If you’ve had pain in the bottom of your foot, you may be wondering about metatarsalgia vs plantar fasciitis. Which one could be causing your pain and discomfort?
Metatarsalgia and plantar fasciitis are two distinct foot conditions that affect different parts of the feet. While metatarsalgia is an umbrella term for a variety of specific conditions, plantar fasciitis is a very specific thing.
Let’s have a look at the differences between the two so you can figure out which one is more likely to be causing your pain, how to treat it effectively, and how to prevent it from occurring again.
What Is Metatarsalgia?
Metatarsalgia is when you experience pain, tenderness, and inflammation in the ball of your foot.
It may start as a mild discomfort just under the toes by the metatarsals. As the metatarsalgia develops, the pain will feel worse and you may find it difficult to walk, stand, or run.
When experiencing pain in the forefoot—metatarsalgia—the pain may be in just one or two toes or you may feel pain across the ball of your foot.
Metatarsalgia commonly affects the base of your 2nd toe, but it can also affect the 3rd and 4th toes.
It’s important to note that metatarsalgia is the medical phrase that’s used to describe the pain in your forefoot, but that pain is often a symptom of an underlying foot condition.
What Is Plantar Fasciitis?
Plantar fasciitis is a common reason people experience pain in the heel of your foot.
Your plantar fascia is a thick band of tissue that’s shaped like a bowstring that runs across the bottom of your foot. This thick tissue connects your heel bone to your toes and it supports the arch of your foot.
The plantar fascia plays a vital role in your foot mechanics when you walk, run, or jump. The thick band of tissues bears your body weight, absorbs shock, and prevents the arch of your foot from collapsing.
When the plantar fascia becomes irritated and inflamed, you may experience a dull pain at first. It also develops over time, with the pain increasing to sharp pain.
Symptoms of Metatarsalgia
The main symptom of metatarsalgia is pain that seems to affect your whole foot, but the worst of the pain is localized to the ball of your foot.
You may experience severe pain or it may be sharp, shooting pain, a dull ache, or burning pain. You may also experience a tingling sensation or numbness in your toes.
It can also feel as though you’re walking with a small stone in your shoe or like your sock bunched up under the ball of the foot.
Your forefoot will feel worse when pressure is placed on it and you’ll notice an increase in pain when you stand, walk—especially if you’re barefoot on a hard surface—or run.
The pain should improve when you rest your feet.
Symptoms of Plantar Fasciitis
The main symptom of plantar fasciitis is stabbing pain on the bottom of the heel or around your heel towards the bottom of your arch.
This pain is often the worst in the morning when you take your first few steps after awakening. You may notice that the pain increases if you’ve been sitting for a long time and get up.
You most likely won’t feel any pain during exercise, but the pain can get worse after you’ve stopped the activity.
Causes of Metatarsalgia
There are often several factors combined that can cause you to develop metatarsalgia, including:
Intense Training or Activity
High-impact activities that put your forefoot under pressure through repetitive motion can cause metatarsalgia.
In particular, distance runners are prone to developing metatarsalgia because of the significant force the foot absorbs as they run.
With that being said, if your job requires you to stand all day or spend a lot of time on your feet, this will place your forefoot under acute localized pressure. This can cause metatarsalgia to develop.
Certain Foot Shapes
Having either high arches or flat feet that put your metatarsal bones under excessive pressure can cause metatarsalgia.
You’re at an increased risk for developing metatarsalgia if your second toe is longer than your big toe. This is because more of your body weight is shifted onto the second metatarsal head, placing it under excessive pressure.
As you age, your feet begin to change shape, and the protective fatty layer in the ball of your foot becomes thinner—fat pad atrophy. This can make your metatarsal heads more prominent and place them under constant pressure.
Foot Deformities
Wearing shoes that are either too small, have a narrow toe box, or have high heels can cause your foot to become misshapen.
You can then develop other foot conditions, such as bunions or hammer toes, which will make you more prone to developing metatarsalgia.
Excess Weight
Your feet carry your entire body weight and when you walk or run, your body weight is transferred to your forefoot.
If you’re overweight or obese, this will place your metatarsal heads and bones under more pressure. This increases the risk of developing metatarsalgia.
Poorly Fitting Shoes
Wearing shoes that have a narrow toe box, are too small, or athletic shoes that don’t have adequate cushioning and support will contribute to the problem.
Metatarsalgia is also more common in women who wear high heel shoes, as your body weight is shifted to the front of your foot. This places your forefoot under acute and constant pressure, which eventually causes metatarsalgia.
Stress Fractures
Stress fractures may be caused by injuries sustained in sports or accidents, which can make your body shift in order to walk more comfortably.
This can distribute your weight unevenly, placing pressure on your metatarsals.
This can lead to the metatarsal heads being placed under constant pressure, which irritates the joints and causes inflammation and pain.
