Pain in the ball of the foot can occur for a wide variety of different reasons.
Two possible reasons are metatarsalgia or a stress fracture. Or it could be something else. But we do recommend seeing a doctor if this kind of pain is affecting your everyday life.
If it’s metatarsalgia or a stress fracture, how do you tell the difference? One is much more serious, and should not be left untreated.
In this article, we compare the symptoms to help you get a better idea of which one you have. We also talk about the best way to treat each one.
Let’s have a look at the two conditions.
What Is Metatarsalgia?
Metatarsalgia is a blanket term that’s used to describe pain and inflammation in the ball of the foot. It’s not a specific condition on its own, but rather a symptom of an underlying condition.
Most often, metatarsalgia is a result of an overuse injury where excessive, localized pressure is placed on the forefoot.
High-impact sporting activities such as running and jumping can lead to you developing metatarsalgia.
Due to the persistent pressure placed on the forefoot, you may experience pain and inflammation underneath the metatarsal heads or around the metatarsal phalangeal joints.
Metatarsalgia can also develop due to abnormal weight distribution, unusual foot structure, and musculoskeletal stressors, such as overpronating, tight calves, or stiff Achilles tendons.
Wearing shoes that aren’t supportive, have a narrow toe box, or are ill-fitted can also lead to metatarsalgia.
Medical conditions such as Morton’s neuroma, capsulitis, arthritis, hammer toe, sesamoiditis, and bursitis can also cause metatarsalgia to develop in the forefoot.
Symptoms of Metatarsalgia
The pain of metatarsalgia develops gradually over time, and the pain should improve when you rest your feet. It will, however, feel worse when you stand, walk, or flex your foot.
The main symptom of metatarsalgia is a sharp, aching, or burning pain in the ball of your foot, which is commonly felt beneath your 2nd and 3rd metatarsal heads. But you may also feel pain around the metatarsal phalangeal joints.
You may also experience tingling or numbness in the toes. It may even feel like you have a pebble stuck in your shoe or like your sock has bunched up under the ball of your foot.
If you’re experiencing metatarsalgia, you should rest your foot as much as possible. You may have to limit any activities that cause pain or switch to a low-impact activity that doesn’t place pressure on your foot.
Apply ice to the painful area for 10 to 20 minutes several times a day. This will help reduce the swelling and alleviate the pain. Wrap the ice pack in a towel so that it doesn’t come into direct contact with your skin.
Elevate your foot while sitting or lying down by using pillows, so that your foot is above your heart level. This will help to reduce the swelling and is also an excellent time to apply ice.
You can use over-the-counter pain medication such as ibuprofen—Advil or Motrin—naproxen—Aleve—or acetaminophen—Tylenol—to alleviate pain, discomfort, and swelling.
Include strength and rehabilitation exercises into your daily routine. This will help correct muscle imbalances in the foot, restore normal foot function, help to alleviate pain, and reduce swelling.
Avoid wearing shoes that have a narrow or pointed toe box, and choose shoes that have a wide toe box. This will allow your toes to splay naturally, creating space between the metatarsal bones, which will reduce the pressure on the forefoot.
Your shoes should provide adequate support for your arch type and have plenty of cushioning. This will reduce the amount of shock that’s absorbed by the foot and make sure that your body weight is evenly distributed.
You can use either a metatarsal pad or an insole in your shoe to provide additional support. These orthotic devices can help to reduce the localized pressure on the forefoot, alleviate pain, and reduce swelling.
Maintaining a healthy weight can reduce the amount of pressure that’s placed on your feet by everyday activities, like walking, running, and standing. Studies have shown that excessive pressure is placed on your foot and can affect your mobility of you’re overweight or obese.
Once the pain and swelling have subsided, you can begin with your normal day-to-day activities once again. You should start slowly and gradually increase the intensity of your activities, paying attention to how your feet feel.
If there’s any pain or discomfort during or after your activity, then you should give your feet some more time to heal.
With that being said, if your metatarsalgia is complicated by other foot conditions such as bunions or hammertoe, then surgery may be the only option to realign the metatarsal bones.
What Is a (Metatarsal) Stress Fracture?
A metatarsal stress fracture is a small, incomplete crack—fracture—in one or more of the metatarsal bones. Stress fractures most commonly develop in the 2nd and 3rd metatarsal bones of the foot.
Stress fractures develop over time, and are often caused by overuse. Excessive pressure can be placed on the metatarsals through muscle fatigue or repetitive muscular forces being placed on the bones.
It’s a common overuse injury in people who take part in high-impact activities, such as running, basketball, gymnastics, and dancing. A sudden increase in frequency, intensity, and duration can also increase your risk of developing a stress fracture.
You may also be at an increased risk of developing stress fractures if you have flat feet or high, rigid arches.
Exercising or performing activities while wearing shoes that are worn out or that don’t provide the necessary support for your foot type will increase your risk.
Medical conditions such as diabetes, arthritis, or osteoporosis, where your bones are weakened, will increase your risk of stress fractures.
Symptoms of a Metatarsal Stress Fracture
If you have a stress fracture, you’ll have pain in the ball of the foot, especially during the push-off stage of walking or running. You’ll notice that the pain is located either in the front or towards the middle of your foot.
There will be a sharp pain in the forefoot, which gets worse when you try to walk or stand. Unlike metatarsalgia, the pain won’t go away when you rest your foot. Instead, it may be a constant aching pain throughout the day and night.
You’ll notice that there’s swelling across the top of your foot, with a specific tender spot on the bone. This tender spot will be where the fracture is located, and the pain will intensify if you press on the bones around this area.
Metatarsal Stress Fracture Treatment
While an early diagnosis of a stress fracture will prevent it from becoming a complete fracture, it may not show up on an X-ray until it starts to heal.
The best way to start treating a metatarsal stress fracture is to follow the R.I.C.E principle.
Rest your foot, and avoid any activities that cause pain or place your metatarsals under pressure.
Ice the top of your forefoot for 10 to 20 minutes several times a day to reduce the swelling.
You can also apply a compression bandage, as this helps reduce the swelling. Keep your foot elevated above your heart, as this will alleviate pain and reduce swelling.
For the first few weeks of your healing period—4 to 8 weeks—you may have to wear a walking boot or short walking cast.
This will allow the stress fracture to heal, while you’re able to walk comfortably without placing pressure on the forefoot.