Definition

Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe).

Cause

With this common foot condition, one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with metatarsalgia. Ball-of-foot pain is often caused from improper fitting footwear, most frequently by women’s dress shoes and other restrictive footwear. Footwear with a narrow toe box (toe area) forces the ball-of-foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot. Other factors can cause excessive pressure in the ball-of-foot area that can result in metatarsalgia. These include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Also as we get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball-of-the-foot. Overweight and obese patients are also more susceptible to develop such metatarsal pain due to increased pressure. 

Common medical conditions causing metatarsalgia include: 

• Morton’s Neuroma – a common condition in which the nerves inside the feet become compressed causing a sharp or dull pain between the toes, often resulting in tingling sensation along the smaller toes.
• Hammer toes – causing uneven distribution of pressure along the metatarsal area. 
• Diabetes – uncontrolled diabetes may result in irreversible nerve damage. 
• Gout – a condition where crystals form inside the joints causing them to become very painful and inflamed.
• Bunions – an abnormal deformity of bone that can occur in the big toe, which can weaken the toe placing excessive pressure on the other metatarsals.
• Tight toe extensors and weak toe flexors (muscles attached to the smaller toes) causing flexible toe deformities. 
• Tight Achilles tendon (tendon at the back of the heel) causing plantarflexion (downward movement) of the ball of the foot that causes an increased pressure. 
• High arched foot (pes cavus) causing increased pressure on the ball of the foot and heel area. 

Treatment and Prevention

The first step in treating metatarsalgia is to determine the cause of the pain and any related medical condition which are causing the metatarsalgia. If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot. Unloading pressure to the ball-of-the-foot can be accomplished with a variety of devices. Your podiatrist might advise custom made prescription orthotics designed to relieve ball-of-foot pain, which usually feature a metatarsal pad/ dome. The orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used along with proper footwear, you should experience significant relief. Corticosteroid injections may also be used to alleviate the painful symptoms. This is only recommended when a correct diagnosis has been given and all other treatment options have been tried and tested.