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Although generally not
serious, metatarsalgia can sideline you, whether you're an
Olympic contender or a weekend warrior. Fortunately,
conservative treatments such as ice, rest and physical
therapy can often relieve symptoms. And proper footwear,
along with special arch supports (orthotics) or
nonprescription shoe inserts, may be all you need to
prevent or minimize future problems.
Signs and symptoms
The main symptom of metatarsalgia is pain in the ball
of your foot — the part of the sole just behind your toes.
The pain may be sharp, aching or burning, and you may feel
it in the area around the second, third and fourth toes or
only near your big toe.
Other symptoms of metatarsalgia include:
- Pain that gets worse
when you stand, walk or run and that improves when you
rest.
- Sharp or shooting pain
in your toes.
- Numbness or tingling
in your toes.
- Pain that worsens when
you flex your feet.
- A feeling in your feet
as if you're walking on pebbles or have a bruise from a
stone.
- Increased pain when
you're walking barefoot, especially on a hard surface.
Sometimes these symptoms
come on suddenly, especially if you've recently increased
your usual amount of running, jumping or other high-impact
exercise, but problems are more likely to develop over a
period of months.
Causes
In each foot you have five metatarsal bones that run
from your arch to your toe joints. The first metatarsal
is shorter and thicker than the other four bones, which
are usually similar in size. During the push-off phase
when you walk, jump or run, your body weight is
transferred to your toes and metatarsals. The first and
second metatarsal bones take the brunt of this force,
which can be as much as 275 percent of your body weight.
Most metatarsal problems develop when the impact load or
the mechanics of your foot affect the way your weight is
distributed. This can put excess pressure on the
metatarsals, leading to inflammation and pain,
especially in the metatarsal heads — the rounded ends of
the bones that connect with your toe bones.
Sometimes a single factor can lead to metatarsalgia, but
more often several factors are involved, including:
Intense training or activity Runners have the
highest incidence of metatarsalgia, primarily because
the front of the foot absorbs more force when running
than during any other activity — as much as 110 tons of
force per mile. But anyone who participates in a
high-impact sport is at risk. Training intensely or for
long periods puts even more stress on the metatarsals,
often leading to chronic irritation and inflammation.
Certain foot shapes A high arch (pes cavus foot)
can put extra pressure on the metatarsals. So can having
a second toe that's longer than your big toe, which
causes more weight than normal to be shifted to the
second metatarsal head.
Hammertoe This foot problem has a genetic basis
but can also develop when high heels or too-small shoes
prevent your toes from lying flat. As a result, one of
your toes — usually the second — curls downward because
of a bend in the middle toe joint. This contraction
depresses the metatarsal heads.
Bunion This is a swollen, painful bump at the
base of your big toe. Sometimes the tendency to develop
bunions is inherited, but the problem can also result
from wearing high heels or too-small shoes. Bunions are
much more common in women than in men. A bunion can
weaken your big toe, putting extra stress on the ball of
your foot. Sometimes surgery to correct a bunion also
can lead to metatarsalgia.
Excess weight Because most of your body weight
transfers to your forefoot when you move, even a few
extra pounds mean more pressure on your metatarsals.
Sometimes just losing weight can reduce or eliminate
symptoms of metatarsalgia.
Poorly fitting shoes High heels, which cause more
weight to be transferred to the front of the foot, are
one of the most common causes of metatarsalgia in women.
Shoes with a narrow toe box or athletic shoes that lack
support and padding also can contribute to metatarsal
problems.
Stress fractures Small breaks in the metatarsals or
toe bones can be painful and change the way you put
weight on your foot.
Morton's neuroma This noncancerous growth of
fibrous tissue most often occurs between the third and
fourth metatarsal heads. It causes symptoms that are
similar to metatarsalgia and can also contribute to
metatarsal stress. Morton's neuroma frequently results
from wearing high heels or too-tight shoes that put
pressure on your toes. It can also develop after
high-impact activities such as jogging and aerobics.
Aging As you grow older, the fat pads on the
balls of your feet become thinner, making the metatarsal
bones more susceptible to injury. Your podiatric
physician/surgeon has been trained specifically and
extensively in the diagnosis and treatment of all manners
of foot conditions. This training encompasses all of the
intricately related systems and structures of the foot and
lower leg including neurological, circulatory, skin, and
the musculoskeletal system, which includes bones, joints,
ligaments, tendons, muscles, and nerves. |
Metatarsalgia
frequently affects runners and other athletes who
participate in high-impact sports. That's because
excessive amounts of running or jumping put extra stress
on the metatarsals — the long bones located in the front
part of your feet just below your toes. People with
certain foot shapes that create more stress on the
metatarsal bones also may have these problems.
