What Is Metatarsalgia

Metatarsalgia is the technical Latin term for pain that occurs in the ball or forefront area of the foot. It can occur on either foot singly, or in both feet at once. The term encompasses pain occurring anywhere in the section of the foot located between the arch and the toes.  There are several different bones and structures present in this area, but some of the most significant when it comes to Metatarsalgia are the fat pad between bones and skin, which serves as a cushioning barrier to protect the bones from pain and injury, and the metatarsal heads.

metatarsalgiaThe metatarsal heads are the ends of the ends of the metatarsal bones. These bones connect to the toes, and they can be prone to injury because of the way human gait is structured. Every time a human steps out with one foot, the forefront area of the foot comes under great pressure as we move our weight forward onto it. When a person pushes off with the ball of the foot and the toes during walking, pain will occur unless the structures, including bones, in this area are not perfectly aligned. Likewise, if the protective fat padding over the bones has thinned, been damaged in some way, or has slipped out of place, walking will cause pain in the ball of the foot region.

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Symptoms of Metatarsalgia or Ball of Foot Pain

Although this condition is associated with a great many different symptoms, the primary one is a sensation of pain that can take on a variety of forms. However, there are other warning signs besides pain.

The following symptoms may occur in isolation or in various combinations with one another:

pain in the forefront of your foot – the area between the arch and the heels

The pain can take on several forms. It may be sharp and feel like it is shooting through the foot, or it might resemble more of a dull, constant ache when the feet are in use. Some patients even report a burning sensation that has been diagnosed as metatarsalgia.

Many patients report that the pain associated with metatarsalgia improves or even vanishes with rest, but returns upon standing, walking, running, and jumping. Another common profile is for the pain to get worse the longer the physical activity goes on.

  • pain that seems to radiate, moving from the ball of the feet toward the toes or even into the toe area
  • tingling in the toes
  • numbness in the toes
  • difficulty flexing the foot without experiencing worsening pain
  • increased pain when walking or running across hard surfaces
  • increased pain when walking or running barefoot
  • an odd sensation on the sole of your feet, making you suspect you have a small rock or other obstruction inside your shoe. Upon examination, no pebble or other small object can be found.
  • the development of calluses across the ball of the foot.

What Causes Metatarsalgia or Ball of Foot Pain

Any adequate discussion of the exact causes of metatarsalgia will contain some technical terminology. In order to better understand the structure of the foot and how metatarsalgia can develop in this area, a review of some basic foot anatomy will prove helpful.

metatarsalgia imageThe main structures inside the foot are bones and soft tissues. The bones work together in joints because they are connected to one another by various soft tissue elements such as ligaments, tendons, and muscles. In order for joints to work properly, the ligaments, tendons, and muscles must hold the bones in perfect alignment. If anything goes wrong inside these anatomical structures, bones will be pulled out of alignment.

The result of this is pain, sometimes extreme, and difficulty using the joints. This may mean that walking becomes difficult or impossible; it can also mean that people change their customary gait in order to adapt. This change of gait can lead to misalignment in other bodily structures over time; lower back problems are particularly frequent among people who have begun walking awkwardly in order to compensate for pain in their feet.

Another result of a changed gait can be the development of calluses. While some people regard calluses as normal or even inevitable, in many cases they result from something going wrong in the underlying structures in the foot, notably the bones and the joints.

When it comes to understanding the bone structure in the front of the foot, a few pointers about terminology can be very helpful. Each foot has five bones called metatarsals. These are not the toe bones themselves, but rather are the bones that connect the toes to the rest of the foot. The metatarsals must be in precise locations relative to one another in order for the foot to function in a correct and pain free manner. The ends of the bones we call the metatarsals are referred to as the metatarsal heads. The structure that all the metatarsals form together is called the metatarsal arch because it has a curved appearance that gives the front of the foot its characteristic shape.

Exact Causes Metatarsalgia or Ball of Foot Pain

One cause can be genetic in nature: a foot that happens to possess naturally high arches. The problem with this foot profile is that when the person takes steps, the high arch will not make contact with the ground. The result of this is to force all of the person’s weight forward onto the ball of the foot. In a normal gait, some of the weight rests on the ball of the foot and some of it rests on the arch itself.

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Forcing excess weight onto the metatarsal heads, especially over time and with regularity, the joints take on too much stress. This results in not only pain, but also swelling and inflammation in the forefront area of the foot. This is unavoidable unless medical attention is sought since people will high arches, like the rest of us, can’t avoid a daily routine that includes a great deal of walking.

Another cause is a dropped metatarsal. In medical jargon this can also be called a displaced metatarsal head or even a plantarflexed metatarsal head. In this situation, there is a problem with the metatarsal arch, which has started to flatten out instead of keeping its characteristic curved shape. It is normal for the metatarsal arch to flatten out each time we take a step, but it should “spring back” into position as we walk forward. If it doesn’t, it can be said that the metatarsal arch is beginning to lose its shape.

