If you’re experiencing pain in the ball of your foot, you’re probably wondering what caused it. Maybe you’re feeling it across the entire ball of your foot or perhaps it’s just in one specific place. Either way, it’s likely putting a damper on your activities, and you want to eliminate it. If you’ve already been to a doctor they may have diagnosed you with metatarsalgia. While metatarsalgia is a catch-all phrase for different types of ball of foot pain, they all have two things in common---pain and inflammation.
Symptoms of Metatarsalgia
Metatarsalgia symptoms can occur across the ball of your foot or under one or more of your five metatarsals or mid-foot bones. Symptoms can occur suddenly or over time and develop from weight-bearing activities like walking, running, or standing. Other signs and symptoms you can experience are:
- Pain that is sharp, shooting, aching, or burning. It can feel worse when you flex your toes or are physically active.
- Tingling or numbness in your toes
- Feeling like there’s a stone or pebble in your shoe or a bunched-up sock
- Adjusting your walk to avoid putting pressure on the ball of your foot
Causes of Metatarsalgia
There are two major ways to describe what causes this condition. Primary and secondary metatarsalgia.
Primary metatarsalgia is caused by problems with your foot structure including the following:
- High-arched feet
- Flat feet or overpronation
- A longer 2nd toe which can lead to overload of the metatarsals.
- A foot condition such as bunions, hammertoes, sesamoiditis, stress fractures, or Morton’s Neuroma
Secondary metatarsalgia is caused by activities that put more pressure on the ball of your foot or by having a particular health issue. These include:
- High-impact activities like running, hiking, or sports that involve jumping
- Working on hard surfaces, such as in construction or retail
- Wearing pointy, high-heeled, or tight-toe box shoes (common for women) or rigid-soled work boots (common for men)
- Wearing shoes with little or no shock absorption like flip-flops
- Wearing backless shoes—these shoes require you to grip with your toes and ball of your feet
- Having an Inflammatory condition like rheumatoid arthritis or gout
- Being overweight, which adds pressure to the ball of the foot
When you come into the office, I’ll diagnose your condition by examining your foot structure and mechanics, taking x-rays, and doing a computerized walking analysis.
Treatment of Metatarsalgia
Let’s talk about treating this condition. First, we'll discuss home treatment and then what to expect in the office.
Home Treatment of Metatarsalgia
There are a lot of actions you can take at home to relieve the pain and inflammation of metatarsalgia.
- First is rest: You may need to temporarily stop activities like hiking to give your foot time to heal.
- Ice: Apply ice to the affected area several times a day to reduce inflammation for 20 minutes at a time.
- Take anti-inflammatory medication as long as your doctor approves it.
- Wear proper footwear: Make sure your shoes have a wide toe box for wiggle room, are supportive, and have a heel no higher than one inch.
- Athletes replace your shoes every 500 miles: Choose shoes specific to your activity.
- Replace your inserts: Remove your current insert and add an over-the-counter full-length support with a metatarsal pad.
- Wear sandals with straps and arch support: Flip flops and backless shoes can put extra pressure on the ball of feet and toes--avoid them.
- Try gentle foot and ankle stretching- check out this video!
Treatment for Metatarsalgia At Your Podiatrist's Office
While there’s a lot you can do at home, you'll need to be seen in the office for additional help in reducing pain and inflammation and for long-lasting relief.
- Taping: At your first visit we’ll begin by taping the ball of your foot to relieve the pressure.
- Cortisone shot: In addition to taking anti-inflammatory medication at home we may also give you a cortisone injection to reduce the pain and inflammation.
- Custom orthotics: If your metatarsalgia is caused by improper foot mechanics, we’ll recommend custom orthotics to reduce pressure on the ball of the foot. This is the best long-term treatment for metatarsalgia.
- Metatarsal pads: In addition, metatarsal pads are often recommended to further offload pressure from the affected area, which can be used with or without orthotics.
- MLS laser therapy: We also use a cold laser to help speed healing and decrease pain.
If your pain can’t be resolved with conservative treatments like the ones I just described, surgery may help depending on the cause of your metatarsalgia. For example, if you have a bunion that’s the primary cause of your ball of foot pain, then surgery for your bunion may relieve it.
Prevention of Metatarsalgia
While you can’t prevent all cases of metatarsalgia, there are some steps you can take to avoid developing it.
- Avoid wearing shoes that add more pressure to the ball of your foot. That means wearing lower heels and a wider toe box as I just described for at-home treatment of this condition.
- Try wearing rocker-soled shoes to avoid pressure on the ball of your foot. Some brands you can try are Hoka, New Balance, and Alegria for women.
- If you already have custom orthotics to treat another condition, make sure you wear them all the time. Worsening of bunions and hammertoes can make metatarsalgia pain more likely.
- Maintain a healthy weight to prevent adding pressure to the ball of your foot.
By following these steps and working with your podiatrist, you can effectively manage metatarsalgia and get back to enjoying your favorite activities pain-free.
