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What is it?

Metatarsalgia is a term used to describe a painful foot condition in the area just before the small toes (more commonly referred to as the ball of the foot). The condition is characterized by pain and inflammation on the sole in the region of the metatarsal heads, which are the ends of the long bones in your foot. The joint capsule or tendons may also be inflamed.

The pain is generally aggravated by putting pressure (as in walking) through the ball of your foot. Metatarsalgia can affect anyone who spends significant time on their feet and frequently affects runners and other athletes who participate in high-impact sports. Although generally not considered a serious condition, the pain can sideline you whether you are an Olympic athlete or a weekend warrior.

Besides pain on the ball of your foot, other symptoms can include numbness and tingling in the toes, sharp pain that worsens when you flex your feet, and a feeling that you have a bruise in your foot or are walking on a stone.

How did I get it?

As with many conditions of the foot, metatarsalgia is commonly caused by improper function of the foot.  When your foot does not function properly (as in over pronation or flattening of your arch) too much weight is shifted to the 2nd, 3rd and 4th metatarsal heads. These smaller heads are not designed to take such repetitive excess loads, so they may inflame as in any overuse injury.

Other contributing factors can include: an increase in activity or training, excess weight, length of time one must be on their feet in a day, and poorly fitting shoes.

How is it treated?

The first step in the treatment of metatarsalgia is to determine the cause of your pain.  Different cases may require different treatments but your doctor is likely to recommend a conservative approach first including:

Anti-Inflammatory Agents:  These may include ice and oral anti-inflammatory medications.  These may provide some temporary relief from the pain of inflammation, but are not helpful in addressing the underlying cause of your condition.

Top image: Arch flattened   Bottom image: Arch restored

Exercises:  A regular calf stretching routine should be a part of any treatment regimen.

Footwear: Advice that focuses on taking the pressure off the metatarsals should also be followed. Unloading the pressure on the ball of the foot with a reduced heel height shoe may be helpful.

Injections: Depending on the cause of your metatarsal pain, this intervention may be considered. It involves the injection of a medication that blocks the transmission of pain through the nerves of your foot. Risks include permanent numbness in areas of your foot so be sure to discuss the indications and risks for this treatment with your doctor.

Surgery: In cases that do not respond to conservative measures, your doctor may recommend surgery. This may include realigning the bones of your feet. Parts of the bone may be removed and ligaments or tendons may be cut in an effort to reduce weight bearing on the metatarsal heads.  If you are considering surgery, talk to your doctor carefully about the benefits and risks.

Foot Orthotics: The right custom made orthotics will address your pain by correcting the cause of your foot dysfunction. A Sole Supports orthotic, unlike typical custom orthotics, is designed to completely support the corrected arch of your foot, determined by a unique way of capturing your optimal foot position. Abnormal joint stresses are reversed, allowing affected tissues to heal and normal joint function to be restored. In this way, Sole Supports provide both primary treatment and preventative care by restoring normal weight bearing function to your big toe and first metatarsal. When this is done, the cause of your pain is being addressed rather than just the symptoms.

What can I expect from treatment?

With a proper diagnosis, and a well-rounded treatment plan including orthotics, the prognosis is excellent. With Sole Supports foot orthotics, you can expect either a dramatic loss of pain within the first weeks of use or a more gradual reduction of symptoms, depending on how long the problem has existed, normal body weight or how well you follow other therapeutic regimens prescribed by us.

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