METATARSALGIA  

 

What Is Metatarsalgia?
Metatarsalgia is a general term used to refer to any painful foot condition affecting the metatarsal region of the foot.

Traditionally the term tends to refer to pain under the ball of the foot or “metatarsal heads”. However there are a range of specific conditions that exist under the umbrella term of “metatarsalgia”
 
What causes it?
What causes metatarsalgia is dependent on the specific condition that exists.
 The cause may be:
•    Overuse
•    Wearing high heeled shoes
•    Being overweight 
•    Having a stiff ankle/tight calf muscle 
•    Morton’s neuroma
•    Foot shape and/or toe deformities
•    Previous surgery to the foot
•    Stress fracture of a metatarsal
•    Freiberg’s disease, arthritis or gout
•    Diabetes
•    Age – the protective fat pad under the ball of the  foot gets thinner

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What are the symptoms?
•    Pain in the ball of the foot
•    Some people describe this as being like walking on pebbles; others describe a general aching under the ball of the foot 
•    The symptoms can be localised i.e. under one or two metatarsal heads or can be general and felt under all the metatarsal heads
•    The symptoms can be made worse by standing, walking or running and may affect both feet

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Treatment Options
•    Rest: reduce or avoid the activities that aggravate the pain
•    Footwear: 

• Avoid high heels (over  1”) and tight or poorly fitting shoes with thin soles. Wear shoes that are wider, deeper and more cushioned to provide shock absorption for your feet.

• Replace worn out footwear

•    Lose weight -  this will reduce the load on your feet
•    Painkillers such as paracetamol or ibuprofen may help.

•  Do not take anti-inflammatories such as ibuprofen for more than 14 days as they can interfere with healing after e.g. stress fracture

•    Calf stretches:  Stiff muscles can affect the way the weight is being distributed over your feet when walking and cause foot pain. See below
•    Padding: Apply soft padding to the foot or cushioned insoles in the shoes 
•    Orthotics: These are bespoke insoles which can help support and control faulty foot mechanics whilst also helping to “offload” pressure points under the ball of the foot. 
•    Investigations:

• Blood tests can check for diabetes, gout or inflammatory arthritis.

• X-ray can show a fracture

• Scans can show a suspected stress fracture

• Ultrasound scan can confirm a Morton’s neuroma.

•    Corticosteroid injection therapy:

• Steroids are used to reduce inflammation arising from either a joint or soft tissue.

• If the metatarsalgia is due to an inflamed metatarsophalangeal joint (between the ball of the foot and the toe) or a pinched nerve (Morton’s neuroma) – the steroid can help to settle the inflammation.

•    Surgery: If your metatarsalgia is proving resistant to settling down with conservative measures e.g. pain in the ball of the foot due to a misshapen toe “hammer toe” - surgery may be an option.  

Calf Stretches

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Calf stretching exercises: Gastrocnemius Muscle Calf stretch.
 Stand in a walking position with the leg to be stretched straight behind you and the other leg bent in front of you.
 Hold the stretch for a count of 30 seconds – relax. Repeat 5 times, 5 days a week for 6 weeks.

Calf stretching exercises: Soleus muscle calf stretch. 
 Stand in a walking position with the leg to be stretched behind you. Hold on to a support. Bend the leg to be stretched and let the weight of your body stretch your calf without lifting the heel off the floor.
 Hold for 30 seconds – relax. Repeat 5 times, 5 days a week for 6 weeks.