What is Metatarsalgia?

Metatarsalgia refers to pain and inflammation in the ball of the foot, specifically around the metatarsal heads—the bones that connect the toes to the midfoot. This condition often develops gradually and can affect one or more metatarsal heads.

Causes of Metatarsalgia:

1. High-Impact Activities: Engaging in high-impact sports or activities that involve running and jumping can put excessive pressure on the metatarsal heads, leading to inflammation and pain.
2. Foot Structure: Certain foot shapes, such as having a high arch or a second toe longer than the big toe (Morton’s toe), can predispose individuals to metatarsalgia.
3. Fitting Footwear: Wearing shoes that are too tight, narrow, or have inadequate cushioning can increase pressure on the forefoot, contributing to metatarsal pain.
4. Foot Deformities: Conditions like bunions, hammertoes, or rheumatoid arthritis can alter the distribution of weight on the forefoot, leading to metatarsalgia.
5. Overuse or Stress Fractures: Repetitive stress on the metatarsal bones, commonly seen in athletes or individuals who stand for prolonged periods, can result in stress fractures and subsequent metatarsalgia.

Symptoms of Metatarsalgia:

1. Pain and Discomfort: Patients often describe a burning or aching sensation in the ball of the foot, which may worsen with activity or when wearing certain footwear.
2. Swelling and Inflammation: Inflamed metatarsal heads can lead to swelling and tenderness in the affected area.
3. Difficulty Walking: The pain associated with metatarsalgia may cause difficulty walking or standing for extended periods, impacting daily activities.

Treatment Options:

1. Footwear Modification: Encourage patients to wear supportive shoes with a wide toe box and ample cushioning to reduce pressure on the forefoot.
2. Orthotic Inserts: Custom foot orthotic inserts can help redistribute weight evenly across the foot, relieving pressure on the metatarsal heads.
3. Padding: Padding the ball of the foot to offload pressure can provide symptomatic relief.
4. Physical Therapy: Stretching and strengthening exercises prescribed by a physical therapist can improve foot mechanics and alleviate symptoms.
5. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce pain and inflammation in acute cases. Alternatively, corticosteroid injections can be used to help decrease inflammation.
6. Surgical Intervention: In severe or refractory cases of metatarsalgia, surgical procedures such as metatarsal osteotomy or neuroma excision may be considered to realign the metatarsal heads or release compressed nerves.