Metatarsalgia is the most common problem affecting the forefoot. However, it is often not considered a specific disease, but more of a symptom of other problems. Although it can affect both genders of all ages, middle aged females and those who are physically active in running or jumping are more prone to it.

What is Metatarsalgia?

Metatarsalgia refers to a condition where there is pain and inflammation in the front or ball of the foot, just before the toes. There are five metatarsal bones that start at the arch of the foot and end at the toe joints. The bones and joints, as well as the soft tissues around the heads of the metatarsal bones, may become inflamed due to overuse or injury. The inflammation is typically found around the 2nd, 3rd and 4th metatarsal heads, but can also occur near the big toe.

Symptoms of Metatarsalgia

The symptoms include acute or chronic pain, burning, discomfort, tingling or numbness localised around the forefoot during walking, running or just standing. Some describe it as being like “walking on pebbles”; others may have shooting pain or tingling sensations in or near the toes. It is also not uncommon to experience intense and unbearable pain. The onset of the pain is more likely to develop over time rather than to come upon suddenly.

Causes of Metatarsalgia

There are many conditions that could contribute to a higher risk of developing metatarsalgia. Often, more than one cause is present. Some of the more common ones include:

  • Some physical foot types such as having high arches, pronated feet or thin feet without much fat padding, which can be inborn or deteriorated with age
  • A stiff ankle or Achilles tendon at the heel can tip the balance of pressure on the foot and lead to added stress on the metatarsal heads
  • Intense activities that put lots of mileage on the feet, especially on the forefoot
  • Inappropriate footwear for specific physical activities or high-heel narrow shoes that put added pressure on the metatarsal heads or the anterior metatarsal arch
  • Systemic conditions such as diabetes, which may give rise to damages in the nerves
  • Joint disorder such as arthritis, gout or other degenerative disease of the joints
  • Obesity
  • Morton’s neuroma where one of the nerves between the metatarsal bones is affected and causes pain between the toes or on the ball of the foot
  • Calluses or skin lesions that may lead to an uneven distribution of the body’s weight to different parts of the foot

Prevention and Treatment

Depending on the underlying cause of metatarsalgia, treating and managing the root cause is first and foremost. Get the medical attention you require first.

If you participate in sports that put a lot of impact on the forefoot, such as running and tennis, you should take extra care to choose well-fitted shoes for adequate support and cushioning. Shoes with a wide toe box and a rocker sole will help to distribute weight more evenly to the rest of the foot. When at rest, elevating your feet will be helpful. If you are overweight, it certainly helps to shed some pounds to lighten the load for the foot.

Foot orthotics designed for metatarsalgia has also proven to be effective for many struggling to take their daily steps in less discomfort. One type of orthotics is a metatarsal pad placed behind the ball of the foot to distribute weight away from the sore area to the rest of the foot. Metatarsal cushions or pads can also be inserted in shoes to reduce the impact on the forefoot.

Most people are able to find relief with the conservative approaches, only a minority may need injections or surgery. Even after surgery is administered, using orthotic arch supports and wearing suitable footwear will help to prevent future recurrence.