Metatarsalgia

Metatarsalgia is a type of pain that occurs in the ball of the foot, also called the metatarsal region.

The pain can range from mild to severe and often gets worse when you stand or move. It is sometimes described as a burning or aching sensation and you may have shooting pains, tingling or numbness in your toes. Some people also experience a sensation that feels like walking on pebbles.

The pain often occurs in the area where the second, third and fourth toes meet the ball of the foot.

Read more about the symptoms of metatarsalgia.

Metatarsalgia treatment

Most cases of metatarsalgia can be treated using self-care techniques such as:

• RICE – this means rest, applying an ice pack, using a bandage to compress your foot and elevating the foot
• taking painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve pain
• using shock-absorbing insoles, which can be fitted inside your shoes to help cushion the pressure when walking – these are available from pharmacies as well as sports shops (runners often use insoles to protect their feet)

Most cases of metatarsalgia respond well to self-care treatment. In rare cases, orthotic supports or surgery may be required to repair underlying damage to the foot.

Read about treating metatarsalgia.

What causes metatarsalgia?

Metatarsalgia occurs when something damages the long bones in the foot which connect the ankle bones to the bones of the toes. These are known as metatarsals.

Common reasons why these bones can become damaged include:

• wearing poorly fitting shoes
• being overweight or obese (very overweight with a body mass index of 30 or above)
• high-intensity exercise such as running, tennis or squash

Read about the causes of metatarsalgia.

The most common symptom of metatarsalgia is a sharp, burning or aching pain in the ball of your foot. The ball of your foot is the area of sole just behind your toes.

The pain is worse when you walk or run, and feels better when you rest your feet.

Other symptoms associated with metatarsalgia include:

• pain near your second, third and fourth toe, or alternatively pain in your big toe
• numbness or tingling in your toes
• a feeling like you are walking with a pebble in your shoes

The symptoms of metatarsalgia usually develop gradually and get worse over time.

When to seek medical advice

Try self-care techniques first. You can find these in the section on treating metatarsalgia.

If the pain doesn’t improve, see your doctor.

If necessary, they can refer you to a health professional who specialises in foot care (a podiatrist, also known as a chiropodist).

Alternatively, you could see a podiatrist privately.

Metatarsalgia is caused by damage to the metatarsal bones in the foot.

The metatarsals

The metatarsals are five long bones that run underneath the soles of your feet. They connect your ankle bones to your toe bones.

The main purpose of the metatarsals is to support your weight when you are walking, jumping and running, specifically when you are pushing up with your feet.

However, the metatarsals can sometimes become painful.

Common causes

Some common causes of metatarsalgia include:

• Badly fitting footwear, high-heeled or tight, restrictive shoes or boots – shoes with a narrow toe area or high heels can force the ball of the foot into a small amount of space, which puts more pressure on that area.
• Being overweight or obese – this can increase the pressure on the foot.
• Age – older people are more susceptible to metatarsalgia as the fat pad that protects the foot can thin with age, making them more likely to feel pain in the ball of their foot.
• Bone structure of the foot – narrow, high-arched feet or flat feet can increase the chance of metatarsalgia.
• High-impact sports, such as running or tennis, put extra pressure on the foot.
• Stress fractures in the foot – these occasionally occur in athletes or walkers and cause pain to come on rapidly.

Medical conditions known to cause metatarsalgia

Several medical conditions can cause foot pain, which often changes the way you walk. This in turn places excessive weight onto your metatarsals, triggering metatarsalgia.

These conditions include:

• arthritis – pain and swelling of the joints, which can be the result of general wear and tear (osteoarthritis) or your immune system mistakenly attacking the joints (rheumatoid arthritis)
• 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
• Morton's neuroma – a common condition in which the nerves inside the feet become compressed causing a sharp or dull pain between the toes
• diabetes – the high levels of blood sugar associated with diabetes can, over time, cause nerve damage and pain affecting the feet
• hammertoe – when one of your middle toes is bent downwards, which can cause an uneven distribution of weight onto your metatarsals

If you've tried the self-care techniques for treating metatarsalgia but your symptoms have not got better, see your doctor.

Your doctor can arrange a number of tests which can check for any underlying problems that may be causing the symptoms of metatarsalgia.

These may include:

• blood tests – which can be helpful in diagnosing conditions such as gout or rheumatoid arthritis
• X-rays – which can check for any fractures that may have occurred in the bones of your feet
• ultrasound scans – where high-frequency sound waves are used to build up a picture of your foot (ultrasound scans can often be useful in diagnosing the condition Morton’s neuroma)
• magnetic resonance imaging (MRI) scan – which uses strong magnetic fields and radio waves to produce a detailed image of the inside of the body, and can often help detect underlying problems with the nerves or blood circulation in the feet

Your doctor may also refer you to a foot specialist (podiatrist), who will examine your foot and may ask you:

• about your medical history, lifestyle, footwear and hobbies
• where and when the pain occurs
• when the pain started
• how often the pain happens
• whether the pain is getting worse
• whether you have pain anywhere else

Your podiatrist may also analyse your gait (the way you walk) on a treadmill or pressure plate to find areas of high pressure on the foot.

Most cases of metatarsalgia will respond well to a number of self-care techniques. These are discussed below.

RICE

RICE stands for:

• Rest – avoid regular exercise and reduce your daily physical activity. Using crutches or a walking stick may help if you cannot put weight on your foot.
• Ice – apply an ice pack to the affected foot for 10–30 minutes. A bag of frozen peas, or similar, will work well. Wrap the ice pack in a towel to avoid it directly touching your skin and causing ice burn.
• Compression – use elastic compression bandages to limit swelling.
• Elevation – keep the injured foot raised above the level of the heart. This may also help to reduce swelling.

After 48 hours of RICE therapy, stop compression and try moving the injured area. If, after this time, your symptoms are worse, seek advice from your doctor.

Other measures

You can try the following measures to ease the pain of metatarsalgia:

• Use orthotics (specially fitted insoles), which are designed to improve foot function, redistribute pressure and protect the ball of the foot.
• Use shock-absorbing insoles, which can be fitted inside your shoes to help cushion the pressure when walking.
• Take non-steroidal anti-inflammatory medicines, such as ibuprofen, which can help prevent inflammation and ease pain.
• Exercise your ankle and stretch your Achilles tendon (tendon at the back of the ankle).
• Change your style of shoe to something more roomy and flat-heeled.

More severe cases

If you have more severe inflammation (swelling) and pain, see your doctor or podiatrist, who may recommend steroid injections into your foot joints to reduce the inflammation. Steroid injections (corticosteroids) may cause some pain and swelling at the site of the injection, but this should pass within a few days

Read more about corticosteroids.

If all the above measures have not eased the pain, you may be referred to an orthopaedic foot surgeon for an operation to:

• release a trapped nerve or remove an irritated nerve
• straighten a hammer toe (where the toe is bent at the middle)
• reshape or shorten prominent metatarsal bones (toe bones)