Metatarsalgia - Pain in the Forefoot 

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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.

 

Diagnosis and Tests

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.

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