Metatarsalgia

What is Metatarsalgia?

Metatarsalgia is a general term for pain in the forefoot, specifically around the metatarsal heads. It often arises from excessive pressure or stress in that area.

• Common in high-impact sports or with improper footwear
• Can involve one or multiple metatarsals

Overview of the Condition

Repeated loading of the forefoot leads to inflammation and pain under the metatarsal heads. Contributing factors include foot structure (high arch), tight Achilles, or toe deformities.

Symptoms

• Sharp or burning pain under the ball of the foot
• Worse with running, standing, or walking barefoot
• Possible numbness or tingling in the toes

Causes

High-impact activities, wearing high heels, foot deformities, and excess weight can overload the metatarsal region, causing chronic irritation.

Diagnosis

Clinical evaluation identifies tender areas and checks for alignment issues. X-rays rule out fractures or arthritis; ultrasound/MRI rarely needed unless complicated.

Treatment Options

• Activity modification and rest
• Supportive footwear with metatarsal pads
• Orthotics to redistribute forefoot pressure
• Stretching, strengthening, and occasionally steroid injections

Conservative Management

Most cases improve with changing to supportive shoes, using forefoot padding, and performing exercises to relieve stress on the metatarsals.

Rehabilitation Exercises

1. Calf stretches to reduce forefoot load
2. Toe flexor strengthening for better weight distribution
3. Rolling the foot on a small ball to massage the arch

When is Surgery Needed?

Surgery is rare but may be considered if severe or persistent pain results from metatarsal alignment issues or structural deformities unresponsive to conservative care.

Surgical Procedures

• Metatarsal osteotomy to realign the foot
• Excision of bony prominences or calluses
• Toe deformity correction (e.g., hammer toe surgery)

Anatomy Overview

The forefoot bears significant load during gait. The metatarsal heads, located just behind the toes, can become painful under excessive stress or poor mechanics.

Affected Areas

• Metatarsal heads (commonly 2nd and 3rd)
• Soft tissues under the ball of the foot
• Adjacent toe joints if deformities shift pressure

Frequently Asked Questions

QuestionAnswerCan metatarsalgia go away on its own?Yes, if triggers (poor footwear, high-impact stress) are removed and appropriate supportive measures are taken.Do I have to stop running permanently?Not necessarily. Lower-impact cross-training and gradually resuming running with proper shoes can help manage symptoms.

Prevention Strategies

• Wear supportive shoes with cushioning
• Gradually increase running or sporting activities
• Maintain a healthy weight to reduce forefoot load

Related Conditions

• Morton’s neuroma
• Hammer toe
• Plantar fasciitis

Additional Treatments

In chronic cases, custom orthotics or metatarsal bar inserts provide relief by redistributing weight away from painful areas.