By John Sigle, DPM, FACFAS, Foot & Ankle Center of Illinois
Unlike most Americans who can’t wait to come home at night and kick off their shoes, some people with Metatarsalgia (met-a-tar-sal-gia) actually experience more pain when they walk in their socks or bare feet. Metatarsalgia is a condition characterized by a sharp aching or burning pain and inflammation in the ball of the foot. It affects the metatarsal heads, the bones that make up the ball of the foot. The first metatarsal head behind the big toe is the most common area affected but it can also affect the other toes, the entire foot, or both feet. Other symptoms include tingling or numbness in the toes; pain around the second, third, and fourth toes or only near the big toe; increased pain when you walk, run, jump, or when you stand or flex your feet. Patients with this condition often feel like they have a stone in their shoe, or that their socks are wadded up causing them to walk on the side of their foot to avoid pressure. Also, calluses often form on the ball of the foot because of the friction caused by unequal pressure distribution points.
Metatarsalgia can affect males and females of all ages. It is primarily related to repetitive stress and impacts on the foot, and is often experienced by people who participate in intense physical
activities or training such as running, tennis, soccer, and basketball. Metatarsalgia generally occurs from a single cause, but other factors may contribute to this condition. These include wearing ill-fitted shoes (high heels), having certain foot and toe shapes (high arches, a second toe that is longer than the first metatarsal), being overweight, or old age. It can also be attributed to a stress fracture or other foot deformities like a hammer toe or bunion, or from Morton’s Neuroma (a fibrous tissue around the digital nerve between two metatarsal heads of the toe), diabetes, Rheumatoid Arthritis, fluid in the foot, and gout.
There are a variety of home remedies that should be tried prior to contacting your podiatrist. This condition is relatively easy to treat if addressed during the early stages. Some of the things that can be done include wearing properly fitting shoes indoors and outdoors. avoiding pressure and impact loads, resting your feet and keeping them elevated, applying ice throughout the day, taking anti-inflammatory drugs (such as ibuprofen), using metatarsal pads, shock absorption pads, or arch supports. If your pain persists for a month or so, schedule an appointment with a podiatrist for a diagnosis and proper treatment. There are a variety of problems that can cause symptoms similar to Metatarsalgia. Most likely, it will be necessary to do a gait analysis to identify the areas in the foot that are receiving pressure, image tests (X-ray or MRI) or ultrasound to confirm if there are fractures or if the problem is related to a metatarsal drop or improper length. Imaging will also help your podiatrist determine if the pain is being caused by a
Morton’s Neuroma. Blood tests may also be necessary to rule out
gout, diabetes, or arthritis.
Your podiatrist may also be able to offer you a custom orthotic device to alter the pressure distribution of the metatarsal region and relieve inflammation and pain. An orthotic device can be added to all shoe types (except sandals) and will be particularly helpful for running and athletic shoes. Orthotics is also well suited for individuals who have a high arch because it can prevent the arch from collapsing and relieve stress on the metatarsals. Orthotics is also effective for people with a Morton’s Neuroma because it provides an extension underneath the big toe.
Laser therapy is the latest advancement that is being used for patients in the acute phase of Metatarsalgia. The lasers are designed to reduce pain, relieve inflammation, and restore mobility. These lasers use specific wavelengths of light that have a strong anti-inflammatory, anti-edema effect on tissues. Photons of laser energy penetrate deeply into tissue and accelerate cellular reproduction and growth, thereby speeding recovery. Painful conditions accompanied by swelling or inflammation benefit from this technology. Once the inflammation subsides, physical therapy may also be used to increase range of motion, reduce stress on the forefoot, and strengthen the toe flexor muscles.
For more severe cases where conservative treatment and therapies have failed, steroid injections or surgery may be recommended. Surgery may involve a correction of a hammertoe deformity, release or removal of a nerve impingement, or reshaping of the metatarsal bones. If you are suffering from Metatarsalgia foot pain and want relief today, follow some of the home remedies listed above or contact a podiatrist for a diagnosis and treatment. If you are seeking assistance from a board certified podiatrist, contact the Foot & Ankle Center of Illinois at 217-787-2700. Visit myfootandanklecenter.com to view a short video on cutting edge MLS Laser Therapy and to obtain information on custom orthotics.