What is metatarsalgia?
Metatarsalgia is a general term that refers to pain and inflammation affecting the ball of your foot. It can be quite localised to one area or affect more than one of the joints.
The ball of your foot is known as your forefoot and is made up of 5 metatarsal bones connecting to the toes via the metatarsophalangeal joints (MTPJ). These joints provide anchors for many tendons and ligaments, with nerves, blood vessels and other soft tissues structures between each of the joints. Under the joints lies a thick fat pad that helps to cushion the joints.
Pain can be anything from sharp and stabbing to aching or burning and usually is worse with prolonged standing or walking, especially on hard surfaces or when barefoot.
What causes metatarsalgia?
There are many different causes of metatarsalgia, including:
- Certain foot shapes: High arched feet tend to load the forefoot more, causing higher pressure points over the joints. This can cause overload of these joints which can lead to pain and discomfort. Foot deformities such as bunions, hammer toe and claw toes can similarly cause over load to the joints in the ball of your foot and can cause metatarsalgia
- Plantar plate injury:
The plantar plate is a thickening of the joint capsule and ligaments that sit under each of the joints in the ball of your foot. Its role is to add additional support and protection to the joint, particularly when the forefoot is flexed during push-off. This structure can be injured when the joint is overloaded which may be the result of bunions, excessive pronation, variations in your metatarsal bone lengths, poor footwear or excessive activity e.g. walking or running. The extent of injury can be anything from a strain to a tear and even a full rupture.
Pain from a plantar plate injury is generally described as a localised pain under the affected joint and is worse when the toe is pulled upwards. It may also feel like you are walking on a marble or soft swelling due to the inflammation from the injury.
Correct diagnosis is important and is made with a combination of a thorough physical examination, sometimes confirmed with an ultrasound scan.
This is an important injury to diagnose and treat effectively as if it is left untreated, the joint can become so unstable that it may lead to deformities such as claw toe or hammer toe.
- Age As the foot ages, the fat pad under the ball of the foot becomes thinner, providing less cushioning. This can be a cause for metatarsalgia, particularly if the joints are also affected by osteoarthritis or rheumatoid arthritis
- Footwear Poor fitting footwear or footwear with inadequate cushioning or support can increase the load under the forefoot. In some cases dress shoes with high heels can cause metatarsalgia.
- Excessive exercise – metatarsalgia often develops in people who are engaged in prolonged walking or standing at work e.g. nurses, teachers, factory workers. Others may develop metatarsalgia if their training routine exposes the ball of the foot to repeated high pressures e.g running or jumping sports.
- Excessive body weight – Higher body weight places more pressure on the foot, making it even more important to use appropriate footwear and to protect the ball of the foot.
Metatarsalgia could also be attributed to conditions such as stress fractures, Morton’s neuroma, and bursitis.
How can metatarsalgia be treated?
Treating your forefoot pain involves making a clear diagnosis, then improving your pain by reducing inflammation, protecting the ball of the foot, stabilising the joints and improving foot function. Other contributing factors such as lifestyle factors may need to be considered. A tailored treatment programme may include :
- icing, massage and rest
- stretching and strengthening exercises
- padding and strapping
- computerised gait analysis to measure the pressure under the foot
- supportive, well-cushioned footwear
- arch supports or prescription orthoses with support and additional cushioning
- advice about your training.
At FootMotion, our podiatrists have many years of experience successfully managing metatarsalgia, so you don’t need to suffer any longer. Make an appointment TODAY and let us help you start your recovery.