Metatarsalgia, or ball of foot pain, is diagnosed and treated by the Podiatry Division of Premier Medical Group.

What is metatarsalgia?

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Metatarsalgia is the medical term for pain and inflammation in the ball of the foot. Rather than describing a specific condition, metatarsalgia is an umbrella term for symptoms that can have varied causes. People experiencing this generally feel pain in the padding directly below the toes. This point marks the metatarsal heads, or the joints present just under the toes. The term can describe numbness, shooting pain, and/or soreness, especially when flexing the toes. In generally, injuries to the balls of feet are common in athletes and those who spend a lot of time on their feet.

What causes the pain in the ball of the foot?

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This pain is generally the result of excessive walking and running. Metatarsalgia is an overuse injury, and the condition is often due to abnormal weight distribution, persistent pressure on the area, and other musculoskeletal stressors. All causes result in excessive, localized pressure on the forefoot, which creates the pain in the ball of the foot.

Many conditions and habits can lead to ball of foot pain, including high levels of activity, prominent metatarsal heads, weak toe flexor muscles, tight toe muscles, a tight Achilles tendon, ill-fitting footwear, and excessive pronation, which is the side-to-side movement of the foot when walking or running.

However, experiencing pain in the ball of the foot is not always the result of physical activity. Sometimes, inherited anatomical conditions may predispose people to metatarsalgia. This may include having a high arch, a Hammertoe deformity, a short first metatarsal bone, or a long second metatarsal bone. Any of these conditions can affect weight distribution across the foot.

This pressure and weight distribution causes inflammation, which in turn causes the foot pain. Blood vessels in the ball of the foot dilate, and blood flow increases to allow white blood cells to swarm the injured area. In some cases, the forefoot will become red or swollen.

What are the symptoms of metatarsalgia?

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Ball of foot pain can manifest differently depending on the cause. Symptoms often include a sharp, aching, or burning pain in the forefoot, especially in the part of the sole just behind your toes. Metatarsalgia can also feel like a sharp or shooting pain, numbness, or tingling in the toes, or like having a pebble in your shoe. In most cases, the pain in the balls of a person’s feet generally appears over a period of several months.

A tell-tale sign of metatarsalgia is that the pain worsens and improves with varied activity. With this type of injury, the inflammation, or pain, should decrease when resting and increase when you stand, walk, or flex your feet.

What are the risk factors for metatarsalgia?

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People who sustain this forefoot injury are often physically active. This includes runners, swimmers, walkers, and/or people who spend a lot of time on their feet. Those who weigh more are also at risk for developing metatarsalgia. Body weight transfers to the forefoot when we move and added weight puts more pressure on the foot bones.

Certain genetic conditions can also put a person at risk of developing this type of foot pain. Certain foot shapes, such as having a high arch or a hammertoe, can add pressure to foot and toe bones. Morton’s neuroma, a noncancerous growth around a nerve in the toes, and inflammatory arthritis can cause symptoms similar to metatarsalgia and contribute to the pain.

In addition to lifestyle and genetic risk factors, ill-fitting footwear is a frequent cause of ball of foot pain, specifically high heels. These shoes transfer extra weight to the front of the foot. Shoes with a narrow tow box, or shoes that lack sufficient support and padding, can also cause metatarsalgia.

What are the home remedies and ways to prevent metatarsalgia?

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Preventing pain in the balls of the feet may require a lifestyle change. Endurance and high-activity athletes should incorporate rest days each week to give the feet time to heal properly. Icing the feet in 20-minute intervals after especially long or intense runs can also aid in prevention. If you are at risk of developing metatarsalgia, consider purchasing orthotic or commercial shoe inserts, which can help align the foot and provide extra cushioning.

If you suspect you have metatarsalgia, ice the painful area regularly to reduce inflammation, and apply a pressure bandage. Try not to put weight on that foot for 24 hours, and consider taking anti-inflammatory drugs, such as Aspirin, Ibuprofen, or Naproxen. If you cannot fully rest, metatarsal pads and other orthotic devices can provide some relief. Switch to more comfortable and supportive footwear, like running shoes, and take a break from high-level activity, such as exercise. Targeted stretches can ease pain and increase your flexibility. Losing weight within a healthy range can help relieve metatarsal pressure as well.

How is metatarsalgia diagnosed?

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Metatarsalgia is often diagnosed with a foot examination. A doctor will examine the foot while you stand and sit, then ask a range of questions regarding lifestyle and footwear. If you have diabetes, let your doctor know even if they do not ask.

If the doctor can deduce the cause of pain from this patient history overview, they will likely recommend rest or orthotic inserts.

If the ball of foot pain is severe or complicated, a doctor may also employ X-rays to rule out other causes of ball of foot pain, such as a stress fracture. A doctor might also suggest a bone scan to pinpoint places of inflammation or an ultrasound, which can help identify bursitis, Morton neuroma, or other possible causes of severe foot pain. Finally, if the cause of the pain is still unclear, a doctor may order an MRI to detect and diagnose one or many causes of inflammation in the forefoot region.

What else causes pain in the ball of the foot?

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Metatarsalgia can have countless causes. Rather than listing every possible cause, we wanted to highlight those conditions that have a realistic chance of mimicking or causing ball of foot pain. Some of these conditions can be distinguished from metatarsalgia, and some coincide with this type of inflammation. Feet and extremities are less sensitive than other parts of the body, so pain and sensation can be more difficult to interpret. Before assuming that your foot pain is metatarsalgia, here are some other possible causes that you or your doctor may need to rule out.

  • Achilles tendinitis
  • Achilles tendon rupture
  • Bone spurs
  • Broken foot or toe
  • Bursitis (joint inflammation)
  • Diabetic neuropathy (nerve damage caused by diabetes)
  • Abnormally high or low foot arch
  • Gout
  • Hammertoe and/or mallet toe
  • Ingrown toenails
  • Morton’s neuroma
  • Osteoarthritis
  • Bunions
  • Osteomyelitis
  • Plantar fasciitis
  • Psoriatic arthritis
  • Rheumatoid arthritis
  • Raynaud’s disease
  • Paget’s disease of bone
  • Peripheral neuropathy
  • Tendinitis
  • Tarsal tunnel syndrome
  • Septic arthritis
  • Stress fractures
  • Reactive arthritis
  • Plantar warts

When to see the doctor for metatarsalgia treatment?

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People experiencing ball of foot pain for more than two weeks, or if the pain is severe and accompanied by swelling or discoloration, should seek a doctor for treatment. If there is a callus, a thickening of the outermost layer of skin, the doctor may shave it down to provide temporary relief. Otherwise, the doctor will likely use a range of imaging techniques to diagnose the pain’s source and make any recommendations to treat the metatarsalgia.

How is metatarsalgia treated?

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In many cases, lifestyle changes and home remedies are enough to reduce and eliminate ball of foot pain. But especially when ball of foot pain is ignored and neglected, complications may arise along with the need for metatarsalgia treatment. Eventually, metatarsalgia can cause pain in other parts of the foot, the opposite foot, and/or elsewhere in the body, most often in the lower back and hips. This expanding pain is usually caused by an altered gait, such as limping, that puts pressure and weight on other parts of the body.

Bunions and hammertoe are also potential complications that require advanced metatarsalgia treatment. These conditions often require surgery to reshape the bones and straighten the toes. If the pain is chronic, a doctor may also consider surgery to relieve or remove a trapped or irritated nerve.