Pain under the ball of the foot – Metatarsalgia

MetatarsalgiaMetatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. Metatarsalgia is often referred to as a symptom, rather than as a specific disease. Common causes of metatarsalgia include interdigital neuroma (also known as Morton neuroma).

Where is the pain?

As the heading suggests, patients will feel pain under the ball of the foot.  Historically the general term used to describe pain under the ball of the foot is Metatarsalgia.

The ‘ball of the foot’ consists of the metatarso-phalangeal joints (MTPJs) of the foot, i.e. the joint before the toes. The primary symptom of metatarsalgia is pain at one or more of the metatarsal heads. Diffuse forefoot pain and midfoot pain are often present in athletes with combinations of high-impact inflammatory conditions. The pain is typically aggravated during the mid-stance and propulsion phases of walking or running.

When will I experience pain under the ball of the foot?

Most often patients describe that they suffer this pain on weight bearing, the pain may increase with increased walking or sport.  In the situation of long standing metatarsalgia the patient may feel pain at rest as well as on weight bearing.

What causes pain under the ball of the foot?

These joints may become painful as a result of increased pressure, joint inflammation, fracture of the bone or perhaps a neuroma may develop between these joints as a result of loss of joint space from overuse. A Morton neuroma (interdigital neuroma) produces symptoms of metatarsalgia due to irritation and inflammation of the digital nerve located in the web space between the metatarsal heads. Patients with a Morton neuroma may complain of toe numbness in addition to pain in the forefoot. The term Morton neuroma is a misnomer because no neuroma truly exists. Rather, the lesion results from a mechanical entrapment neuropathy.

Is Metatarsalgia linked to foot position?

Most often patients that present with pain here will experience this pain under the 2nd and 3rd MTPJs, i.e. behind the 2nd and 3rd toes.  This is usually due to over pronation of the foot, which brings about changes in the foot that stop the patient from using the joint of the big toe when they push off on their foot.  By not being able to use the big toe joint and push off, the patient will over use the joints behind the 2nd and 3rd toes.

How to treat metarsalgia?

The initial treatment includes regular icing and application of a pressure bandage (or RICE: rest, icing, compression, and elevation). Recommend non–weight-bearing ambulation for the first 24 hours. The use of metatarsal pads and other orthotic devices may provide relief, even in the early phases of treatment.

Semi-rigid orthoses worn in supportive shoes have been shown to be effective treatment for metatarsalgia.  Supportive shoes worn alone, with or without soft orthoses, have not been shown to provide adequate pain relief.

If you are having pain under the ball of the foot and you want relief contact The Foot and Leg Clinic  today.