Metatarsal, Metatarsalgia, forefoot pain


Pain in the fore-foot

Don't let anyone tell you to "push off" in pain. 

If you have pain in the forefoot, particularly in the bottom of the forefoot, often called the ‘ball of the foot’, you most probably have metatarsalgia. 

It is not really a diagnosis, but rather an umbrella term describing symptoms of pain in the forefoot. If anyone says you have metatarsalgia, ask them, "which type?" 

There are a great many different conditions causing metatarsalgia. And they all have specific symptoms. These can range from a painful feeling, rather like a having a stone in your shoe on weightbearing; to deep aching pain; to sharp stabbing pain and even stinging, burning pain radiating into the toes.

If these symptoms are made worse with standing on hard floors, when wearing high heels, or when you wear thin-soled shoes, or tightly fitting shoes, then you are most probably suffering from a type of metatarsalgia. Most patients say the worst time they feel this type of pain is at ‘push-off’ at the end of a step.

Common Metatarsalgia Conditions:

  • Callus & corns caused by excessive pressure & friction on the skin.
  • Muscle fatigue in the ball of the foot can give rise to aching burning sensations.
  • Joint capsulitis (plantar plate stretch or strain) seems to be the most common reason people suffer pain in the balls of their feet. This often starts with a vague discomfort which gets worse with longer periods of walking, and can feel like a stone in your shoe. The most common area affected is underneath the 2nd metatarsal head, just behind where the 2nd toe attaches to the foot. It can also affect other joints.
  • Plantar plate ruptures (pre-dislocation syndrome) is pain experienced in the same area as capsulitis except, instead of a gradual onset, you feel a very sudden sharp onset of pain, sometimes accompanied by a toe suddenly drawing upwards, or sideways.
  • Morton’s neuroma (plantar digital perineural fibroma) is a common nerve entrapment, usually occurring in the space between the 3rd & 4th metatarsals. It causes a variety of symptoms ranging from numbness in the toes, stinging or burning pains, aching or shooting pains radiating into the toes. And sometimes a combination of several of these symptoms.
  • Metatarsal stress fractures can occur in the forefoot when they undergo a sudden increase in repetitive loading over a short period of time, such as when someone increases their walking or running mileage quickly. Most often they occur in the thin bone at the 2nd metatarsal neck, but can also occur in several forefoot bones. Training for marathons is very common cause, particularly as running on roads & pavements is especially hard on feet. However, any sudden increase in activity can increase your risk, as well  as having osteoporosis.
  • Sesamoiditis is an uncommon condition affecting the small bones found under the ball of the big toes. The problem manifests as sharp pain in this area at push-off. The sesamoid bones can be become inflamed and painful with activities involving long periods of time where one’s weight is on the ball of the foot, for instance from wearing high-heeled court shoes, or with some foot shapes which overload the first metatarsal head, and in people with weak arch muscles.

Other, more rare conditions include arthritis in its various forms, Freibergs and rare neoplasms.

Hopefully, you can see from this list of conditions, that pain in the ball of the foot is varied, with causes ranging from foot shape & bone structure, activity level, and footwear choice.

This makes it particularly important to only be examined and treated by a health professional who has specialised training & experience in treating the broad range of metatarsalgia conditions.

We have great success in treating all the different types of metatarsalgia. So you don't have to suffer in pain. 

If you need to a consultation with our Full-time Specialist Musculo-skeletal Podiatrist Steve Bloor please phone our reception staff on 01326 565 565

Stephen Bloor

Stephen Bloor

Clinical Director

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