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Metatarsalgia: Symptoms, Causes, and Treatment

We spend a lot of time on our feet on a daily basis, and when we feel certain ache it’s easy to assume that it is the toll of a long day. But certain cases of foot pain or discomfort could hint at bigger problems.

What is metatarsalgia?

One of the most common afflictions when it comes to foot problems is metatarsalgia, a condition characterized by the inflammation of the metatarsal bones- located between the phalanges and the mid-foot. This happens because the ball of the foot is the part of the bone structure that supports more weight when we walk, run, or jump. Because of this, the metatarsals are prone to injury and, if not treated correctly, it can cause intense pain even when we are not on our feet.


This condition tends to be more common among athletes, and the main cause is that during the mechanics of walking (called gait) the toe-off phase is badly executed. This produces an excessive pressure on the head of the metatarsals, provoking pain and inflammation with every step.

Sports such as running add a lot of stress in the metatarsals that leads to the overuse of the area, which can end up afflicting the cartilage, ligaments, and tendons around the bones. Although athletes who engage in high-impact activities are the most susceptible, there several other habits that can end in metatarsalgia even if we don’t practice sports.

Other causes are:

  • Being overweight: The forefoot receives most of the body weight when we move, and having extra weight can put a strain on the metatarsal area.
  • Age: It is normal for the layer of fat that covers the foot to get thinner with age, leaving the bones more exposed.
  •  Footwear: Shoes that are too tight, or too lose, can contribute to metatarsalgia as well. High heels, shoes that are too narrow, or sneakers without the appropriate padding and support can add pressure to the ball of the foot.
  •  Foot shape abnormalities: a high arch, a hammertoe, bunions, calluses, and a second metatarsal bone that is larger than the big toe can cause metatarsalgia.
  • Lastly, there are some medical conditions that can lead to extreme pressure over the ball of the foot:
  •  Morton’s neuroma
  •  Arthritis
  •  Tight Achilles Tendon
  •  Stress fractures
  •  Weak toe flexors
  • Bursitis


At first, the discomfort can disappear with proper rest, but you might want to consider paying a visit to your doctor if you experience any of the following for a prolonged time:

· Severe pain that get worse when you flex your foot, walk, stand, or run.

· A sensation of numbness or tingling in the toes.

· Shooting pain right in the area behind your toes.

· When you walk, you get the impression that there are pebbles in your shoes.

· A dull ache when you walk barefoot.

Diagnosis and Symptoms

X-rays and bone scans are the most common type of evaluation to determine the source of forefoot problems, with an ultrasound sometimes used to pinpoint other conditions that might be causing pain in the metatarsal area. The doctor might also ask for an RMI to exclude other diseases such as traumatic disorders that could be causing foot pain.

There isn’t a “one size fits all” way to treat forefoot problems, and the treatment for metatarsalgia tends to be holistic, meaning that the doctor will recommend a series of treatments and alternatives that take into account the patient as a whole.

Depending on the severity of the conditions, there are a few paths to be followed.

In the first instance, the use of heat and cold compresses at home and a pressure bandage can alleviate significantly the symptoms. Resting is essential to treat the inflammation, and avoiding putting too much weight on the foot, and elevating it after walking and standing, are usually part of the initial therapy.

It is essential though, if any kind of treatment has started, to only usie shoes that are special to Metatarsalgia. These shoes must be extremely comofrtable and have high padded cushioning. If you do use the appropraite shoes, than a regresion might happen or the treatment may be not effective. 

Other conservative measures can be taken. If the patient engages in high-impact sports, he might need to change his routine and opt for other activities like swimming and cycling. Changing footwear is normally an effective part of the treatment as well, choosing shoes with good cushioning, a wide toe-box, and a flexible and supportive outsole.

In severe cases, surgical intervention may be need to realign the metatarsal bones.