Metatarsalgia

Metatarsalgia (met-uh-tahr-SAL-juh) is a condition in which the ball of the foot becomes painful and irritated. Metatarsalgia results from activities that involve running and jumping. Other causes include feet that aren't formed correctly and shoes that are too tight or too loose.

Although not often serious, metatarsalgia can make it hard to move. At-home treatments, such as ice and rest, often relieve symptoms. Wearing proper footwear with shock-absorbing insoles or arch supports might prevent or lessen future problems with metatarsalgia.

Symptoms of metatarsalgia can include:

• Sharp, aching or burning pain in the ball of the foot. The ball is the part of the sole just behind the toes.
• Pain that gets worse with standing, running, flexing the feet or walking. Doing any of these barefoot on a hard surface makes the pain worse. The pain gets better with rest.
• Sharp or shooting pain, numbness or tingling in the toes.
• A feeling of having a pebble in the shoe of the affected foot.

Not all foot problems need medical care. Sometimes feet ache after a long day of standing or a hard workout. But it's best to act on foot pain that lasts more than a few days. Talk to your health care professional if you have a burning pain in the ball of your foot that doesn't improve after changing your shoes and your activities.

Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:

• Hard training or activity. Distance runners are at risk of metatarsalgia. This is mainly because the front of the foot takes in a lot of force when a person runs. But anyone who does a high-impact sport is at risk. This is especially true if shoes fit poorly or are worn down.
• Certain foot shapes. A high arch can put extra pressure on the metatarsals. So can having a second toe that's longer than the big toe. This causes more weight than usual to be shifted to the second metatarsal head.
• Toes that have different shapes. Wearing too-small shoes or high heels can cause feet and toes to change shape. A downward-curling toe, called a hammertoe, can cause metatarsalgia. So can swollen, painful bumps at the base of the big toes, called bunions.
• Excess weight. Most of a body's weight goes to the forefoot while moving. So extra pounds mean more pressure on the metatarsals. Losing weight might reduce or get rid of symptoms.
• High heels or poorly fitting shoes. High heels are a common cause of metatarsalgia. Wearing high heels puts extra weight on the front of the foot. Shoes with a narrow toe box or athletic shoes that don't have enough support and padding also can be part of the problem.
• 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 around a nerve usually occurs between the third and fourth metatarsal heads. It causes symptoms that are like those of metatarsalgia. The growth can stress the metatarsal.

Almost anyone can develop metatarsalgia, but you're at higher risk if you:

• Do high-impact sports that involve running and jumping.
• Wear high heels, shoes that don't fit well or shoes with spikes, such as cleats.
• Are overweight or obese.
• Have other foot problems, including hammertoe and hard, thickened areas called calluses on the bottom of the feet.
• Have inflammatory arthritis, such as rheumatoid arthritis or gout.

Left untreated, metatarsalgia might lead to pain in other parts of the same foot or in the other foot. Limping because of the foot pain of metatarsalgia also can cause pain in other parts of the body, such as the low back or hip.

Various foot problems can cause symptoms like those of metatarsalgia. To find the source of your pain, your health care professional will look at your foot while you stand and while you sit and ask about your lifestyle and your activities. You might need an X-ray to see if you have a stress fracture or other foot problems.

Self-care measures might be all you need to relieve symptoms. These might include resting, wearing different shoes, or using an arch support or a pad on the affected area of your foot, called a metatarsal pad.

Rarely, surgery on the metatarsal bone might be an option. This might happen if self-care measures don't relieve your pain and you have foot conditions such as hammertoe.

To help ease metatarsalgia pain, try these tips:

• Rest. Protect your foot from further injury by not stressing it. Keep your foot raised after standing or walking. You might need to not play your favorite sport for a while. But you can stay fit with low-impact exercises, such as swimming or cycling.
• Ice the area. Apply ice packs to the area for about 20 minutes at a time several times a day. To protect your skin, wrap the ice packs in a thin towel.
• Take pain reliever you can get without a prescription. Try ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or aspirin to reduce pain.
• Wear the right shoes. Avoid too-tight or too-loose shoes. Limit your wearing of high heels. Wear shoes that are made for the sports you play.
• Try arch supports. Arch supports might lessen the stress on the metatarsal bones. You can buy arch supports without a prescription, or they can be custom fitted.
• Try metatarsal pads. You can get these without a prescription. Put them in your shoes just ahead of the metatarsal bone to help keep stress off the painful area.

You'll likely start by seeing your family health care professional. Or you might be sent to a bone specialist, called an orthopedist, or a foot specialist, called a podiatrist.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms, including any that may seem unrelated to your foot pain, and when they began.
• Key personal information, including sports you play and your medical history.
• Questions to ask your health care professional.

For metatarsalgia, basic questions to ask include:

• What's causing my symptoms?
• Do I need tests?
• Is my condition likely to go away quickly or be long lasting?
• What treatment do you recommend?
• Do I need to restrict my activities?
• Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your health care professional is likely to ask you questions, including:

• What type of shoes do you wear?
• What activities do you do?
• Does your daily routine involve a lot of walking or standing?
• Do you often go barefoot? On what types of surfaces?
• Do you have symptoms all the time or just sometimes?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• What, if anything, appears to make your symptoms worse?

What you can do in the meantime

While you're waiting for your medical appointment, rest your foot as much as possible and wear shoes that fit well. Pain relievers might help ease discomfort.