Metatarsalgia

What is metatarsalgia?

Metatarsalgia (pronounced “MET-ah-tar-SAL-gee-ah”) refers to pain and inflammation in the ball of your foot, or forefoot. This is the area between the arches and toes on the bottom of your foot. The pain of metatarsalgia typically centers under one or more of the five bones at the bases of your toes, the metatarsal heads.

Metatarsalgia has a number of different causes, including:

• Foot deformities.
• Health conditions involving your foot or ankle.
• Sports and other activities involving running or jumping.
• Wearing shoes that are too tight or too loose.

Treatment varies depending on your condition, but typically starts with simple measures like rest, stretches and over-the-counter (OTC) pain medications.

What are the symptoms of metatarsalgia?

The main symptom of metatarsalgia is pain in the metatarsal area under the ball of your foot. The condition may or may not be accompanied by swelling or inflammation. Metatarsalgia symptoms can come on quickly or develop over time. They include:

• Pain in the ball of your foot. This can be sharp, shooting, aching or burning. The pain may get worse when you stand, run or walk.
• Numbness or tingling in your toes.
• Feeling like you have a pebble in your shoe.

What causes metatarsalgia?

You may develop metatarsalgia if you participate in activities that involve jumping or running. Other causes of the condition include foot deformities and wearing shoes that are too high-heeled, too soft, unsupportive or overworn.

Foot and ankle surgeons divide metatarsalgia causes into three groups: primary, secondary and iatrogenic.

Primary metatarsalgia

You can develop primary metatarsalgia if there’s an issue with your metatarsals that affects their relationship with other parts of your foot. Examples include:

• Bunions (hallux valgus).
• Hammertoes.
• Calluses.
• High arches.
• Second toe is longer than your big toe.

Secondary metatarsalgia

Secondary metatarsalgia can happen if you have health issues or do activities that increase pressure on your forefoot. Examples include:

• Inflammatory conditions, like rheumatoid arthritis, gout, sesamoiditis and Morton’s neuroma.
• Neurological disorders, like Charcot-Marie-Tooth disease and Freiberg disease.
• Metabolic diseases, like obesity and diabetes.
• Other health issues, like a torn ligament and plantar warts.
• Trauma, from activities such as running and wearing ill-fitting shoes.

Iatrogenic metatarsalgia

Iatrogenic metatarsalgia is a complication of forefoot surgery. For example, bunion surgery may lead to changes in your big toe that cause metatarsalgia pain. Other complications include broken bones (fractures) that don’t heal properly (or at all) and avascular necrosis. While rare, these complications can occur.

What are the risk factors?

Anyone can get metatarsalgia, although runners and others who take part in high-impact sports or spend more time on their forefeet have the condition more frequently than others.

People who wear shoes that are ill-fitting, or don’t wear shoes when they need support (for example, when exercising, walking up and down stairs, or using ladders) experience metatarsalgia more than others. Also, wearing high-heeled shoes puts extra pressure on your metatarsals and heels.

In addition, people who have foot deformities and preexisting inflammatory conditions are more likely to have metatarsalgia pain.

What are the complications of metatarsalgia?

If you have any ongoing symptoms of metatarsalgia, you should see your healthcare provider. Untreated metatarsalgia can lead to other foot and ankle conditions that can cause you to limp. Metatarsalgia can also cause pain in other parts of your body, including your lower back and hip when you compensate and begin to walk abnormally.

How is metatarsalgia diagnosed?

Your healthcare provider will begin an exam for metatarsalgia by asking about your symptoms. They’ll also examine your foot manually. You may need a foot X-ray to rule out stress fractures or other problems that could be causing your pain. Other times, they may order an ultrasound or MRI (magnetic resonance imaging) to assess the soft tissues surrounding your metatarsophalangeal joints.

How is metatarsalgia treated?

Metatarsalgia treatment starts conservatively. That means your healthcare provider will want to avoid invasive measures like surgery and try simple, cautious options first. Treatment options may include:

• RICE method: Rest, Ice, Compression, Elevation.
• Over-the-counter pain medications: Acetaminophen (Tylenol®) or ibuprofen (Advil®).
• Stretches: Gentle foot and ankle stretching exercises.
• Changing your footwear: Wear athletic shoes or rocker soled shoes.
• Shoe inserts: Insert soft insoles or metatarsal pads in your shoes.

If these measures don’t help relieve your metatarsalgia, your provider may recommend an injection or surgery to resolve the underlying cause of your pain.

Can it be prevented?

You can’t prevent all cases of metatarsalgia, but there are ways you can avoid developing it. You may be able to prevent metatarsalgia by:

• Picking shoes with good soles, a wide toe box and a lower heel.
• Using comfortable inserts in your shoes.
• Avoiding walking barefoot.
• Soaking and using a pumice stone on your feet to help remove calluses. Removing these calluses can help relieve pressure.
• Maintaining a healthy weight for you.

What can I expect if I have metatarsalgia?

If you have metatarsalgia, you may have severe pain and inflammation in your foot. The pain may come on quickly or develop over time. You may experience other symptoms, as well.

The first thing you’ll want to do is rest your foot. Don’t participate in any activities or sports that you think may have caused the pain. If possible, don’t stand for too long or walk too much. Avoid wearing unsupportive footwear. Avoid walking in your stocking feet for long periods of time.

With some basic measures, you should be able to treat metatarsalgia yourself and be on your way. If the pain continues after at-home treatment, you’ll want to see your healthcare provider for further evaluation.

When should I see my healthcare provider?

You can usually treat metatarsalgia at home, but you should see your healthcare provider if:

• Metatarsalgia hasn’t improved after two weeks of home treatment.
• Pain prevents you from participating in your typical activities.
• Pain gets worse and/or keeps returning.
• You have a loss of sensation or tingling in your foot.
• You have diabetes along with foot pain, as it can be more serious if you have diabetes.

When should I go to the ER?

If you notice any of the following signs, you should go to the emergency room immediately. You may have a more severe injury, like a broken bone.

• Severe pain in the ball of your foot.
• The pain causes faintness, dizziness or nausea.
• You can’t walk.
• The shape of your foot has changed.
• You injured yourself and heard a snap, popping or grinding noise.

What questions should I ask my healthcare provider?

Questions you may want to ask your provider about metatarsalgia include:

• Do you know what caused my condition?
• What treatment do you recommend?
• Can I still participate in the activities I enjoy?
• When will I start to feel better?
• What can I do to prevent metatarsalgia in the future?

A note from Cleveland Clinic

Metatarsalgia pain can be intense. It can make it difficult for you to enjoy the things you love. You may not even be able to walk. Luckily, you can usually treat the condition yourself with some simple at-home measures. If rest and a new pair of shoes don’t do the trick, reach out to your healthcare provider. They can evaluate your symptoms and determine if you need more extensive treatment.