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Metatarsalgia

Metatarsalgia is not an injury; it’s actually a symptom or a group of symptoms. These may include pain in the ball of the foot, with or without bruising, and inflamation. Metatarsalgia can have a number of causes and, as a result, a number of treatments.

What to look for:
Localized pain in the ball of the foot, on the bottom of the foot, in the area of the sole of the foot just before the toes. Metatarsalgia, the scientific name for this problem, is a painful but common occurrence. It is often localized in the metatarsal heads (the areas just before the second, third and fourth toes), or it may be more isolated, in the area near the big toe. One of the hallmarks of this disorder is pain in the ball of the foot during weight-bearing activities (running, walking, standing, etc.). Sharp or shooting pains in the toes also may be present, and pain in the toes and/or ball of the foot may increase when the toes are flexed. Accompanying symptoms may include tingling or numbness in the toes. It is common to experience acute, recurrent or chronic pain as a result of this problem. Some patients describe the feeling as being like “walking over pebbles, ” and others, whose pain is localized in one area, may wonder if they actually have a stone bruise.

Other notes:
There is no one specific cause of metatarsalgia. The podiatric community has narrowed it down to a handful of factors, all of which have a common denominator: a forced change of the dynamics of the foot. In plain English, that means the foot is not moving as it should, and as a result, one or more of the metatarsal heads has become painful, often because of inflammation. More specific information on the causes of metatarsalgia appears below.

What it means to you:
If you’ve noticed pain in your forefoot, which gets worse during walking, running or standing, and/or pain in your toes, particularly when flexing them, you have some of the classic symptoms of metatarsalgia. Another hallmark is increased pain when going barefoot, particularly when standing or walking on a hard surface like tile, concrete, marble or asphalt, as opposed to carpet or grass. You may notice that over time, you begin to adjust your stride to avoid putting pressure on the ball of the foot.

The good news is that while painful and annoying, metatarsalgia is generally treatable with conservative measures, particularly once the origin of the problem is identified.

What causes it?
Metatarsalgia develops when something changes or threatens the normal mechanics (working action) of the foot. Ultimately, this creates excessive pressure in the ball of the foot, and that leads to metatarsalgia. Some of the causes of metatarsalgia include:

  • Being overweight: Nobody likes to talk about it, but the plain truth is that the more weight is brought to bear on the foot, the greater the pressure is on the forefoot when taking a step. As men and women age, the fat pad in the foot tends to thin out, creating less cushioning and making them more susceptible to pain in the ball of the foot. Keeping body weight within a healthy range can decrease your chance of having metatarsalgia; if a case already exists, losing weight can lessen its severity. In many cases, weight loss alone can eliminate the symptoms entirely.
  • Wearing shoes that do not fit properly: Shoes with a narrow, tight toe box, or shoes that cause a great deal of pressure to be put on the ball of the foot (high heels, for example) are often the cause of metatarsalgia. Because such footwear inhibits the walking process and forces the wearer to alter his or her step to adjust to the shoe, the mechanics of the foot are compromised.
  • A bunion or arthritis in the big toe can weaken the big toe, and cause extra stress on the ball of the foot. This also can occur after surgery on the big toe, such as a bunionectomy, when the patient does not allow the foot to rest long enough before resuming normal activity; post-operative pain will often cause the patient to modify his or her stride, causing problems to the forefoot. (Note: A bunionectomy will not cause metatarsalgia; a too-short recuperative period, however, will).
  • Stress fractures of the metatarsal, or toe, bones often cause pain and force an individual to change their stride, thus bringing more pressure to the ball of the foot and stressing that area as well. (This is not uncommon among athletes such as runners, although they are not by any means the only ones who get stress fractures).
  • Certain foot shapes contribute to metatarsalgia, according to podiatric physicians. A high-arched foot, or a foot with an extra-long metatarsal bone can case pressure on the forefoot region and contribute to pain and inflammation there.
  • Claw toes or hammertoes can press the metatarsals toward the ground and cause stress on the ball of the foot.
  • Arthritis, gout or other inflammatory joint disorders can produce pain in the ball of the foot.
  • What else? Sometimes, a combination of the factors listed above will lead to metatarsalgia, and sometimes, the condition will appear with no apparent cause, to the frustration of patient and physician, since often a recurrence of the problem can be avoided by pinpointing the reason it developed in the first place.

