Metatarsalgia (Pain in the Ball of the Foot)

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-the-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).

Metatarsalgia is most often a result of faulty distribution of weight on the forefoot. Normally when walking, weight is transferred from the heel to the outside of the foot, and then we finish with the weight on the inside as we ”toe-off” at the end of each step. During toe-off, most of the weight is carried by the big toe. When standing, the first metatarsal (at the big toe) carries 2/6 (1/3) of the body weight and each of the others carries 1/6. If increased weight is habitually carried on the lateral (outer) metatarsals, this can cause microtrauma in the joint capsule and around the head of that particular metatarsal, and lead to injury.

Normally, the little muscles that run between the bones of the feet contract during the final phase of each step to prevent the forefoot from splaying (widening) and the toes from curling. If these little intrinsic muscles don't do their job, the forefoot spreads and the toes curl which causes the metatarsal heads to be forced down; they contact the ground harder which can lead to injury.

As you can probably guess, onset is usually gradual, as microtrauma takes a while to add up into an injury. However, it may arise suddenly if there is trauma to the area or if new shoes are involved. Sudden trauma might include landing hard on the ball of the foot while barefoot or wearing non-cushioned shoes, or stepping on a stone when running.

Signs and Symptoms—Metatarsalgia

• Pain is in the ball of the forefoot.
• Pain is often a dull ache, much like a bruise.
• If one bends the toes upwards and applies pressure over the “knuckles” of the foot, the pain can often be localized to one metatarsal head.
• Pain is worse when walking barefoot, especially on hard surfaces like concrete or ceramic tile.
• Pain often forces a person to walk on the outside of the foot in an effort to avoid stepping on the ball of the foot.
• Pain is often less in good running shoes, especially those with forefoot cushioning.

What to Do About Metatarsalgia

Most cases of metatarsalgia should respond to conservative care. In fact, many times all that is needed is some home treatment. First, start with ice on the ball of the foot. This will help to decrease the inflammation in the joint. Second, make sure your shoes aren't worn out and that they are the correct type of shoe for your foot. If you pronate excessively, you will need a good structured shoe and possibly additional arch support. If you are replacing your shoes, consider a pair that offer some form of forefoot cushioning. At SHOES-n-FEET^®, we can help you find shoes with these features.

Over-the-counter arch supports can work wonders for metatarsalgia by helping to transfer the weight off of the ball of the foot. Next we might want to try creating a little forefoot pad that will help protect the metatarsals. We can add this pad directly to your arch support. It doesn't take much padding to notice a difference.

If the above methods do not provide enough relief of your ball-of-the-foot pain, it may be necessary to look into custom orthotics to correct a biomechanical problem of the foot. In that case we recommend that you see your podiatrist.

Other problems can also cause pain in the ball of the foot. Two common ones are neuromas and stress fractures. If your foot pain is severe, long-lasting, or resistant to treatment, or you just want to make sure you are treating the correct problem, be sure to see your foot doctor.