Metatarsalgia is a condition in which discomfort is felt under the forefoot region, often referred to as the “ball of the foot”. This is a generic name, which may have many underlying causes.

What are the symptoms?

The symptoms of metatarsalgia usually develop gradually and can get worse over time. They include:

Pain

The pain is varied and can range from mild to severe discomfort and is often made worse with standing or walking. It is sometimes described as a burning or aching sensation, sometimes sharp, shooting pains.

Tingling or numbness

You may experience tingling or numbness in your toes. Some people also experience a sensation that feels like walking on pebbles or socks feel ruffled.

What can cause this condition?

• Certain footwear may predispose you to this condition, including high heels, tight fitting shoes and shoes with little cushioning.
• Being overweight or obese - this can alter your foot function and increase stresses through the foot
• Foot type and function - this may include a “flatter” or “high arch foot type”
• Foot deformities, such as hammer toes, may predispose you to pain in the forefoot
• Age - the fat pad that protects the foot can thin with age, making patients more likely to feel pain in the ball of their foot
• Tight muscles such as the calf muscle, which can cause increased pressures through the front of the foot
• Tendon or ligament injury
• Referred pain from another area
• Stress fractures in the foot - these occasionally occur in athletes or walkers and cause pain to come on rapidly, often with some degree of swelling.
• Inflamed small nerves known as neuromas, can cause forefoot pain.

Some medical conditions may lead to pain in the “balls of the feet”. These may include:

• Inflammatory arthritis, such as rheumatoid arthritis or gout
• Osteoarthritis - a “wear and tear” type arthritis
• Diabetes - which can lead to nerve damage and an altered foot shape

How is this condition diagnosed?

A foot care practitioner may diagnose your condition by examining the foot. In some cases blood tests and imaging such as ultrasound may be required.

What treatment options are available?

Treatments will depend on the underlying cause of your condition.

Calf stretches

Calf stretches are carried out regularly - as directed by your practitioner

Footwear

Appropriate footwear is worn, with cushioning and adequate width. Avoid footwear such as high heels which direct more pressure under the forefoot regions.

Orthoses

Orthoses (medical shoe insoles) may be prescribed to reduce the pressure under the forefoot and improve foot function

Weight management

If you are overweight, weight loss is important to support your health and recovery.

Pain killers

Pain killers may help to reduce some of your symptoms.

Injections

Injections may be useful for some cases of metatarsalgia

Surgery

Surgery may be required in a number of cases, (such as toe straightening) but this will depend on the underlying cause and your suitability for surgery

Prescribed medication

Prescribed medication may be given if the cause of the foot pain is due to a systemic condition such as rheumatoid arthritis.