The medical term for foot pain, metatarsalgia, comes from the name of the bones that are in this part of the foot. It is a common forefoot disorder, which affects the ball of the foot and is marked by pain and inflammation in that area. Each foot has five metatarsal bones that run from the arch of your foot to the toe joints. Together it is called the metatarsal region. The main purpose of the metatarsals is to support the body weight when the person is walking, jumping, running, and specifically when the person is pushing up with the feet. The pain, burning or discomfort often occurs in the area where the second, third and fourth toes meet the ball of the foot, or more isolated at the first metatarsal head (near the big toe). It is not a disease but a symptom which is not generally serious.
Metatarsalgia occurs when something damages the long bones in the foot which connect the ankle bones to the bones of the toes. The most common cause for metatarsalgia is excessive pressure over a long period of time (high-intensity exercise), improper fitting footwear, being overweight or obese or the thinning of the foot pad. The bone structure of the foot like narrow, high-arched feet or flat feet or a second toe that’s longer than the big toe can also play a vital role in increasing the chances of developing metatarsaigia. Stress fractures in the foot, especially in athletes or walkers can cause metatarsalgia.
Certain medical conditions like rheumatoid arthritis, gout, bunions, Morton’s neuroma, diabetes and hammertoe, often changes the way a person walks, which in turn places excessive weight onto the metatarsals, triggering metatarsalgia.
- Hammertoe – this problem occurs when high heels or too-small shoes prevent the toes from lying flat, resulting in the second metatarsal to curl downwards. This causes an uneven distribution of weight, depressing the metatarsal heads and causing metatarsalgia.
- Bunion – an abnormal deformity of bone that can occur in the big toe, which can weaken the toe placing excessive pressure on the other metatarsals. This condition is more common in women than in men. Hallux Valgus Deformity can co-exist with a bunion.
- Morton’s neuroma – under this condition there is a noncancerous growth of fibrous tissue around a nerve which usually occurs between the third and fourth metatarsal heads. It mainly develops after high-impact activities such as jogging and aerobics.
- Other risk factors are muscle fatigue, avascular necrosis, sesamoiditis, vascular insufficiency, poor blood supply to the feet, tight toe extensors, interdigital neuroma, metatarsophalangeal synovitis and certain neurological problem.
The key symptoms are sharp or shooting pain in the toes, sometimes accompanied by numbness or tingling in that area. Burning or aching pain in the ball of the foot behind the toes, which increases while standing, walking or running and improves upon resting. The person can experience pain near the second, third and fourth toe, or alternatively pain in the big toe or a pain that worsens while flexing the feet. Other symptoms include a feeling in the feet as if the person is walking on pebbles or have a bruise from a stone. If these symptoms are left untreated it may lead to complications like pain in the other parts of the same or opposite foot, or pain in the lower back or hip due to limping from foot pain.
The symptoms mentioned above are usually enough to ascertain Metatarsalgia. However a doctor (GP) can recommend the following tests:
- Blood test to rule out any possibilities of gout or rheumatoid arthritis.
- X-rays, to check for any fractures that may have occurred in the bones of the feet.
- Ultrasound scans and/or magnetic resonance imaging (MRI) scan are useful in getting a clear picture of the foot and also help in detecting any underlying problems with the nerves or blood circulation in the feet.
- The patient can also be referred to a bone specialist (orthopedist) or a foot specialist (podiatrist). The doctor starts the diagnosis by first looking at the patient’s medical history, lifestyle, footwear and hobbies. A podiatrist may also analyze the gait (the way a person walks) on a treadmill or pressure plate to find areas of high pressure on the foot, and then begin the actual treatment.
The first step in treating metatarsalgia is to determine the cause of the pain. While mostcases of metatarsalgia will respond well to a number of self-care techniques like:
- Maintaining a healthy body weight can take a load off the feet.
- Rest: resting the affected foot provides relief from the pain. Avoiding regular exercise and protecting the foot from further injury also relieve the pain.
- Ice: Applying an ice pack to the affected site several times during the first 24 hours can reduce inflammation and help relieve pain.
- Providing physical therapy like ultra sound, electrical stimulation, paraffin, deep heat, whirlpool, gel metatarsal cushions and metatarsal bandages gives significant relief to the patient.
- Proper footwear: wearing proper and comfortable shoes is highly recommended by doctors. A high, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia as it allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot. Other alternatives are shock absorbing insoles made of cork, plastic, rubber or a gel-like substance. Arch supports are another option which minimize stress on the metatarsal bones and improve foot function.
- Foot surgery to realign the metatarsal bone is considered only if conservative methods fail.