Metatarsalgia: An Overview

What is Metatarsalgia?

Metatarsalgia is a term used to describe painful forefoot conditions in the metatarsal region, or the area often referred to as the ball of the foot. Your foot has five bones that run from the mid arch to your toe joints.  They are called metatarsal bones.  You may experience pain when the soft tissues around the heads of the metatarsal bones become inflamed. This is a condition called metatarsalgia.  It usually occurs around the 2nd, 3rd, and 4th metatarsal heads, at the ball of the foot, and can affect the bones and joints.

What are the Symptoms of Metatarsalgia?

Pain, burning and discomfort under the ball of the foot are all signs of metatarsalgia. This pain could be experienced when you are standing, walking or running. Sharp or shooting pain in your toes, or numbness and tingling in your toes can also be signs of metatarsalgia. It is not uncommon to see intense or long term chronic pain.

What Causes Metatarsalgia?

Metatarsalgia is a common foot condition that is often aggravated as the metatarsal heads become inflamed due to excessive pressure over a long period of time. Some causes for metatarsalgia include intense activity, physical foot types such as high arches or pronated feet, arthritis, fat pad deterioration (this can happen with age), and excessive weight.

Metatarsalgia is also often caused from improper footwear. The narrow toe area you will find in a women’s dress shoe, for example, forces the ball of the foot area to be squashed into the shoe and the toes and metatarsals to be compressed. This leads to an altered walking process, more forefoot pressure, and can cause metatarsalgia pain.  In addition, wearing high heels, or using inappropriate footwear for specific physical activities can cause metatarsalgia. 

How Do You Treat Metatarsalgia?

One of the most effective treatments for metatarsalgia are foot orthotics arch supports. Orthotic arch supports designed for metatarsalgia generally have a pad behind the ball of the foot called a metatarsal pad.  They work to distribute weight away from the painful area to other areas of the foot. Metatarsal cushions or pads placed in the shoes may also be helpful to reduce pain associated with metatarsalgia, but do not help correct underlying alignment problems the way foot orthotics do, so they are usually not as effective.

Improper fitting footwear is frequently the cause of metatarsalgia. Footwear designed with a wide toe area and a rocker sole is best to accommodate metatarsalgia. A rocker sole is curved on the bottom (like a rocking horse) so the foot rocks forward as the weight moves forward.  The wide toe area enables the foot to spread out while the rocker sole works to decrease the stress on the forefoot and alleviate the symptoms of metatarsalgia.

Injections sometimes help alleviate metatarsalgia pain, and occasionally surgery will be recommended, but less invasive treatments like orthotic arch supports should be tried first for metatarsalgia.  Using orthotic arch supports after surgery or injection can also prevent the recurrence of metatarsalgia by correcting the alignment problems that caused the problem in the first place.