The underlying cause of the metatarsal arch losing its shape is that one of the metatarsal heads has fallen out of alignment with the rest of the arch. In some cases, more than one metatarsal head on the same foot may simultaneously be in a “dropped” position.

A dropped metatarsal can become a serious issue because it will cause a deformation in the way the foot functions whenever the patient walks, runs, or even stands. Because the dropped metatarsals sit lower than the rest of the arch, they will take on a disproportionate amount of body weight during physical activities. Over time, the metatarsal heads so affected will more or less object to this treatment by reacting with pain and swelling or inflammation.

A related problem with dropped metatarsals is that as excess pressure is brought to bear on a single bone, it tends to push itself downward into the fat padding that normally separates the bones of the feet from the skin. This is painful, to be sure, but with enough time the bone can actually begin to emerge through the fat pad – or to the side of it if the metatarsal has pushed the fat pad away rather than pushed through it. It is not uncommon for patients with a severely dropped metatarsal to be able to feel the bone sticking out where it doesn’t belong when they press against the ball of their foot.

The situation in turn can lead to the development of a callus.

There are several reasons why a dropped metatarsal might develop in the first place. Among the most prominent are the following:

  • wearing high heeled shoes:  As these tend to force more weight than usual onto the ball of the foot, they place undo strain on the tendons and ligaments that serve to connect the metatarsals together. This can flatten out the metatarsal arch and cause individual metatarsal heads to “drop.”
  • injuriesIt is very important that any damage to the front of the foot be seen by a medical professional so that it can be properly healed. Improper healing can lead to joints or bones getting “fixed”  into a position which is abnormal. After this happens, it becomes more likely that a metatarsal head will be pushed, or even snap, out of position and end up dropping. Common bottom of foot injuries that must be treated by a physician include dislocated joints and fractures of the metatarsal.
  • Naturally flexible feet:  This underlying cause is genetic in nature. If the tendons, muscles, and ligaments are not stretched to the correct degree of tautness in the natural structure of the foot, the metatarsal arch will not be adequately held together in the proper alignment. It then becomes somewhat likely that over time, one or more metatarsals may drop.
  • A third major cause of dropped metatarsals is a problem with the fat pad on the bottom of the foot rather than with the bones or tendons. The purpose of this fat pad is to provide shock absorption as people walk, run, or go about their daily business.  The fat pad must be of sufficient thickness in order to take on this role.  Several factors can contribute to thinning of this important fat pad:
    • Diseases such as arthritis or endocrine disorders. Connective tissue diseases can also contribute to thinning.
    • The aging process. How fast the fat pad thins is a genetic consideration. Some people are more naturally prone to rapid thinning.
    • Excessive strain on the forefront of the foot. This can arise from a myriad of causes including inadequate footwear (insufficient padding on the bottom), going barefoot, or wearing high heeled shoes.

Treatment Options for Metatarsalgia

Home Care

A variety of basic home care procedures are recommended for people dealing with pain in the ball of the foot area. These include:

  • Rest and elevation, particularly after spending time on your feet
  • Reducing the total time you spend on your feet and / or engaged in physical activity
  • Ice applied to the arch of the foot and the ball area, not to the toe area. Many experts recommend 15-20 minutes per session, repeated 2-3 times each day to provide relief.
  • Wearing shoes when walking or running
  • Avoiding high heels – limit heel height to no more than an inch, and less than that if you still experience problems
  • Callus pads made in a large U shape to keep your metatarsals from taking on as much weight
  • Commercial metatarsal pads and arch supports
  • Losing weight if you are overweight – this is also a preventative measure that you can take to help avoid the condition of metatarsalgia
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Custom Orthotics

Many physicians recommend the use of orthotics (shoe inserts) and support the view that custom made inserts are preferable to store bought ones. Custom orthotics are made to conform exactly to the contour that an individual foot needs to maintain a proper metatarsal arch.  Custom orthotics are generally not made of cheap plastic, which can be brittle, but of advanced polymers which provide shock absorption and comfort.

Over time, the use of custom orthotics will move the metatarsals into proper alignment and help them to stay in place. As this process occurs, pain will lessen on its own.

The reason why custom orthotics are so beneficial is because each case of dropped metatarsal is a little different. Not only is each individual foot of a unique shape, size, and contour, the insert must also take into account which of the five metatarsal heads has dropped and by how much. Custom orthotic will provide just the needed amount of support in exactly the needed position. They also serve to provide an artificial layer that can augment the action of the fat pad in cushioning the ball of the foot during physical activities.

Additionally, custom orthotics help correct incorrect gait that may have developed as a compensating factor to deal with pain, and they serve to provide support to high arches so that less pressure ends up on the tender balls of the feet.