Metatarsalgia: Foot Pain’s Evil Brother

Metatarsalgia is a general term relating to forefoot pain secondary to inflammation in the area of the distal foot and toes.

No One Can Ignore Metatarsalgia Foot Pain

Metatarsalgia is a general term relating to forefoot pain secondary to inflammation in the area of the distal foot and toes.  The swelling involves the joints that connect the metatarsal bones of the foot and the phalanges (toe) bones.  The 2nd, 3rd and 4th MTP joints are most often stricken with this disorder.  With the joints of the toes, Metatarsalgia is commonly found within the 2nd, 3rd and 4th interphalangeal joints.

Morton’s Neuroma is a similar condition that demonstrates with forefoot pain.  Unlike Metatarsalgia, Morton’s Neuroma pain is located between the distal metatarsal bones where Metatarsalgia is typically pain within the joints themselves of the forefoot and toes.

Morton’s Neuroma is caused by a pinching of the nerves between the 2nd, 3rd and 4th metatarsal bone creating an inflammation of the nerves.

Ball of the foot pain is not typically linked to either of these condition although it is not surprising to develop such symptoms by compensating for any lower extremity dysfunction.

Signs and Symptoms of Metatarsalgia

  • Forefoot and toe pain which increases with weight bearing activities.
  • Tight fitting shoes and high heels increase symptoms.
  • Point tenderness pain in the distal foot area and proximal toes.
  • Excessive blistering, callus and wear patterns are commonly found in the forefoot and toes.
  • Passive bending and rotating of the toe will increase pain.
  • Ball of foot pain can be present which tends to be more related to compensation mechanics with chronic foot pain symptoms.
  • Long-term abnormal toes alignment such as claw toes or bunions may be contribute to the condition.
  • There may be excessive skin or calluses under the foot due to excess pressure.

Sign and Symptoms of Morton’s Neuroma

  • Localized pain between the 3rd and 4th distal metataral bones and toes.
  • Complains of increased weight bearing symptoms as if they are “standing on a pebble”.
  • Pain increases with weight bearing activities.
  • Symptoms into the distal foot and toes can include sharp pain, burning, numbness and/or tingling.
  • Increased symptoms between the metatarsal bones with squeezing of the forefoot.
  • Excessive callus and wear patterns are commonly found under the distal forefoot and great toe.
  • Ball of foot pain can be present which tends to be more related to compensation mechanics with chronic foot pain symptoms.

Treatment for Metatarsalgia and Morton’s Neuroma

  • Aggressive icing of the arch, foot and toes with ice bags, ice massage or, ideally, an ice bucket for 10 to 15 minutes.
  • Wear the proper footwear for the activity you are performing
  • Minimize activities that include weight bearing.
  • Massage and soft tissue treatments to the arch, great toe, ankle joint and calf.
  • Biomechanical evaluation to assess contributing issues such as: a leg length discrepancy, hyper pronation/supination, tight ankles, restricted toe extensor tendons, hypomobile toes, knee, hip or low back factors.
  • Consistent calf stretching.
  • Orthotics with possible rigid steel insert of ball of foot pain is present.

Questions a Pro Athlete Would Ask

A smart professional athlete with Metatarsalgia who wants to safely return to his/her sport should ask his sports medicine specialist the following questions:

  1. Do you have any concern that I may have stress fracture in my foot or toes?
  2. Is there any chance that some of my foot symptoms are coming from nerves in my back or leg?
  3. Will orthotics help me and if so, where can I get them at a reasonable price?
  4. If you had this same problem, where would you go to do your therapy?

Sports Medicine Tips

If the Shoe Doesn’t Fit, Don’t Wear It – True fact:  woman’s shoes are the best invention for the foot doctor profession.  They look sexy and stylish but they are killing your feet.  Ladies or dudes:  You know that it’s true so get rid of any shoes that are creating foot problems.

Sole Searching – The shoes are typically the source of your problem.  Old shoes, improper shoes and worn shoe soles are common factors that lead to foot and arch pain.

#2 Pencil – Using the eraser end, use it to apply pressure between the metatarsal bones of the foot.  It’s a simple tool to help determine the location of the pain and the diagnosis.

Ice is Your Friend – It’s a reality check:  Ice hurts but it’s exactly what you need for this injury.  The Pros will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.

Author: Mike Ryan

After 26 seasons as a full-time certified athletic trainer and registered physical therapist in the National Football League, Mike Ryan has outstanding first-hand experience. His unique professional and athletic background has sharpened his skills in the arts of sports injury management, elite rehabilitation, performance enhancement and injury prevention. Mike is now taking his experience to mainstream America. His mission is simple: Sports Medicine advice that is easy to use and brings fast results. Learn more about Mike Ryan

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