What is it?
Metatarsalgia is described as an umbrella term for pain that occurs at the ball of the foot. It incorporates a few different forefoot pathologies, each with its own set of symptoms.
Metatarsalgia most commonly affects middle-aged women, although it can affect men as well, and all age groups. It can be caused by improper footwear (footwear that is too short or too narrow, as well as continued use of high heels), an overloading of the joint due to trauma or injury, as well as excessively flat feet. Unfortunately, rheumatoid arthritis (RA) or osteoarthritis (OA) can also predispose the joint to inflammation that may lead to metatarsalgia.
What do people experience?
Depending on the diagnosis of the type of metatarsalgia that you are experiencing, symptoms and levels of discomfort may vary and include the following:
- Pain/discomfort at the bottom of the foot where the second toe meets the midfoot
- Feeling like there is a stone in your shoe
- Fatigue/nonrestorative sleep
- Pain worse when barefoot than in shoes
- Symptoms worse when pushing off while walking
- Increased pain with activity
- Pain at the top of the foot over the ball of the foot
- Stiffness or pain during or after activity
Symptoms can vary in intensity between individuals, and there may be periods of time where symptoms are more intense than others.
Risk factors and how to avoid discomfort
Metatarsalgia can affect all factors of the population, but are found to be more prevalent with certain risk factors.
Risk factors for discomfort include:
- Age: your risk factor for developing toe deformities increases as you age
- Female: studies have suggested metatarsalgia may be more common among females, but this may be associated to poor footwear choices
- Excess weight: excessive weight increases the pressure on the joints of your feet
- Abnormal foot posture: excessively flat or excessively high arches
You can reduce symptoms by avoiding risk factors, including:
- Ill-fitting footwear
- Excessive weight gain
- Modifying current activity to decrease the pressure on the forefoot
What are my options for treatment? Who else can help?
Many conservative treatment options are available for managing metatarsalgia symptoms. An MRI, ultrasound, or x-ray can be helpful in diagnosis and symptom relief. Only once all conservative treatment options are exhausted will more invasive procedures be considered, including cortisone injections and surgery.
Conservative treatment options include:
- Custom foot orthoses
- Stretching program
- Activity modifications
- Changing your footwear
- Adding metatarsal support to existing footwear
A physiotherapist may be part of your treatment plan and can implement ultrasound therapy and exercises that may help to reduce inflammation.
A registered massage therapist may be able to help alleviate symptoms associated with metatarsalgia by helping to stretch and reduce tightness in the calf muscle.
Although surgery is very rare in metatarsalgia cases, for patients who have chronic metatarsalgia and are not experiencing symptom relief through activity modifications and other less invasive treatment options, surgery may be an option to discuss with your family physician.
Staying active with a plan
Maintaining your current level of activity can be difficult with metatarsalgia; however, modifying your activity can help you stay active while limiting your symptoms of pain.
- Modify your activities to decrease excessive time spent on your tip toes
- Try swimming or cycling as aerobic exercise instead of walking or running
- Choose a cushioned pair of running shoes that fit you properly for your active needs.
1. Espinosa N, Brodsky JW & Maceira E. (2010). Metatarsalgia. Journal of the American Academy of Orthopaedic Surgeons, 18: 474-85.