Metatarsalgia

Metatarsalgia is a condition in which increased pressure under the metatarsal bones (ball of the foot) cause pain. Numerous reasons for this condition exist and treatments should address the patient's specific foot type and presenting complaints. If conservative treatment options fail to provide pain relief, surgical options may then be considered.

Do you have pain under the ball of your foot? The "ball of your foot" corresponds to the area where the long bones (metatarsals) of your foot join with the toes (phalanges). As you walk, the joints in the ball of the foot are under up to three times your body weight during the push-off phase of walking. Normal pressure loads on the bottom of the foot are distributed from the heel to the front of the foot as it contacts the ground.

Metatarsalgia is typically the result of an increased pressure under the metatarsals. There are multiple reasons why this can occur, including:

• A long or short metatarsal can create an abnormal metatarsal head parabola. A normal metatarsal parabola is needed for the foot to transfer weight from the outside of the foot to the inside of the foot during toe-off.
• A plantar callous or intractable plantar keratosis may form under the metatarsal head; clinical findings suggest significant pressure distribution to the specific area.
• Patients with a high arch (cavus foot) may be more prone to develop abnormally high pressures beneath the metatarsal heads. This is because the entire bottom aspect of the foot does not contact the ground and evenly distribute pressure.
• Hammertoes may also create increased pressure on the associated joints throughout the ball of the foot. The worse the hammertoe contractures, the greater the pressure, due to the toes being essentially "on top of" the foot pushing down.

In addition, systemic conditions, such as arthritis in the joints of the ball of the foot or diabetes can lead to painful walking. Obese patients are obviously more likely to have excessive plantar foot pressures. Stress fractures, enlarged bones or neuromas are other possible reasons for pain at this area of the foot.

Pain beneath the ball of the foot can vary in severity from mild to severe. The pain can be sharp and shooting, dull and aching or burning. These sensations can be focused in one specific area or may be diffuse over multiple metatarsal heads. These symptoms most commonly occur under the first and/or second metatarsal heads (toward the inside of the foot). Painful symptoms can be localized or can radiate up the leg or down to the toes. Pain is generally worse with weight bearing and while being barefoot. You may feel as if you are walking on a pebble and standing on your toes often results in increased symptoms.

Proper diagnosis and recognition of the cause of metatarsalgia is necessary in order to guide adequate treatment.

Non-surgical treatments for metatarsalgia include:

• Supportive footwear, including sneakers
• Arch supports
• Gel insoles or foam padding
• Use of over-the counter or custom shoe inserts (orthotics)
• Decreasing weight-bearing and strenuous exercises and activities
• Cold therapy
• medication

Gel insoles or foam padding under the metatarsal head region may successfully distribute pressure and eliminate pain.

If these methods do not work, custom-molded orthotic inserts may be tried.

Ice and oral anti-inflammatory drugs may also reduce local inflammation.

Surgical treatment of metatarsalgia depends on the cause of the condition. If there is a relatively short metatarsal bone, it can be lengthened or the other portions could be shortened.

Exostectomies, or cutting and removing a portion of the bone, may be required depending on prominences present. If hammertoes are part of the problem, repair or straightening of the toes is also an option. If arch collapse or too high of an arch is part of the problem, other treatment options may be employed.

This information on foot, leg and lower body health conditions is provided by The Podiatry Institute, dedicated to advancing the standard of care in podiatric medicine and its effects on musculoskeletal health. The Podiatry Institute does not endorse a specific treatment, product, or therapy. This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider on all matters relating to this or any other condition that may affect your health.