Metatarsalgia  (ball of foot pain)

  • Metatarsalgia is not an injury; it’s actually a group of symptoms that may include pain in the ball of the foot, with possibly bruising, and inflamation. Metatarsalgia can have a number of causes and, as a result, a number of treatments. 


What to look for:

 Localized pain in the ball of the foot, on the bottom of the foot.  It is a painful but common occurrence. It may occur during weight-bearing activities (running, walking, standing, etc.). Sharp or shooting pains in the toes also may be present.  Accompanying symptoms may include tingling or numbness in the toes. It is common to experience acute, recurrent or chronic pain as a result of this problem. Some patients describe the feeling as being like “walking over pebbles or on balloons”.

There is no one specific cause of metatarsalgia. The podiatric community has narrowed it down to a handful of factors, all of which have a common denominator: a flaw in the biomechanics of the foot.


What it means to you:

If you’ve noticed pain in your forefoot, which gets worse during walking, running or standing, and/or pain in your toes, particularly when flexing them, you have some of the classic symptoms of metatarsalgia. Another hallmark is increased pain when going barefoot, particularly when standing or walking on a hard surface like tile, concrete, marble or asphalt, as opposed to carpet or grass. You may notice that over time, you begin to adjust your stride or gait to avoid putting pressure on the ball of the foot.


What causes it?

Metatarsalgia develops when something changes or threatens the normal mechanics (working action) of the foot. Ultimately, this creates excessive pressure in the ball of the foot, and that leads to metatarsalgia. Some of the causes of metatarsalgia include:

· Being overweight: the more weight is brought to bear on the foot, the greater the pressure is on the forefoot when taking a step.

· As men and women age, the fat pad in the foot tends to thin out, creating less cushioning and making them more susceptible to pain.

· Wearing shoes that do not fit properly: Shoes with a narrow, tight toe box, or shoes that cause a great deal of pressure to be put on the ball of the foot (high heels, for example). Because such footwear inhibits the walking process and forces the wearer to alter his or her step to adjust to the shoe, the mechanics of the foot are compromised.

· A bunion or arthritis in the big toe can weaken the big toe, and cause extra stress on the ball of the foot.

· Stress fractures of a metatarsal bone often causes pain and forces an individual to change their stride (This is not uncommon among athletes such as runners).

· Certain foot shapes such as a high-arched foot, or a foot with an extra-long metatarsal bone, or tight heel chords.

· Hammertoes can press the metatarsals toward the ground and cause stress on the ball of the foot.

· An inflamed nerve, called a neuroma can cause sharp shooting pain that radiates into the toes.  Often people must remove their shoe to rub their feet to obtain relief.

· Arthritis, gout or other inflammatory joint disorders can produce pain in the ball of the foot.


How can metatarsalgia be treated?

 Some of the best treatments come from being proactive. Keep body weight at a healthy level, and stick to shoes that fit properly, particularly in the toe area. Avoid high heels whenever possible. A regular checkup with a podiatrist or chiropodist who can assess other risk factors, such foot shape, also will allow you to take preventive measures.

If you have pain in the ball of your foot already, don’t panic. Treatment is generally conservative not surgical. All pain in the ball of the foot is not always metatarsalgia, since there are other problems which have similar symptoms but require different treatment.

Assuming you have a routine case of metatarsalgia, with no complicating factors, such as diabetes, your podiatrist may recommend one or more of the following measures, based upon your particular case of metatarsalgia:


· Custom Orthotics: If the foot specialist feels the case warrants it, they may prescribe custom orthotic inserts, which can help align your foot inside your shoe. In some cases, a pad that allows some cushioning under the ball of the foot may help lessen the load on this tender area.  This is often the best long term treatment but only your foot specialist can incorporate patient specific modifications for optimal results.

· Rest: Elevate your feet after periods of standing and walking. This will take pressure off the ball of the foot, and allow it to recover. Using an ice pack at the site of the pain for 20 minutes on, 20 minutes off, may provide additional relief.

· Wearing appropriate footwear: Your foot specialist will let you know whether you should change the type of shoes you wear.

· Keeping body weight in a healthy range

· Your foot specialist can decide whether medication will help reduce your symptoms. Whether medication is necessary depends upon the patient, and upon the progression of the case. In cases of more severe inflammation and pain, your foot specialist may decide to utilize injectable steroids, which can treat the pain at its source.

· Taping and padding the foot may be a simple yet effective treatment.


· Ultrasound or phonophoresis are non-invasive treatments aimed at reducing pain and inflammation

· What else? Occasionally, if other factors are complicating the problem, such as hammertoes or a trapped or pinched nerve in the foot, the podiatrist may recommend corrective surgery.


Who is most susceptible?

Athletes including weekend warriors, the obese, the elderly because of thinning ball-of-foot fat pad cushioning, females who wear high heels, those who are on their feet all day such as teachers, nurses and factory workers. 

Do these symptoms always mean metatarsalgia?

No – there are several problems with similar symptoms. Your foot specialist knows how to assess and treat them, although treatment can vary according to the specific problem. Using home remedies and waiting for the problem to go away on its own is not a good idea. After all, if your feet hurt, nothing else matters.