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Metatarsalgia

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Having pain at the front of your foot or your midfoot can make it difficult to walk and live comfortably. Our podiatrists understand the importance of prompt and effective treatment of forefoot pain so you can get back to moving without pain.

What Is Metatarsalgia?

Metatarsalgia is the name given to describe pain at the front of your foot. The name comes from combining the area of pain - your metatarsals (the long bones of the feet), with the ‘algia’ suffix which means ‘pain’. Hence, the literal translation is pain at the long bones of the feet. 

Interestingly, despite metatarsalgia being listed as a common diagnosis by health professionals, it is actually a broad term that encompasses a range of potential forefoot problems and conditions. If your initial diagnosis with us is unclear and you need medical imaging to confirm the exact structures that have been damaged, we may label your interim diagnosis as metatarsalgia.

Metatarsalgia is a common problem because of the large amount of weight the joints and tissues at the ball of your feet take on with every step. During every part of your gait cycle where one foot is in the air, the other is bearing the entire weight of your body. This places a very large demand on your feet, which is why it’s essential to always keep our feet supported with the right footwear, take good care of our feet in general, and treat any aches or niggles as they arise - before they get worse.

Symptoms Of Metatarsalgia

As metatarsalgia can include a range of problems or conditions, you may feel anything from a dull or throbbing ache to sharp severe pains at the ball of your foot. The pain will likely be exacerbated by walking, especially in hard or unsupportive shoes. Going up on the ball of your foot or your toes may feel very painful, which can catch you off guard during regular activities like walking up stairs or hills. You may find that your pain is localised to a specific joint or area that is tender to touch, swollen, red, or warm. You may also feel some burning or tingling if the nerves in the area have been affected.

What Causes Metatarsalgia?

Anything that overloads the ball of the foot and places it under excess strain or pressure may lead to metatarsalgia. There is a wide range of causative factors which include:

• Wearing unsupportive or poorly fitting shoes, especially high heels that overload the forefoot, can contribute to the development of metatarsalgia
  
• Physical activity that overloads the forefoot. This may be purposeful exercise like from playing sports or doing gym workouts, or from incidental exercise like climbing stairs
  
• Our foot structure or function can play a role, like having a tight Achilles tendon, or from other foot problems like claw toes or a bunion.
  

If you suspect you have metatarsalgia, it’s important to see your podiatrist who can help identify the likely causes and create an effective treatment plan. Specifically, they may also diagnose you with:

• Bursitis or capsulitis
  
• A plantar plate tear
  
• A Morton’s neuroma
  
• Arthritic changes to the forefoot
  
• Metatarsal stress fracture
  

Risk Factors For Metatarsalgia

You may be more at risk of developing metatarsalgia if you participate in a lot of high-impact activity such as those that involve running or jumping, have a higher body weight, are older (our protective pad at the bottom of the foot can thin with age), or have differences in the shape of your feet or toes that places more pressure on the ball of the foot such as flat feet or high arches.

Diagnosis

Diagnosing metatarsalgia accurately is important to understand exactly which structures have been damaged, so that the best, specific and timely course of treatment can be prescribed. 

Our podiatrists will undertake a comprehensive assessment to identify the cause of your forefoot pain. This will involve a video gait analysis and an in-shoe pressure analysis which help uncover whether the way you are loading your feet during gait is likely to have contributed to the development of the problem, along with your shoes. If needed, we will refer you for x-ray or ultrasound imaging to gain a clearer picture of the severity of the damage.

Metatarsalgia Treatment

After we understand the extent of your injury and importantly why it has occurred, our podiatrists will prescribe a custom treatment plan for you. There are three stages to treating metatarsalgia: relieving your initial symptoms, supporting the damaged structures to heal and make a full recovery, and finally keeping you pain-free by putting the right measures in place to help reduce the risk of the problem returning in the future.

Treatment At Home

• If your forefoot feels inflamed, you can apply ice to the area for 15 minutes at a time, taking a break between icing sessions. Be careful not to apply the ice directly to the skin, instead wrap it in a tea towel or other protective layer. Alternatively you can place your foot in an ice bath for the same time, doing so a few times per day.
  
• To help with pain, you may use non-steroidal anti-inflammatories (NSAIDs) to help give you some relief
  
• Avoid any action that exacerbates your pain. This will likely include standing on your tiptoes
  
• Keep your feet supported in good shoes, even inside the home. This can help reduce the stress on the damaged, painful area, and help reduce your symptoms
  
• If you already have orthotics at home, wear them, and continue to do so if they are helping you get relief from your symptoms
  

 

Podiatrist Treatment For Metatarsalgia

We use an evidence-based treatment approach that considers your unique preferences, goals and characteristics. Your podiatrist will discuss all of your treatment options with you during your appointment to create the best plan. This may include:
 

• Footwear advice or modifications: to ensure your footwear is supporting your recovery and keeping you pain-free, instead of contributing to the development or perseverance of the problem
  
• Laser treatment: laser treatment is a proven, painless and safe way to treat a range of pains while reducing inflammation, promoting wound healing and supporting soft tissue repair. We often use it to accelerate the recovery from metatarsalgia
  
• Custom foot orthotics: to help offload the painful structures in order to alleviate pain and support healing, while also supporting an optimal gait
  
