What is Metatarsalgia?

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
Medications
Changing your footwear
Adding metatarsal support to existing footwear

Physiotherapy
A physiotherapist may be part of your treatment plan and can implement ultrasound therapy and exercises that may help to reduce inflammation.

Massage therapy
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.

Surgery
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.

Don’t let Metatarsalgia Get you down. Get back on your feet, today.

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How can SoleScience help you feel better?

Your SoleScience Pedorthist will create an individualized treatment plan that suits your specific needs, goals, and symptoms. We will work with you to determine not only what we need to do to address your current concerns, but also to prevent future problems.

Your pedorthist will complete a thorough and comprehensive foot examination at your initial appointment. A comprehensive follow-up exam will ensure that you are meeting your goals and allow your pedorthist to reassess your treatment plan (as necessary). During these appointments we will:

Assess joint and muscle function, including range of motion and gait assessment
Assess your footwear for both fit and function
Identify any risk factors that can be modified and make recommendations for change
Identify areas of risk with specialized tools such as pressure mapping (F-Scan or
Pedograph)
Discuss a treatment plan, which may include a change in footwear, activity modification, or custom foot orthoses and/or a complementary treatment referral (such as physiotherapy)

In addition to your individual treatment plan, your SoleScience Pedorthist will provide you with educational resources to help you best maintain your foot health.

Our take on the need for custom foot orthoses

Metatarsalgia is one of the most common sources of foot pain that people present with in a clinical setting (1). It is often one of the most interesting foot problems for pedorthists because it can manifest itself in different ways, produce different symptoms, and treatment options can be variable. Because foot pain often results in limited activity and may lead to mobility issues, the team at SoleScience is focused on getting you back on your feet.

Custom vs. OTS

Custom foot orthoses are made using a mold (cast) of your foot. This type of insole is made specifically for you and your needs. Your pedorthist will not only take a cast of your foot in a specific position, but also choose the materials and construction details tailored specifically to you. The evidence suggests that custom foot orthoses can be a viable part of your treatment plan to decrease symptoms of pain and discomfort and aid in movement function.

Off-the-shelf (OTS) devices are pre-fabricated for an “average” foot and are designed to slip into most footwear. This type of insole may be heat moldable or modifiable for a degree of customization, but is not entirely custom-made to your foot. There are dozens of insoles available in your local pharmacy or drugstore that may provide support and relief for various foot conditions. When dealing with the mild forms of metatarsalgia, an OTS device may be appropriate for pain management, but in more severe cases, a custom orthotic device may be better suited to your overall needs.

Footwear recommendations

Your pedorthist will recommend shoe choices for you, and will take into consideration the most appropriate shoes for work and activity requirements. If necessary, your pedorthist may also be able to stretch or modify your shoes to provide more comfort.

Changing the footwear you wear most often may reduce the amount of pain and discomfort.  

If at all possible, avoid shoes that have a high heel.
When was the last time you had your feet measured? Feet have a tendency to change throughout our life, and it may be time to have your feet measured for both length and width. This will help ensure your shoes are not too tight or too short.
Try to choose shoes that offer extra depth in the toe area; this often allows for more cushioning and more space for your feet.
Limit the amount of time you spend in thin-soled shoes if you have difficulty walking barefoot due to pain.
Wear cushioned footwear or slippers around the house if you find more comfort while wearing shoes.
Choose shoes that have a wide, deep toe box. If you have custom foot orthotics, the deep toe box will allow extra depth in the shoe for added cushioning.
Look for athletic shoes that have a rocker toe. This feature helps decrease the load on the forefoot while running or participating in various other activities.

Make a confident choice in SoleScience, and we’ll do everything in our power to make you a raving fan!

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