Metatarsalgia

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-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).

Causes of Metatarsalgia
Metatarsalgia is most often a result of faulty distribution of weight on the forefoot. Normally, when standing, the first metatarsal (at the big toe) caries 2/6 of the body weight and each of the others carries 1/6. If increased weight is habitually carried on the outer metatarsals, this can cause damage around the head of that particular metatarsal and thereby lead to injury.

Onset is usually gradual as the 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.

Other Causes of Metatarsalgia
Bunions, metatarsal length deformities, hammer toes, high arched feet, arthritis, stress fractures, and increased loading due to bunion surgery are all possible causes of metatarsalgia. 

It's important to recognize that metatarsalgia may be due to one of these conditions or a combination of several.  It is not uncommon to find several different forefoot problems occurring simultaneously.  

Signs and Symptoms

• 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.

Custom Orthotics and Metatarsalgia
If over-the-counter arch supports do not provide enough relief, custom functional 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.  Then we use accommodative pads to transfer force directly off the painful area and special shock absorbing materials to cushion the area. 

All pages on this website © 2008
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.