Metatarsalgia is a general term describing pain in the metatarsals, which are the long bones of the feet. It is commonly referred to as a symptom (pain at the ball of the foot) of other conditions, as opposed to a condition in itself. Because the metatarsal bones should have weight and forces evenly distributed between them through every step, problems that overload a particular metatarsal or group of metatarsals can quickly become very painful for those affected.  

What causes metatarsalgia?

Because metatarsalgia is a broad term that can refer to many conditions, the causes can vary greatly. Commonly, there may be biomechanical and alignment issues involved that place greater stress on the metatarsal bones at the ball of the foot. This may not refer to just the bony structure, but also refer to weak muscles and ligaments that allow the positioning of the metatarsals to change and take on a greater load. Generally, causes can include:
  • Systemic diseases such as diabetes
  • Joint degeneration such as from arthritis
  • Irregularities in bone size or shape, such as an enlarged metatarsal head
  • Other conditions in the feet such as hammertoes or claw toes
  • Any skin conditions affecting the bottom of the foot that alter the weight distribution on the met heads, such as callus
  • Fat pad atrophy, which reduces the cushioning beneath the met heads
  • High-impact activities that overload and stress the metatarsals
  • Poor footwear that cramps the feet and causes changes in the position of the bones, place greater pressure on the metatarsals or offer little support or cushioning to the midfoot and metatarsals
  • Increased weight

What are the symptoms?

Metatarsalgia is characterised by pain at the ball of the foot. The pain can range from sharp to a dull ache. The pain is usually exacerbated by walking and putting pressure on the metatarsals. Depending on the cause, swelling may also be present, which may irritate the surrounding structures of the foot and cause the pain to radiate.  

How is it treated?

The treatment of metatarsalgia must address its specific cause. The first step is then to identify this cause. This can be done through an assessment with your podiatrist, which will examine everything from the biomechanics and alignment of your feet and legs to pressure testing, muscle strength testing, footwear assessment, gait analysis and more. Any concurrent conditions, such as callus or bursitis in the feet, also need to be managed appropriately. While the PRICE (protection, rest, ice, compression and elevation) principles can help relieve the painful symptoms, treatment needs to be directed at correcting the cause so that metatarsalgia doesn’t become an ongoing issue. To achieve this, treatment may include:
  • Orthotics to correct alignment issues in the feet and legs and offload pressure away from painful metatarsals
  • Assessing footwear to ensure it is helping and not hindering your recovery
  • Increase cushioning at the forefoot
  • Strengthening weak muscles
  • Stretching tight muscles
  • Gait retraining and assessing running technique