By definition, metatarsalgia (pronounced: meta-tar-sal-gia) is pain in the ball of the foot. This is a very common condition that most people have experienced in some way at some point in their life. Metatarsalgia usually presents itself while walking or performing physical activity and usually does not cause pain when you are at rest. When you are in bare feet it becomes more symptomatic and when you are walking in shoes it tends to be less painful. When it’s painful it’s usually at the base of the toes, feels sometimes like you have a wad of paper that’s stuck underneath the toes or your sock is wadded up. It usually can cause you to feel that you have to walk to the side or to the inside or outside of your foot to avoid pressure in the area.
Metatarsalgia is often associated with a callus or thickening of the skin underneath the ball of the foot. Metatarsalgia is also often confused with other conditions such as Morton’s neuroma and metatarsophalangeal synovitis. A big word, but it really just means inflammation of the joint at the base of the toe. When we refer to metatarsalgia, we are referring more to a pressure problem that occurs because of the ball of the foot being too prominent or receiving too much pressure. It’s often caused by metatarsal drop, where the middle metatarsals drop down a little bit further than the others. In most cases the body usually wants to have pressure more at the first and the fifth metatarsals and not directly on one of the middle metatarsals. When the middle ones get too much pressure they tend to cause pain, calluses and other issues.
How to treat metatarsalgia
Metatarsalgia can usually easily be treated at home. The first thing to do is start wearing shoes both outside and inside the house. I usually recommend purchasing some type of a slip on comfortable shoe for wearing around the house that you put on as soon as you come in the home. By doing so it allows for pressure to be relieved and cushioned over a longer period of time and often the swelling and the pain that has developed under the ball of the foot will disappear.
In addition, you should choose shoes that have more cushioning in the ball of the foot and allow the metatarsal heads to be able to sink in and be a little bit more cushioned. You should also make sure they aren’t too flexible, a little stiffer sole on the shoe will actually reduce the pain that you might have in your metatarsal head area.
You can also treat metatarsalgia with anti-inflammatories for soreness that comes on very rapidly and seems to be inflamed maybe after a hike or some type of sports activity. If you are not able to treat this at home using these methods then you will need to see your podiatrist. In most cases I would give it six weeks to two months to clear up and then at that point consider this something that should be treated properly by a doctor.
What to expect when you visit your doctor
When you see your doctor, your doctor will usually get an x-ray of your foot to determine whether the length of your metatarsals is appropriate and also to determine whether or not you’ve had a drop of the metatarsals or other deformities of the foot that might have led you to develop this pain. In addition, your doctor will often put a pad in your shoe that allows it to lift up so you don’t have pressure. Your doctor will then sometimes also use a custom orthotic which is contoured to your foot to allow reduction of pressure. If you have a hammer toe he or she will show you how to tape the toe and to reduce pressure from it.
Surgery for metatarsalgia
Metatarsalgia can be effectively treated with non-operative treatments most of the time using these things that we’ve discussed, but in some instances, and I would estimate that being anywhere from 20 to 50 percent of the time people do not get completely better with the use of these different types of pads and treatments. In those cases surgery is most appropriate. Surgery for this can be done in several ways. If your metatarsals are too long your doctor may shorten the metatarsal with surgery, and that allows for less pressure in that area. If the metatarsal has dropped the doctor may do a cut in the bone back further in the foot and may lift up the metatarsal to reduce the pressure from it. If it’s just simply because the metatarsal head has a spurt or is too prominent on the bottom you may have a surgery where the doctor will shave off the bottom of that metatarsal head and reduce pressure from that. In addition, he or she may also correct a hammertoe or a toe deformity that is causing a problem.
It’s very important that the diagnosis be made before any surgery is recommended because if this is confused with a Morton’s neuroma, for example, the appropriate surgical treatment may not be administered if the diagnosis isn’t correct. You should be aware of these other diagnoses and make sure that that diagnosis is made properly.