Overview

Metatarsalgia is a broad term used to describe any pain and inflammation in and around the bones at the ball of the foot and can often include swelling around these joints. These bones and joints absorb our weight when we walk and move. If damaged or weakened, they can become painful and dysfunctional, causing discomfort and restricted movement.

Also commonly referred to as a “stone bruise”, it can be debilitating if left untreated. You may notice the pain appears gradually over several weeks.

Causes

Some of the more common causes of metatarsalgia include:

  • Overuse and repetitive stress from activities such as running and jumping, commonly seen in most sports and made worse when performed on hard surfaces.
  • Wearing high-heeled shoes and footwear that does not fit properly or support the foot appropriately.
  • Being overweight. The metatarsals absorb the weight of our body when we are on our feet. The heavier we are, the more weight these bones are forced to support.
  • Stiffness or limited movement in the ankle or Achilles tendon, causing the pressure of our body weight to be distributed unevenly across the foot.
  • Having a very high arch in the foot can place excessive pressure on the ball of the foot.
  • Morton’s Neuroma – a condition that affects one of the nerves running between the bones in the forefoot causing pain, numbness and tingling sensations between two of the toes of the foot.
  • Rheumatoid Arthritis
  • Fat pad atrophy (when the cushion under the forefoot reduces)
  • Bunions – when the 1st metatarsals deviates the lesser metatarsals take most of the load when walking causing pain

Symptoms

People with metatarsalgia are likely to experience pain around the area of the forefoot, particularly at the ball of the feet and toes. This has been described as feeling like you are walking on pebbles. Pain, general aching, burning or tingling sensations in the toes and tenderness of the forefoot area may increase when standing, walking and running. The general area at the ball of the foot will most likely feel tender when pressed.

Diagnosis

We can diagnose a case of metatarsalgia through patient history, a physical examination of the foot and a Biomechanical Assessment to study your range of movement. If there is any suspicion of a bony injury or condition, an X-ray may be requested. Otherwise an ultrasound will show soft tissue damage/injury e.g. bursitis, neuroma.

Treatment

Below is a selection of the methods Dan Everson Podiatry may recommend for patients suffering from metatarsalgia, depending on the cause:

  • Apply ice to the affected area for 15 – 20 minutes two or three times a day.
  • Use pain-relief medication.
  • Avoid running, jumping and other high impact exercises.
  • Rest your feet and keep them elevated as often as possible.
  • Wear shoes that fit well with a low heel. Kinetic Orthotics can be prescribed and inserted into your footwear to balance the foot and reduce stress on the metatarsals and forefoot.
  • Footwear that doesn’t put pressure on the neuroma

Prevention

Dan Everson Podiatry recommends the following steps to help prevent metatarsalgia:

  • Ensuring you have appropriate footwear that distributes your weight evenly across the foot is very important.
  • Massaging of the foot can be effective at the first sign of pain to relieve swelling pressure and increase blood flow to the area.
  • Orthotics may help prevent this condition.
  • Keeping your weight within a healthy range
  • Walking and running on flat surfaces as much as possible.

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