Metatarsalgia

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What is metatarsalgia?

Metatarsalgia is pain in the ball of the foot, or forefoot, just beneath the base your toes. This area of the foot contains five bones, called metatarsals. The metatarsals form joints with the toe bones at one end and other foot bones, called tarsals, at the other end. The pain often affects the heads of the metatarsals, which are the ends at the toes. Forefoot pain can be sharp or achy. It usually worsens when you flex your foot or with weight-bearing activities. This can include walking, running, or even just standing. Hard surfaces can make these activities especially painful.

Metatarsalgia is uncomfortable and can interfere with your life. However, the cause is usually not serious and the pain normally responds to conservative treatments. This includes resting, icing your forefoot, changing your activities, and making sure your shoes fit properly. Seek prompt medical care if ball of the foot pain persists for more than a few days despite making these changes.

What other foot symptoms might occur with metatarsalgia?

Depending on the cause of metatarsalgia, you may notice other symptoms affecting the ball of your foot. You may also have symptoms in other areas of the foot.

Forefoot-related symptoms that may occur along with metatarsalgia

Along with pain, you may also notice inflammation or bruising in the area. People sometimes feel like they have a pebble or another object in their shoe as well. Some causes of the pain can result in deformities you can see, such as bunions and hammer toes.

Other symptoms that may occur along with metatarsalgia

Because metatarsalgia often affects the toe end of the bone, you can have symptoms in your toes. This includes numb or tingling toes and burning or other abnormal sensations in the toes. Moving or flexing the toes can also worsen the pain in your forefoot.

When any of these foot symptoms continue for several days, you should seek medical care. Your doctor may recommend X-rays to see whether a stress fracture or other bone or joint problem is the cause of your pain.

What causes metatarsalgia?

There are various causes of metatarsalgia. They all have a common root cause—something changes that affects the way your foot works. This change puts pressure on the metatarsals, which eventually results in pain and other symptoms. Until you find the cause of the change and make adjustments, the symptoms will continue.

Common metatarsalgia causes include:

  • Arthritis including osteoarthritis, gout, and other forms of inflammatory arthritis

  • Bunions, which are bony bumps at the joint of the big toe and metatarsal. They can also develop at the joint of the little toe and metatarsal.

  • Calluses on the bottom of the foot, which build up and put pressure on the forefoot

  • Damaged ligaments, which are bands of connective tissue that attach bones to other bones

  • Failure to rest adequately after foot surgery, particularly surgery on the big toe such as bunion surgery

  • Foot shapes that predispose people to having excess pressure on the forefoot. This includes having extra long metatarsals or high foot arches.

  • Hammer toes and claw toes, which cause the toes to contract and bend at the toe joints. This puts downward pressure on the metatarsals.

  • Morton’s neuroma, which is a thickening of the nerve tissue between the third and fourth metatarsal heads at the toe joints

  • Overweight and obesity, which puts excess pressure on the feet. This worsens with age as the fat pad on the ball of the foot thins.

  • Shoes with an improper fit and those that put extra pressure on the forefoot. This includes high heels, loose shoes that let the foot slip, and shoes with narrow or tight toe boxes.

  • Stress fractures, which are thin cracks in a bone due to repetitive stress or force on the bone. This is a form of overuse injury that is common in runners and other athletes.

In some cases, your doctor may not be able to find an underlying cause of the pain.

What are the potential complications of metatarsalgia?

Left untreated, metatarsalgia can lead to complications. Pain in the forefoot often leads people to adapt and change their walking gait to minimize the pain. This can eventually make the problem worse and cause lower back pain and hip pain. When pain in the ball of your foot is due to an injury, such as ligament or bone damage, failing to treat it can lead to improper healing. This can result in chronic pain and foot problems.

Metatarsalgia treatment of the underlying cause usually cures the pain. Working with a physical therapist or occupational therapist can help prevent future problems. These therapists will focus on strengthening supporting muscles, improving flexibility, and wearing proper footwear. You can continue with metatarsal exercises at home. You may also need orthoses or other shoe inserts (orthotics) to accommodate any foot issues.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 23
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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