Metatarsalgia

What is metatarsalgia?

Metatarsalgia is a term to describe pain and inflammation in the ball of the foot. It is often thought of as a symptom, rather than a specific condition

What are the symptoms of metatarsalgia?

The primary symptom of metatarsalgia is pain in the ball of the foot. Often the most symptomatic area is at the base of the 2nd and 3rd toes. The pain is aggravated when walking or running. Most often, the pain comes on over a period of several months, rather than suddenly. You can also have the feeling that there a pebble in your shoe.

Are there other conditions with similar symptoms to metatarsalgia?

Metatarsal stress fractures, inter-metatarsal bursitis, Morton’s neuromas all have similar symptoms to metatarsalgia.

What are the causes of metatarsalgia?

Metatarsalgia is caused by repetitive overloading of the forefoot and often there are several factors involved, these include:

• High impact sport. The front of the foot absorbs significant forces whilst running and during intense training. Long distance runners are at risk of metatarsalgia.
• Foot shapes. Having a high arched foot or a long second toe can put extra pressure on the metatarsal heads. A bunion can also aggravate symptoms.
• Excess weight. Most of your body weight transfers onto your forefoot whilst walking. Being overweight means more pressure on your metatarsals.
• Ill fitting shoes. High heeled shoes transfer more pressure onto the front of your foot. A narrow toe box shoe can also contribute to the problem.
• Tight calf muscles. Having a tight calf muscles means that your heel comes off the ground earlier when walking increasing the forces through your forefoot.

What is the treatment options for metatarsalgia?

In the first instance simple treatment measures are recommended to try and reduce your symptoms. These can have significant benefit and help avoid having surgery. Listed below are some of the main first line treatments for metatarsalgia but it is not exhaustive.

• Activity modification aims to reduce activities that cause symptoms of
  metatarsalgia. A reduction in impact activities, such as running, may be required for a specified period of time.
• Orthoses (medical insoles) can be useful to improve the foot position and reduce
  the forces transmitted through the forefoot whilst walking. You can be referred to the Orthotist for a specialist opinion.
• Simple painkillers such as paracetamol or anti-inflammatory tablets (e.g. ibuprofen) can be beneficial. Ask advice from your doctor or pharmacist before taking anti-inflammatory medicines as they can have side-effects in some people.
• Appropriate footwear is recommended with a wide toe box and thicker soles. Avoid high heeled shoes.
• Weight-loss is an important part of the treatment plan, if you are overweight. It might be discussed as a part of your consultation. If required your general practitioner will be able to refer you onto a weight loss programme.
• Stretching exercises to the calf muscles is a very effective for many patients and form the mainstay of treatment to promote long term resolution of metatarsalgia. It is important the stretching exercises are undertaken regularly. You can be referred to the physiotherapist for specialist input.

Surgery for metatarsalgia would only be considered an option as a last resort after non-surgical treatments have failed, and would depend on the extent of your symptoms and medical co-morbidities. Surgery is not without risks and has an associated recovery period.

Wellbeing Advice

Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.

If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.