Metatarsalgia
Definition
Metatarsalgia is a condition marked by pain and inflammation in the ball of your foot.
Metatarsalgia is caused by the compression of a small toe nerve between two displaced metatarsal bones. Inflammation occurs when the head of one displaced metatarsal bone presses against another and they catch the nerve between them. With every step, the nerve is pushed together by the bones and then rubbed, pressed again, and irritated without relief. Consequently, the surrounding nerve tissue becomes enlarged, with a sheath of scar tissue that forms to protect the nerve fibers.
You may experience metatarsalgia if you’re physically active and you participate in activities that involve running and jumping. Or, you may develop metatarsalgia by wearing ill-fitting shoes. There are other causes as well.
Causes
In the foot there are small toe nerves between the metatarsal bones. When the head of one metatarsal bone is pressed against another, the small nerve is caught between them and starts to become inflamed, thus causing metatarsalgia. The condition can worsen as weight is put on the foot, because with each step the metatarsal bones rub together more and more, which causes the inflammation of the nerve to increase.
Some common causes of metatarsalgia include:
• Badly fitting footwear, high-heeled or tight, restrictive shoes or boots – shoes with a narrow toe area or high heels can force the ball of the foot into a small amount of space, which puts more pressure on that area.
• Being overweight or obese – this can increase the pressure on the foot.
• Age – older people are more susceptible to metatarsalgia as the fat pad that protects the foot can thin with age, making them more likely to feel pain in the ball of their foot.
• Bone structure of the foot – narrow, high-arched feet or flat feet can increase the chance of metatarsalgia.
• High-impact sports, such as running or tennis, put extra pressure on the foot.
• Stress fractures in the foot – these occasionally occur in athletes or walkers and cause pain to come on rapidly.
Treatment and Prevention
Conservative measures usually relieve the pain of metatarsalgia.
• Rest. Protect your foot from further injury by not stressing it. You may need to avoid your favorite sport for a while, but you can stay fit with low-impact exercises, such as swimming or cycling. Continue with stretching and lower body strength training as your pain permits.
• Ice the affected area. Apply ice packs to the affected area for about 20 minutes at a time, several times a day. To protect your skin, wrap the ice packs in a thin towel.
• Take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin, others), naproxen (Aleve, others) or aspirin to reduce pain and inflammation.
• Wear proper shoes. Your doctor may recommend a shoe that’s especially suited for your foot type, your stride and your particular sport.
• Try shock-absorbing insoles. This off-the-shelf shoe inserts — often made of cork, plastic, rubber or a gel-like substance — fit inside your shoes to help cushion shock.
• Use metatarsal pads. These off-the-shelf pads are placed in your shoes just ahead of the metatarsal bone to help deflect stress away from the painful area.
• Consider arch supports. If insoles don’t help, your doctor may recommend arch supports to minimize stress on the metatarsal bones and improve foot function. Off-the-shelf arch supports come in various sizes and can be fitted immediately. More durable arch supports can be custom-made from a foam mold or plaster cast of your foot.
Rigid arch supports are made of a firm material such as plastic or carbon fiber. They’re designed to control motion in two major foot joints below your ankles. Semirigid arch supports are made of softer materials such as leather and cork reinforced by silicone. Arch supports designed to treat metatarsalgia may include metatarsal pads, too.
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