• Shockwave treatment: shockwave has a range of benefits to the tissue repair and recovery process including reducing pain, resetting the inflammation cycle, stimulating collagen production, promoting new blood vessel formation and more. Shockwave is proven to help with a range of forefoot pains including bursitis and a Morton’s neuroma
  
• Immobilsation: in severe cases, like with a fracture of a soft tissue tear, immobilising the foot using a moon boot or CAM walker may be the gold standard approach to helping you get the best results
  
• Stretching and strengthening program: many contributing factors to forefoot pain include tightness of weakness in the muscles and tissues. Part of your assessment always looks at whether any discrepancies are present, and then addresses them appropriately
  
• Strapping: by strapping the foot in a specific way, we can help alleviate pain and help offload the affected area. An example is using ‘plantarflexion’ taping for a plantar plate tear, and ‘buddy strapping’ for a turf toe
  
• Temporary offloading/padding: by placing temporary felt padding inside of your shoes, we can help offload the painful area beneath your forefoot to give you relief, while supporting healing
  

Sports and Metatarsalgia

As high-impact weight bearing sports can overload the forefoot and cause further injury, we may also recommend some activity modifications until we achieve the desired level of healing and pain reduction. We know how important exercise is for many of our patients, and we want to assure you that you can still stay active and exercise with metatarsalgia - it’s just the activities that you do and the way you go about it that may need to change temporarily. 

• Running: running can be particularly demanding on your metatarsals, especially if you’re a forefoot runner. Depending on the severity of your symptoms, we may recommend that you reduce your mileage, run on softer surfaces, or temporarily switch to a low-impact activity.
  
• Cycling: cycling is also closely associated with metatarsalgia. This is especially true if you wear carbon fibre cycling shoes, which have gained popularity for their stiffness, but also unfortunately result in 19% higher peak plantar pressures in the forefoot. Your podiatrist will discuss with you how you may still be able to cycle during your recovery with some adjustments.
  

Exercises for Metatarsalgia

While we always recommend following the guidance of your podiatrist for metatarsalgia exercises as part of your treatment, here are a few simple exercises you can try at home before you’ve seen your podiatrist. It’s important to note that any stretch you do should never feel painful. Tension or tightness is fine, but pain is not. If you feel any pain, cease the action immediately.

Calf stretch

Tightness in your calf muscles and your Achilles tendon (below) can have a direct impact on the pressure on your forefoot with any given step. Hence, keeping the calves stretched and flexible can help reduce this overloading and help prevent the recurrence of metatarsalgia in the future. 

• Stand at an arm’s length away from a wall, placing your hands on it.
  
• Step forward with one foot, keeping the back heel on the floor with your knee straight.
  
• Hold the stretch for 30-60 seconds before switching legs.

Achilles stretch

• Find a step or a small ledge, next to an object that you can keep yourself supported on like a wall or a chair. 
  
• Hang the back of your heels off the edge
  
• Slowly lower your heels until you feel the stretch, and hold for a few seconds.
  
• Lift your heels back up so that they’re level with the step.
  
• Repeat eight times, then switch feet

Big toe stretch

When your big toe is stiff and has reduced mobility, it can lead to extra pressure being placed on your lesser four toes. This can contribute to the development of metatarsalgia.

• Roll up a small hand towel and place it on the floor
  
• With the rest of your foot firmly on the ground, place your big toe up on top of the rolled towel
  
• Keeping the opposite leg behind you for support and stability on the ground, bend your front knee forward until you feel a stretch under your foot.
  
• Hold in this position for 45 seconds and repeat on the opposite side
  

FAQs

What is the difference between a stress fracture and metatarsalgia?

A stress fracture describes tiny micro-cracks in a bone that occur for the same reasons as metatarsalgia - repetitive overloading. Metatarsalgia can include a stress fracture under its umbrella of forefoot pain, but it can also include many other tissue and joint injuries. Learn more about stress fractures here.

Can metatarsalgia be cured?

Absolutely. Once we help repair the damage and address the contributing factors, in most instances you should be back to walking and living without pain and be cured of your metatarsalgia. It can come back in the future, but that is independent of your current course of treatment.

Can you walk with metatarsalgia?

While we don’t encourage going on long walks with metatarsalgia that is not being treated and addressed, or if your foot is not well supported, we also take a realistic approach to treatment that considers your quality of life. Most people cannot take time off work for foot pain, or neglect their responsibilities at home. As such, our treatment supports you in staying active and walking when it comes to your daily responsibilities, while modifying exercise-related walking to support your recovery.

Does metatarsalgia go away?

On its own, if the cause of your metatarsalgia is not addressed, it is unlikely to go away for good. You may go through flares where the pain is better or worse, absent or present. This will likely be influenced by your level of activity and your specific causative factors (like the shoes you wear). Unfortunately for many this means battling with a recurring problem for many years before finally seeking long-term relief from their podiatrist.

How long does metatarsalgia last?

The speed of your recovery really depends on the severity of your pain and injury, and which specific structures have been injured. As this is a broad condition, recovery can take anywhere from weeks to months. Your podiatrist will be able to narrow down the timeframe for you after your assessment, based on what the cause and severity is in your unique case.