Metatarsalgia is the general medical term for having inflammation and pain in the ball of the foot. It isn’t a disease in and of itself but is a symptom of other problems going on with the foot. The main cause of metatarsalgia is overuse of the foot. It is seen often in athletes who must put a lot of force on their foot as part of their sport. Those that do a lot of jumping or running are at a higher risk of getting pain in the area of the forefoot. This is an especially common injury among those who are track and field runners but it can also be seen in those who play football, tennis, soccer, baseball and other sports.

Symptoms of Metatarsalgia

The main symptom of metatarsalgia is pain in the forefoot at the base of the metatarsal bones of the foot. Walking and running tend to make the pain worse. The pain tends not to occur all of a sudden but gradually worsens over several months. Metatarsalgia can be caused by having a Morton’s neuroma in the forefoot or from bursitis of the foot. If Morton’s neuroma is the cause of the metatarsalgia, there is often numbness some of the toes.

Causes of Metatarsalgia

Metatarsalgia is almost exclusively a condition of athletes who overuse the foot in the course of playing sports. The weight isn’t distributed properly on the foot and more pressure is put on the metatarsal bones. This leads to chronic irritation of the bones, tendons, and ligaments of the forefoot.
Things that contribute to having metatarsalgia include the following:

  • Tight muscles in the toes (the extensor muscles)
  • Weak flexor muscles of the toes
  • Increased physical activity
  • Large metatarsal heads
  • Shoes that do not fit well
  • Having hammertoes
  • Having a tightened Achilles tendon
  • Having high arches
  • Having an abnormal first metatarsal bone that shifts too much weight to the rest of the metatarsals.

Diagnosis of Metatarsalgia

Metatarsalgia can be diagnosed by a good medical history and physical examination of the foot. There will be tenderness on the ball of the foot in some cases. A bone scan can be done that shows areas of inflammation of the foot. X-rays may be done to make sure there isn’t a stress fracture of one of the metatarsal bones. Sometimes an ultrasound can be done on the foot to show a Morton’s neuroma or an area of bursitis in the foot. MRI exams are expensive but can be done if the cause of the pain isn’t clear and there are suspected soft tissue tumors or other abnormalities of the soft tissue of the foot.

Treatment of Metatarsalgia

If an athlete has a game to play and is experiencing metatarsalgia, ice can be applied to the forefoot along with the application of an ACE bandage. If weight is kept off the foot for about a day, the inflammation can settle down and the pain can be somewhat relieved. Passive range of motion exercise or treatment with ultrasound can be done to take down the inflammation and relieve the pain. Orthotics can be used to pad the area around the metatarsal bones.

Shoes can be fit better to support the forefoot and prevent further injury. If supportive shoes are ineffective, a flexible corrective device can be placed in the shoe for better protection of the metatarsal bones. Gradually, the foot is strengthened through physical therapy so the problem can be prevented. Activities that make the pain worse can be avoided; however, this may not be possible if athletics are concerned, particularly for professional athletes.

If there is a callus on the forefoot, the podiatrist can trim it so that the pain can be relieved at least temporarily. Pads can be put over the trimmed area to prevent further callus formation. A metatarsal bar can be inserted into the athlete’s shoe to protect the metatarsal bones.

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