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.
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
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.
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.
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
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.
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.
(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,
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.
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.
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
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
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