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Metatarsalgia is a symptom pain at the metatarsal heads ("ball" of the feet), not a diagnosis! Millions of Americans suffer from metatarsalgia, complaining of pain in the ball of their feet worse with standing all days on hard surfaces, painful calluses across the ball of the foot, and, in severe cases, ulceration with infection.

There are many causes for metatarsalgia. In older patients or in patients who have had steroid cortico steroid injections, the skin at the ball of the feet (the normal protective fatpad) withers and atrophies, resulting in decreased cushioning underneath the metatarsal heads. This lack of cushioning leads to increased pressure on the skin with weight bearing. The skin responds by hypertrophy or thickening of the epidermis or dead outer layer of skin. This may produce a painful callus.

Normally, with stance, 50% of the weight is centered over the ball of the foot and 50% is born by the heel. With increase in heel height, the force in the front of the foot is magnified, with over 75% of the weight on the heel ball of the foot when a 21/4 heel is worn.

Several anatomical variations can result in increased pressure on the metatarsal heads and metatarsalgia. A high arched (cavovarus) foot is a normal variant where the foot and arch are curved slightly and the foot is rotated slightly towards the outside or lateral portion of the foot. This results in increased weight bearing on both the ball of the foot and heel and can cause painful calluses and metatarsalgia. Some patients are born with an unusually long second metatarsal and long second toe, which can result in increased pressure underneath the ball of the second toe.

Foot deformities such as claw toes (Figure 1.), hammer toes (Figure 2.) and mallet toes (Figure 3.) can also result in metatarsalgia. In these toe deformities where the toe becomes contracted and rides upward (dorsally) the toe assumes a place on top of the metatarsal, pushing it downward and increasing pressure on the metatarsal heads. The toe therefore rubs against the top of the shoe and the metatarsal heads rub against the bottom of the shoe producing painful corns and calluses.

A bunion deformity often results in Hallux Valgus with the first toe moving underneath the second toe. The second toe is displaced upward pushing the second metatarsal down, resulting in second metatarsalgia.

Finally, there are traumatic causes for metatarsalgia. Metatarsal fractures may result in upper displacement of several metatarsals leaving the remainder metatarsals to bear abnormal, increased weight and producing painful calluses and metatarsalgia. Mid-foot fractures or ankle fractures may result in a stiff, angulated foot and alter weight bearing to put more weight on various metatarsals and create metatarsalgia. Fractures of the tiny sesamoid bones underneath the first metatarsal can also produce thickened callus and pain underneath the great toe.

Inflammation (synovitis or arthritis) of the metatarsophalangeal joints may cause swelling on the bottom of the metatarsophalangeal joints and produce increased pressure and sensitivity leading to metatarsalgia. This is seen with conditions such as Rheumatoid Arthritis, Lupus, Gout, etc.

Metatarsalgia is often confused with other conditions of the forefoot such as Morton's Neuroma and painful warts . Evaluation by a Foot and Ankle Specialist is sometimes required to sort out the exact nature of the problem.

Treatment of Metatarsalgia

Treatment of metatarsalgia usually consists of finding the exact cause of the pressure inequality. In cases of metatarsalgia caused by synovitis and swelling of the metatarsophalangeal joints, non-steroidal anti-inflammatory medications such as Advil ®, Motrin ®, Celebrex ®, etc. may be helpful. A change in shoe-wear to a lower heel, more cushioned shoe may also be helpful. Skin moisturizers such as hand lotions, Vaseline, or synthetic lubricants such Body Glide ® as may be helpful in reducing friction.

Well-cushioned athletic socks or special socks with a gel layer embedded in the sole are helpful to replace loss fatty cushion. Over the counter soft orthoses or custom orthoses with gel cushioning underneath the metatarsal heads are very helpful in reducing the discomfort with metatarsalgia.

Occasionally a metatarsal raise is added behind the metatarsal to additionally reduce pressure on the metatarsal head. Finally, sometimes surgery is required to correct an anatomical deformity such as fixed claw toes or severe bunions or mal-aligned metatarsal fractures and redistribute pressure evenly.

This material does not constitute medical advice. It is intended for informational purposes only. Foot Menders will not answer medical questions via email. Please consult a physician for specific treatment recommendations.