The Burning Pain of Metatarsalgia
Metatarsalgia is frequently called "ball-of-foot pain" as it is a pain on the sole (underside) of the foot just behind the toes, where the foot bends during walking. The metatarsal bones extend from halfway up the foot to the toes. A dysfunction in one or more of these five bones is the cause of pain.
The five metatarsal heads that control and balance the feet during normal gait undergo great pressure. As the metatarsals press against each other, pain is concentrated toward the ball of the foot. As a result, supportive nerves, ligaments, and muscles between the metatarsal heads become inflamed.
While many people with metatarsalgia feel pain where their metatarsal bones join their toe bones, some also feel discomfort along the entire length of themetatarsals and likely between them. Problems in this area can vary from a stiff feeling upon movement of these bones to a burning, stinging sensation or numbness. The degree of discomfort depends upon whether the condition is due to a dysfunction in the joints such as when the metacarpal bones are either too long or too short creating unusual mechanics in the feet producing too much stress upon this area. or an inflammation to the nerves as they travel along the metatarsals. It's possible for these symptoms to develop suddenly, especially with patients involved in excessive amounts of running or jumping, however, the problem usually develops slowly over time. This can make daily actions such as walking, standing, or wiggling the toes excruciatingly painful.
An example of a structural cause is Flat feet or excessive arch can also alter the stresses on the metatarsals causing similar symptoms. Excess body weight, as well as wearing high-heeled shoes, are both contributing factors as they increase stress on the metatarsals that can lead to joint pain and nerve inflammation. Furthermore, excessive or poor running or athletic training can affect the condition because repetitive foot activities directly stress the metatarsals by exposing them to constant trauma.
As stated above, metatarsalgia occurs when there is a change in the mechanics of the foot. According to the American College of Foot & Ankle Orthopedics & Medicine (ACFAOM), while a single factor can sometimes lead to metatarsalgia, it's more common for several factors to be involved, such as:
- Intense activity
- Hammertoes and bunions
- Excess weight
- Poorly fitting shoes
Each of these aforementioned factors can disrupt normal functionality of the feet. During normal gait, any imbalances or misalignments that the metatarsal heads experience will cause inflammation and pain. Certain metatarsals may undergo more or less pressure depending on functionality and gait of the patient. As a result, calluses form on the pressure points of the met pad if left unattended. Intense activity is especially demanding for this area of the foot.
Be wary, however, the source of a patient's metatarsalgia could be more serious. The "pain, burning, numbness and tingling" associated with metatarsalgia are often caused by Morton's Neuroma, which requires different treatment. If you suspect the patient's discomfort is due to Morton's Neuroma, perform the web space compression test: with one hand, squeeze the metatarsals together, while applying pressure to the affected area with the other hand. The patient will experience pain, and often, you'll be able to hear a small 'click' (Mulder's click). If, however, your patient is simply a victim of metatarsalgia, treatment is generally very simple.
Treating metatarsalgia is usually an at-home affair-plenty of ice and rest can usually clear up the nastiest cases. The Mayo Clinic recommends starting with ice on the ball of the foot, which will help decrease joint inflammation[ii]. Once the inflammation has decreased, keeping pressure off the metatarsals is the only thing left to do.
While treating metatarsalgia is easy, preventing metatarsalgia from returning can be tricky. Paul R. Scherer, DPM, believes that preventative treatment starts with footwear and orthotics[iii]. Review your patient's shoe choices with them. Opt for shoe choices with some form of forefoot cushioning: if they're pronators, get them a good motion-control shoe. If they wear high heels, strongly encourage them to stop-high heels smash the feet into unnatural positions and put crushing amounts of force on the forefeet.
In conjunction with good shoes, orthotics are often the best defense against returning metatarsalgia. According to the Foot and Ankle Associates of North Texas, Studies have shown that custom orthotics can consistently decrease pain in the forefoot with proximal padding, which unburdens the metatarsal heads and prevents midtarsal joint pronation.[iv] Footmaxx™ orthotics with the Met Pad accommodation protect the metatarsals and offer patients more protection and support.
Nobody wants to be out of commission as summer starts to heat up. With weight control, good shoe choices and individually designed orthotics, you and your patients can stop metatarsalgia in its tracks.
Dr. Pisarek is able to beneficially treat metatarsalgia, no matter what the cause may be. After diagnosing the underlying factors, you will be given a number of non-invasive therapies, including low-level laser therapy and customized orthotics when necessary, and, you will be advised on how you can avoid future pain.
If you are experiencing any foot problems, call Dr. Pisarek for an appointment to start on your "road" to recovery with pain-free feet.
Call Dr. Pisarek for an appointment at 416-633-3000
[i]"Metatarsalgia." ACFAOM.org. ACFAOM, 12 Apr. 2010. Web. 14 May 2011.
[ii]"Metatarsalgia." Mayo Clinic. N.p., 25 Jan. 2011. Web. 14 May 2011.
[iii]Scherer, Paul R. "Orthotic Intervention for Metatarsalgia Relief." Lower Extremity Review. N.p., n.d. Web. 14 May 2011.
[iv]"Is There Proof in Evidence-Based Literature That Custom Orthotics Work?" Podiatry Management. Sept 2007, pp109-116.