Medical Conditions
Some medical conditions that can result in metatarsalgia are:
- Morton’s neuroma
- Rheumatoid arthritis
- Gout
- Osteoarthritis
- Bursitis
Causes of Plantar Fasciitis
One of the main causes of plantar fasciitis is overuse, although in some cases there may be no direct cause.
But, similar to metatarsalgia, there are several factors that can cause you to develop the condition. These include:
Exercise
Activities like running, tennis, soccer, and volleyball can cause you to develop plantar fasciitis.
These activities place your feet under a lot of pressure, overstretch the sole of your foot, and make your calf muscles tighter.
You also increase your risk of developing the condition if you don’t stretch your feet and legs both before and after you exercise.
Lifestyle Changes
Your plantar fascia is designed to withstand a high amount of strain and absorb the shock of your foot strike.
But if you’ve recently increased how much walking, running, or standing you do—especially on hard surfaces—this would place too much pressure on the plantar fascia.
The extra strain can cause microtears in the tissue, causing inflammation which will lead to pain and stiffness of the heel.
Shoes
Wearing shoes that don’t provide adequate support or cushioning can lead to uneven weight distribution. This places your feet under excessive pressure and increases your risk of this condition.
You may also develop plantar fasciitis if your shoes don’t provide support and you spend a lot of time standing or walking on hard surfaces, like asphalt or concrete.
Women who wear high heel shoes and then switch to flat or running shoes are more prone to suffering from plantar fasciitis.
Weight
A person who is overweight or obese is more likely to develop plantar fasciitis due to the increased pressure placed on their feet.
The extra pounds will increase the load on the foot, which increases the tension in the plantar fascia, and this can cause inflammation.
Medical Conditions
There are medical conditions that can cause you to develop plantar fasciitis. These include:
- Rheumatoid arthritis
- Ankylosing spondylitis
- Lupus
- Reactive arthritis
Risk Factors of Metatarsalgia
Anyone can develop metatarsalgia, but you’re at a higher risk if you participate in high-impact sports like running, jumping, or playing tennis.
Wearing footwear that doesn’t fit properly, forces your toes into a tight space—like high heels—or very pointed shoes that are tight around the toes, will increase your risk of developing this condition.
Being overweight or obese will put your foot under excessive strain, and you will then have an increased risk of experiencing metatarsalgia.
If you have a pre-existing condition such as hammer toes, bunions, or a second toe is longer than your big toe, then you’re more likely to experience metatarsalgia.
Those who suffer from medical conditions such as gout or rheumatoid arthritis may experience metatarsalgia more frequently.
Risk Factors of Plantar Fasciitis
While plantar fasciitis can develop without a direct or obvious cause, there are several factors that can increase your risk of developing the condition.
As you get older, your feet will change shape as they widen and flatten with every step. It then becomes difficult for the plantar fascia to withstand the strain, support the arch, absorb shock, and help distribute your body weight.
This will lead to the plantar fascia becoming strained, inflamed, and irritated.
Your fat pad on your heel will become thinner and won’t be able to provide adequate protection for the foot. Without the padding, more stress is placed on the heel bone and the arch, which can cause inflammation and pain.
Sports that are high-impact, involve a lot of running—like long-distance running—or involve rapid changes in direction, such as soccer or basketball, strain the plantar fascia. This can cause microtears and increase your risk of further injury.
If you have flat feet, your risk of developing the condition will be higher, as the tendons and soft tissue in the feet are overstretched. This will cause inflammation and pain in your feet.
An abnormal walking pattern—gait cycle—will shift your body weight unnaturally, causing it to be unevenly distributed. This will place the plantar fascia under added stress.
Plantar fasciitis is more common in overweight or obese individuals, as a result of increased pressure on their feet.
Those who spend most of their working hours on hard surfaces, such as factory workers and teachers, may damage their plantar fascia.
Treatment of Metatarsalgia
Rest
One of the best things you can do for your feet when you have metatarsalgia is to let them rest.
After you’ve been walking or standing, elevate your foot, as this will help to relieve the pressure on your tendons, ligaments, and bones.
You may have to take a break from physical activities or switch them for low-impact exercises, such as swimming or cycling.
This will give your feet time to heal and protect them from further injury.
Ice
Wrap an ice pack in a towel—to protect your skin—and apply to the balls of your feet for 10 to 20 minutes several times a day.
Don’t use the ice pack for longer than 20 minutes at a time and raise your feet up for some elevation while you’re applying it.
Pain Reliever
Over-the-counter medications, like ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), or aspirin reduce the inflammatory process in the body and relieve pain.
Use Metatarsal Pads
Metatarsal pads can help to alleviate the painful symptoms of metatarsalgia, as they’re designed to support your foot and allow your toes to spread naturally.
The metatarsal pads are placed in your shoes and they absorb shock and reduce the pressure on the balls of your feet. These met pads add an extra layer of cushioning, which helps to protect your forefoot.
This can be very helpful if you’re going to be spending quite a bit of time on your feet or if you’re going to have an active day.