Treatment
Some of the best treatments come from being proactive. Keep body weight at a healthy level, and stick to shoes that fit properly, particularly in the toe area. Avoid high heels whenever possible. A regular checkup with a podiatric physician who can assess other risk factors, such foot shape, also will allow you to take preventive measures.

If you have pain in the ball of your foot already, don’t panic. Treatment is generally conservative. However, it is imperative to have any foot problem checked by a podiatric physician. This healthcare professional can help you determine whether or not the problem is, in fact, metatarsalgia, since there are other problems which have similar symptoms but require different treatment.

Once your podiatric professional has diagnosed metatarsalgia, he or she will make recommendations based upon the severity of your condition. In many cases, he or she will want to know what factors in your daily routine may have contributed to the condition. Make sure you tell him or her whether your job requires a lot of standing or walking, what type of shoes you wear, what kind of exercise you do, and so forth. Let him or her know if you go barefoot often, and if you do, what surface your feet come into contact with as a result. Note: If you have diabetes , it is essential that you let your doctor know.

Assuming you have a routine case of metatarsalgia, with no complicating factors, such as diabetes, your podiatric physician generally will probably recommend one or more of the following measures, based upon your particular case of metatarsalgia:

  • Rest: Elevate your feet after periods of standing and walking. This will take pressure off the ball of the foot, and allow it to recover. Using an ice pack at the site of the pain for 20 minutes on, 20 minutes off, may provide additional relief.
  • Wearing appropriate footwear: Your podiatric physician will let you know whether you should change the type of shoes you wear.
  • Keeping body weight in a healthy range: Your general practitioner can help you determine whether you are overweight, and if so, can provide you with information on better dietary habits.
  • Exercising: The podiatric physician may recommend a regimen of exercises for your feet and/or ankles to build strength and flexibility
  • Non-steroidal anti-inflammatory medications or simple painkillers: Your podiatric physician can decide whether medication will help reduce your symptoms. Whether medication is necessary depends upon the patient, and upon the progression of the case. In cases of more severe inflammation and pain, the doctor may decide to utilize injectable steroids, which can treat the pain at its source.
  • Orthoses or other shoe inserts: If the podiatric physician feels the case warrants it, he or she may prescribe orthotic inserts, which can help align your foot inside your shoe. He or she may recommend an insert that can be purchased in a drugstore or shoe store instead. In some cases, a pad that allows some cushioning under the ball of the foot will be the doctor’s choice.
  • What else? Occasionally, if other factors are complicating the problem, such as hammertoes or a trapped or pinched nerve in the foot, the podiatric physician will recommend corrective surgery. However, it is important to note that the vast majority of patients are helped by the steps outlined above.

Who is most susceptible?
Metatarsalgia isn’t confined to one particular gender or age group, although it is women who wear high heels, and those types of shoes contribute significantly to the problem. However, athletes of either gender (this includes those “weekend warrior” types) who run, walk, play tennis, etc. in worn-out, too-tight or improper shoes can develop the problem, as can anyone who for, whatever reason, wears shoes that cause the forefoot to receive too much pressure. Remember that a lack of shoe cushioning also can play a role, so make sure athletic shoes, work shoes, and others are replaced according to the recommendation of your podiatric physician. (Note, too, that athletic shoes are activity-specific; in other words, tennis shoes are for tennis, not running, and so forth).

As previously mentioned, overweight individuals may find themselves more prone to pain in the ball of the foot; of course, having that pain in and of itself does not signify overweight. (Consult with a doctor to ascertain that you are within a healthy weight range, and ask for a sensible, medically-supervised dietary plan if you are not.)

How can they be prevented?
Controlling your weight and wearing proper footwear are important, as is letting yourself recover from injuries to your feet. If you find you have forefoot pain, back off on the exercise and try some rest, ice and so forth. And of course, have regular podiatric checkups to assess your risk factors. Don’t forget to see your podiatric physician at the first sign of foot pain or discomfort, and get a diagnosis and treatment plan before the problem has a chance to worsen.

Do these symptoms always mean metatarsalgia?
No – there are several problems with similar symptoms. Your podiatric professional knows how to diagnose and treat them, although treatment can vary, according to the specific problem. Using home remedies and waiting for the problem to go away on its own is not a good idea. After all, if your feet hurt, nothing else matters.