.
You can increase your strengthening and stretching exercises, or you could try doing low-impact exercises such as swimming, cycling, or taking a walk.
How to Self-Treat Metatarsalgia:
By stretching and strengthening key muscles, you can treat metatarsalgia while at home.
If you’re already experiencing it, then strength-building exercises can help to alleviate the pain. The parts of the body to focus on are the ankles and toes, calf muscles, and Achilles’s tendons.
This will help to correct muscle imbalances, as well as strengthen both the foot and ankle muscles. This will reduce the amount of strain that’s placed on the metatarsals and the plantar fascia.
You can do the following few stretches and exercises, as these focus on the toes, ankles, Achilles tendons, and calf muscles.
- Calf stretches
- Ankle flexion stretch
- Towel curls