Treatment of Plantar Fasciitis
Physical Therapy
A physical therapist will help guide you through a number of exercises and stretches that will help improve strength and flexibility in your feet. They’ll tell you which exercises to do, and what to avoid if you have plantar fasciitis.
Most stretching exercises can be done easily whenever you have a few minutes to spare. It’s also one of the most effective ways to reduce pain and heal plantar fasciitis.
Strength exercises will help improve your flexibility and range of motion, which can help prevent plantar fasciitis in the future.
Night Splints
Your doctor or physical therapist may recommend that you wear a night splint when you go to bed.
Night splints will keep your feet at a 90-degree angle, while stretching your calf and the arch of your foot.
This prevents your plantar fascia and Achilles tendon from shortening while you sleep, which is the primary cause of the sharp heel pain first thing in the morning.
Orthotics
Your doctor may also recommend a quality pair of either off-the-shelf or custom-fitted orthotics.
Orthotics will support your arch, help distribute weight and pressure more evenly across your foot, and add an extra layer of protective cushioning.
Research has shown that insoles can significantly decrease pain, improve normal foot function, and reduce the painful symptoms of plantar fasciitis.
Recovery from Metatarsalgia
There are a number of factors that will influence your recovery time. These include age, health, weight, and if there’s been previous injuries to your foot.
If you started treatment early when you noticed pain or discomfort in your forefoot, then it could take a few days up to a few weeks for your foot to recover.
However, it usually takes between 6 and 8 weeks for metatarsalgia to improve overall.
With that being said, if you’ve had a stress fracture or undergone surgery, then it could take 3 to 4 months before you’re able to return to full activity.
Recovery from Plantar Fasciitis
Like metatarsalgia, there are a number of factors that come into play for your recovery from plantar fasciitis.
Your activity level and type, age, and weight can have an effect on how quickly you recover.
If you take action soon after noticing symptoms and make sure you’re wearing appropriate shoes or orthotics and begin using stretching exercises, then your plantar fasciitis symptoms may improve after a few weeks.
However, it can take between 6 and 18 months for your foot to heal properly.
If you have plantar fasciitis surgery, you will find that it takes between 6 and 10 weeks for you to recover well enough to be able to walk comfortably without help.
However, it can take up to 3 months before your foot is healed enough for you to resume rigorous activity or sports.
You will have physical therapy for about 4 weeks after surgery to strengthen the feet and improve flexibility.
Your physical therapist will provide you with exercises to do for the weeks to come.
Prevention of Metatarsalgia
Wear Proper Shoes
Choosing the right shoes or sandals for metatarsalgia can help to lower your chance of developing metatarsalgia. Make sure your toes have enough room to splay and they aren’t cramped.
You should also avoid high-heeled shoes or shoes with a high heel-to-toe drop. Choosing a shoe with a low drop or even a zero-drop shoe will help to relieve pressure on the forefoot and can prevent metatarsalgia from developing.
There should also be good cushioning in the forefoot to absorb shock and protect the metatarsal bones from impact.
Your shoes should also provide adequate arch support for your foot. Overpronators should use a stability shoe to keep their weight properly distributed and prevent metatarsalgia from developing.
Orthotic Devices
Consider using an orthotic device to provide better support for your feet. Some options include custom-made orthotics, store-bought insoles, arch supports, or metatarsal pads.
Most insoles will absorb shock and provide additional padding in the forefoot. They will also offer arch support to keep your foot properly aligned and distribute your body weight across the foot evenly.
Alternatively, you could use metatarsal pads—met pads or met domes. These are small pads that you place in the transverse arch, which is just behind your metatarsals. They help to spread the toes and reduce pressure on the metatarsal heads.
Try to use arch supports that fit your foot shape. This will provide the best support and help you to maintain your proper gait, allow for your foot’s natural alignment, and reduce pressure on your forefoot.
Prevention of Plantar Fasciitis
Maintain a Healthy Weight
The more weight you carry, the more pressure is placed on your plantar fascia. In order to prevent plantar fasciitis, you should maintain a healthy weight by eating a nutritious, calorie-controlled diet and getting regular exercise.
This will reduce the strain placed on your plantar fascia, which will allow it to heal and will also help to ensure that your body weight is evenly distributed across your feet.
Choose Supportive Shoes
The best shoes for plantar fasciitis have good arch support for your foot, thick cushioning in the heel, and excellent shock absorption. Try not to walk barefoot – instead sandals for plantar fasciits or flip flops for plantar are a better option.
Change Your Sport
If you participate in high-impact sports—running, basketball, tennis—you can reduce the strain on your plantar fascia by taking part in low-impact activities instead, such as cycling and swimming.
Stretch Your Arches
By doing simple arch exercises at home, you can strengthen your plantar fascia and the supporting muscles and tendons—Achilles tendon and calf muscles.
This will help to support and strengthen the plantar fascia and reduce your chances of developing pain or inflammation.
