Metatarsalgia is an umbrella terms used to describe pain in front of the foot, most commonly in the ball of the foot. This is the first metatarsal-phalangeal joint (MPTJ). It can also occur in the 2nd, 3rd and 4th MPTJ.

What are the symptoms of Metatarsalgia?

The pain can be described as being tender, shooting pain, tingling sensation or burning.  In worst cases stiffness and swelling may occur. The pain is usually more prominent when flexing the toe and walking or running but can also be felt when standing and placing weight on the foot.

As a result, individuals tend to avoid placing weight on the area affected. For example, if the pain is on the first MPTJ, then they may place weight on the lateral side of their foot. This could cause pain to radiation to the other side of the foot as well as form a callous (hard skin).

What are the causes of Metatarsalgia?
  • Poorly fitted footwear: Shoes with a narrow toe box and high heels can cause the pressure on the fore foot which could lead to inflammation in the joints.
  • High arched foot: could place more pressure on the forefoot
  • Short first metatarsal bone may place more pressure on the 2nd and 3rd MPTJ joints.
  • Excessive pronation: This is when the foot rolls inwards and the toes point out. This places pressure on the first MPTJ.
  • Bunions (Hallux Abducto Valgus); This causes restriction in the range of movement (ROM) in the first MPTJ joint.
  • High impact sports: such as running will place excessive pressure on the foot.
  • Arthritis: wear and tear of the joints.


How do you treat Metatarsalgia

The management is based on pain relief and begins with treating the biomechanical causes of the foot.

  • Footwear: The first rule is the use appropriate footwear such as trainers which has allot of cushioning in the insole. Make sure the toe box is wide enough to prevent any excess pressure on the fore foot.
  • Rest: resting the foot and reducing any weight bearing can help provide pain relief. Reduce any high impact sports.
  • ICE: using an ice pack gel or a bag of frozen food wrapped in a towel (to prevent skin burn) placed on the foot for around 12-15 minutes will help to reduce pain and inflammation. Research has shown that ice helps to improve healing. Avoid any heat rubs as this will not help reduce any inflammation.
  • Use an insole/ orthotic: a device with a heel cup to help place the foot in a more neutral position, increase stability of the foot. A poron insole can also help provide extra cushioning on joint.
  • NSAID such as ibuprofen or diclofenac have shown to reduce pain and inflammation. They are also available as creams and can be applied direction on to the joint.


by Ramnik Saandal @podiatrist.ram


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