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Metatarsalgia is a general term used to denote pain under the ball-of-the-foot. (the area just before the toes) This is a very common problem and one of the top three complaints we treat. Metatarsalgia (ball-of-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 usually responds very quickly to proper treatment. It can almost always be treated conservatively and surgery is rarely necessary. Dr. Hale and Dr. Huppin are experts at treating metatarsalgia, so don’t live with your pain any longer. Call today to make an appointment in our Seattle clinic.

Figure 1: Pain under the ball-of-the-foot.

Causes of Metatarsalgia
Metatarsalgia is most often caused by having too much pressure on a small area of the foot. This increased pressure can be caused by many different things, and a major part of our evaluation is to determine what is the cause of the increased pressure on your foot. Bunions, short metatarsal bones, hammer toes, high arched feet, arthritis, stress fractures, and bunion surgery are all possible causes of metatarsalgia.

Onset is usually gradual as it 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 while wearing non-cushioned shoes or stepping on a stone while running.

Goals of Treatment: Reduce Pressure on the Painful Metatarsals
Our primary goal when treating metatarsalgia is to reduce pressure on the painful area of foot. This can be accomplished with custom orthotics, prefabricated orthotics, certain shoes and even specific socks can make a difference.

Custom Orthotics and Metatarsalgia
Custom orthotics, if properly prescribed and fitted, can relieve the symptoms of metatarsalgia.

Orthotics for metatarsalgia are prescribed specifically to help take weight off of the painful area of the foot. We prescribe an orthotic that “hugs” the arch of your foot very closely in order to transfer force off of the metatarsal heads and onto the arch. These are called “Total Contact Foot Orthotics” – and function much better than typical orthotics at reducing pressure under the ball of the foot.1-6 The pressure scans below show the effect of a total contact orthotic on forefoot pressure:

Figure 2: Without orthotic: Red areas show extreme pressure.

Figure 3: With orthotic: Forefoot pressure reduced dramatically.

In addition, many studies show that modifications such as metatarsal pads and cushioning can further reduce pressure under the painful area of the foot. Depending on your exact condition, we will likely incorporate several modifications into your orthotics.7-10

Not all patients will need custom orthotics. Although not as effective at decreasing pressure, some patients will achieve pain relief with high-quality over-the-counter arch supports. We can help you determine which choice is best for your feet. In addition, proper socks and shoes can help provide cushioning. We will work with you to ensure you get the products that will best help your problem.

Additional Treatment: Reduce Inflammation
Once we have reduced the pressure on the ball-of-the-foot, then we will work with you to decrease the inflammation. This could mean one or more of several treatments, including:

  • Ice
  • Medication
  • Rest
  • Physical therapy
  • Injection

Signs and Symptoms of Metatarsalgia

  • Pain in the area of the ball of the forefoot.
  • Pain is often a dull ache, much like a bruise.
  • Pain is worse with 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.
  • Sometimes a callus will form in the area of increased pressure and pain.

The majority of cases of metatarsalgia are due to biomechanical problems of the forefoot. Many cases can be treated with a metatarsal pad, arch support with metatarsal pad, or increased cushion of the forefoot either in the shoe or on the outer soles.

If you pronate excessively, you will need a good motion control shoe. If you are replacing your shoes, consider a pair that offer some form of forefoot cushioning. We can help you find a great shoe for your foot with these features.  

Don’t let your forefoot pain get worse. Early treatment can prevent future problems. Call today for an appointment in our Seattle office

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Medical Literature Relating to Metatarsalgia and Orthotics
1. Stanton P.: Metatarsalgia: Diagnosis and Treatment. JBJS 1980; 62:722-732.
2. Woodburn J, Nelson K, Siegel K, Kepple T, Gerber L.: Multisegment foot motion during gait: proof of concept in Rheumatoid Arthritis. Journal of Rheumatology 2004; 31:1918-27.
3. Postema K, Burm P, Zande M, Limbeek J.: Primary metatarsalgia: The influence of a custom moulded insole and a rockerbar on plantar pressure. Prosthet Orthot Int 1998; 22:35-44.
4. Hodge MC, Bach TM, Carter GM.: Orthotic Management of Plantar Pressure and Pain in Rheumatoid Arthritis. Clinical Biomechanics 1999; 14:567-75.
5. Chalmers AC, Busby C, Goyert J, Porter B, Schulzer M.:Metatarsalgia and rheumatoid arthritis-a randomized, single blind, sequential trial comparing two types of foot orthoses and supportive shoes. J Rheumatology 2000; 27:1643-7
6. Magalhaes EP, Davitt M, Filho DJ, Battistella LR, Bertolo MB.:The effect of foot orthoses in rheumatoid arthritis. Rheumatology 2006; 45:449-453
7. Holmes G, Timmerman L.: A Quantitative Assessment of the Effect of Metatarsal Pads on Plantar Pressures. Foot & Ankle 1990; 11:141-45
8. Chang A, Abu-Faraj Z, Harris G, Nery J, Shereff J. Multistep measurement of plantar pressure alterations using metatarsal pads. Foot Ankle Int. 1994; 15: 654-60.
9. Hsi WL, Kang JH, Lee XX.: Optimum Position of Metatarsal Pad in Metatarsalgia for Pressure Relief. Am J Phys Med Rehab 2005; 84:514-20.
10. Kang JH, Chen MD, Chen SC, Hsi WL. Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study. BMC Musc Disor 2006; 7:95.

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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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