What Is Metatarsalgia: Symptoms, Causes, Treatments, and More

Metatarsalgia simply means pain in the metatarsals and is a relatively common condition, though it can still significantly reduce the quality of life. This terminology reflects how complex and difficult it is to diagnose and treat pain in the forefoot.

Pain caused by metatarsalgia is aching in nature, worsened by activity, and occurs with swelling and bruising at the metatarsal head. Metatarsalgia is progressive, and if not managed early, it can cause joint stiffness, limited range of motion (ROM), and pain in the rest of the kinematic chain (ankle, knee, hip, and lower back).

This article looks at the causes and symptoms of metatarsalgia, how it is diagnosed, and the various treatment options available.

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Causes and Symptoms of Metatarsalgia

The causes of pain in the foot are multifactorial, with the most common being incorrect shoes, traumatic injury, and repetitive injury from either sport or poor foot mechanics. However, systemic illnesses such as rheumatoid arthritis, gout, osteoporosis, and many others are also seen regularly.

Another significant cause of forefoot pain is an existing condition of the big toe joint. HAV’s (Bunions) and Hallux limitus/rigidus both affect this joint's ability to take most of the load when walking, resulting in an overload of the lesser toe joints. Also, previous surgery of this joint can result in dysfunction and, again, overload of the other parts of the foot.

A common symptom of this is numbness or tingling in the toes, and the most common diagnosis is a nerve-related injury called Morton’s neuroma. However, other pathologies such as plantar ligament strains or tears, capsulitis of the metatarsal phalangeal joints, or simple nerve compression from shoes that are too tight can give the same symptoms.

Aggravating Factors

Several factors can make metatarsalgia worse, such as:

• Poor work posture
• Obesity
• Improper exercise technique
• Modified gait due to surgery or injury

Risk Factors for Metatarsalgia

Anyone can develop metatarsalgia. However, you are at a higher risk if you:

• Are obese
• Have a history of foot injury
• Have inflammatory arthritis
• Wear improper footwear (high heels, narrow toe box, flat soles)
• Perform high-impact activities that are repeated often (running, jumping, high-impact sports, etc.)

How Is Metatarsalgia Diagnosed?

The symptoms of metatarsalgia are similar to those of many other foot injuries and disorders. If you have persistent pain in the foot even after resting or changing footwear, seek a medical expert. Your doctor will observe your gait and physically examine the foot to identify any deformities or problems, and there will also be questions about the nature of activities and pain history.

Several tests will be performed to arrive at a differential diagnosis to identify factors that may worsen the condition. There may also be radiological investigations to rule out stress fractures and identify the presence of neuromas, bursitis, or the presence of arthritic signs. You can also order a blood test to check for uric acid levels. The tests and investigations will allow your doctor to accurately prescribe treatments.

You may also expect to be transferred from a general practitioner to an orthopedist, podiatrist, or physiotherapist.

Treatments for Metatarsalgia

The good news is that metatarsalgia is treatable. The approach to the treatment of metatarsalgia depends on the cause, symptoms, and severity of the condition, though the first line of management is typically conservative.

Some of the other treatment methods are discussed below:

RICE (Rest, Ice, Compression, Elevation)

You may need to get off the foot to experience relief. You can also ice the leg for up to 20 minutes after prolonged activity. Compression and elevation above the heart can also aid in reducing swelling from metatarsalgia.

There may also be a need to make changes to your regular activities. For example, it may not be best for you to stand for long periods if you have metatarsalgia.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs directly address the pain and inflammation that occurs because of metatarsalgia, giving room for other treatment methods to be initiated.

Weight Reduction

Sometimes, it may be necessary to lose weight as the more you weigh, the more pressure is placed on the foot, and the more painful it becomes.

Use of Proper Footwear

The best shoes have adequate toe space, proper cushioning, and offer great arch support. Always ensure you use proper footwear instead of one with a stiff sole and inadequate support.

Corticosteroid Injections

These can provide temporary relief from pain due to metatarsalgia that can sometimes last up to 3 months. However, the risks of corticosteroid injections need to be understood as this is not a cure for the condition and can cause lasting damage if used too frequently.

Physical Therapy Exercises

A physical therapist will work with you to relieve the symptoms and stretch or strengthen the muscles through metatarsalgia exercises. The physiotherapist will also encourage proper foot biomechanics and consequently relieve the pressure on the ball of the foot.

Custom Orthotics

The use of custom orthotics is also very effective in treating metatarsalgia. Whether metatarsal pads, hammertoe crests, or arch supports, these provide extra cushioning and padding for the feet, helping to absorb some of the pressure.

Understanding what is causing your forefoot pain is essential when choosing the best orthotic. If you feel that compression is worse when wearing slip-on shoes or high heels, a ¾ length insole is required. However, if your foot has collapsed arches and it hurts more after standing or walking for long periods, and if you have a removable insole to make room for the custom orthotic, then a full-length insole is best as it allows us to add special soft padding under the metatarsal heads.

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Surgery

When non-conservative treatment fails to bring improvement, surgery becomes the last option. The surgical approach will depend on the cause of the metatarsalgia, the severity of the condition, and any complications that may have resulted from it.

Recovery From Metatarsalgia

Complete recovery after metatarsalgia is possible. However, it depends on several factors, including your age, health state, history of injury to the foot, the severity of the condition, complications, and the speed of intervention from the onset. Generally, recovery takes anywhere from a few days to several months, which is why it is essential that you seek treatment as soon as your symptoms cause you enough discomfort or pain to disrupt your normal daily functions.