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Pain in the Ball of Your Foot? Metatarsalgia.


Metatarsalgia is a term used to describe a group of painful condition in the forefoot, typically under the ball of the foot. Metatarsalgia is commonly characterized by pain and inflammation. The metatarsals are the 5-long bones right behind the toes. Each foot has five metatarsal bones that run from the arch of your foot to your toe joints.


(Typical) Symptoms:

  • Pain and/or burning sensation in the ball of your foot when standing, walking or running, which improves with rest

  • Sharp or shooting pain in your toes

  • Numbness or tingling in your toes

Common Causes:

  • Intense activity/ overuse

  • Foot trauma

  • Certain foot types, such as those with high arches are more susceptible to forefoot issues as more pressure is placed on the ball of the foot due to the lack of surface area in contact with the ground to spread the pressure. Or excessive flattening of your metatarsal arch which causes pressure to shift to the metatarsal heads.

  • Foot deformities (i.e. claw or hammer toes)

  • Arthritis

  • Fat pad thinning or shifting (the protective fat pad cushions the bones in the ball of the foot)

  • Bunions (affect weight distribution, and place more pressure on the smaller toes)

  • Excessive weight

  • Improper fitting footwear

  • Calf muscle tightness

Examples of common types of painful forefoot conditions classified under the metatarsalgia umbrella include:

Bunion/ Bunionette

A bunion is a prominent bump (bony enlargement) on the inside of the big toe joint due to increased pressure on the joint. A shift of the big toe toward the smaller toes often co-exists with a bunion. Bunions are progressive - they usually get worse over time, although some grow faster than others - often causing pain and impacting mobility. Bunions often come with inflammation, swelling and redness on the inside of the big toe joint - & shoes often aggregate the problem. A bunionette is the enlargement of the baby toe joint.

Hallux Valgus Deformity

Hallux Valgus is the shift of the big toe towards the smaller toes - it frequently co-exists with a bunion.

Hallux Limitus/ Hallux Rigidus

The most common site of arthritis in the foot is at the base of the big toe. Hallux limitus is the gradual loss of big toe joint range of motion in conjunction with joint degeneration, which can progress to hallux rigidus. Hallux rigidus is typically defined as a complete loss of motion in the big toe joint - a degenerative process in which the joint surfaces in your big toe joint begin to wear away and develop extra, joint-limiting bone. These little excess growths of bone are called osteophytes or more commonly "bone spurs".

Morton’s Neuroma (interdigital neuroma)

A Morton's Neuroma develops in response to irritation, pressure or injury to one of the nerves that lead to the toes.Typical symptoms include forefoot pain, numbness, tingling, burning or the sensation like you are walking on a marble or a pea. The common plantar digital nerves run between the metatarsal (long) bones in the foot. They are responsible for giving sensation to the toes. A Morton's Neuroma most commonly affects the nerve between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes, but can also occur between the second and third toes.

Metatarsophalangeal (MTP) Joint Capsulitis

This refers to a local inflammation under the metatarsal head (ball of the foot) sometimes due to degeneration of the ligaments that stabilize the metatarsal head. Often tenderness localized to the area under the metatarsal head is present.

Metatarsal Stress Fracture

A small break in the metatarsal bone often caused by repetitive stress. Typical symptoms include localized tenderness, which increases as the injury progresses if left untreated.

Freiberg's Disease

Although uncommon this condition occurs from a lack of blood supply to the 2nd metatarsal head which results in damage to the bone tissue. Usually pain presents on the top of the 2nd metatarsophalangeal joint, which becomes more severe with activity.

Conservative Treatment Options:

Depending on the cause, treatments options may include:

  • Wearing properly fitted footwear

  • Including a wide, square toe box

  • Low heel height (less than 1-inch)

  • Avoiding seams over prominent bones and joints (ie. bunions)

  • Thicker soles to help absorb shock

  • Wearing a supportive sandal or shoes inside the home, especially on hard flooring

  • Orthotics - to offload the ball of the foot and improve foot function

  • Footwear modifications and lacing techniques

  • Anti-inflammatory agents (including ice or oral anti-inflammatory medications)

  • Calf muscle stretching routine

Not all foot pain requires medical intervention, however if pain persists contact your physician for a referral to a Canadian Certified Pedorthist.

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