Feb82011

Metatarsalgia: Foot Pain’s Evil Brother

Metatarsalgia is a general term relating to forefoot pain, secondary to inflammation in the distal foot and toe area.  Joints that connect metatarsal foot and toe bones become swollen, and the second, third, and fourth MTP joints are most often affected.  Additionally, Metatarsalgia is commonly found within the second, third, and fourth joints between the toes.

Morton’s Neuroma is a similar condition that presents with forefoot pain.  Unlike Metatarsalgia, Morton’s Neuroma pain is located between the distal metatarsal bones as opposed to within the forefoot and toe joints themselves.

Morton’s Neuroma is caused by pinched nerves located between the second, third, and fourth metatarsal bones, resulting in nerve inflammation.

Pain in the ball of the foot is not typically linked to either of these conditions, although it is not surprising to develop this symptom by compensating for lower extremity dysfunction.

Signs and Symptoms of Metatarsalgia

  • Forefoot and toe pain that increases with weight-bearing activities
  • Symptoms that worsen when wearing tight-fitting shoes or high heels
  • Point tenderness pain in the distal foot area and proximal toes
  • An excessive pattern of blisters, calluses and wear and tear in the forefoot and toes
  • Increased pain from passive toe bending and rotating
  • Pain in the ball of the foot (related to compensation mechanics that sometimes present with chronic foot pain)
  • A contributing factor of long-term abnormal toe alignment, such as claw toes or bunions 
  • Excessive skin or calluses underneath the foot due to excess pressure

Signs and Symptoms of Morton’s Neuroma

  • Localized pain between the third and fourth distal metatarsal bones and toes
  • An increase in weight-bearing symptoms, such as feeling as if you are  “standing on pebbles”
  • Increased pain with weight-bearing activities
  • Sharp pain, burning, numbness and/or tingling in the distal foot and toes
  • Increased symptoms between the metatarsal bones when squeezing the forefoot
  • Excessive callus and wear patterns under the distal forefoot and great toe
  • Pain in the ball of the foot (related to compensation mechanics that sometimes present with chronic foot pain)

Treatment for Metatarsalgia and Morton’s Neuroma

  • Aggressively ice 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 specific activities.
  • Minimize weight-bearing activities.
  • Massage and apply soft-tissue treatments to the arch, great toe, ankle joint and calf.
  • Perform a biomechanical evaluation to assess contributing factors such as a leg length discrepancy, hyper pronation/supination, tight ankles, restricted toe extensor tendons, hypomobile toes, or knee, hip or low back conditions.
  • Stretch your calves on a consistent basis.
  • Wear orthotics, ideally with a rigid steel insert, when experiencing pain in the ball of the foot.

Questions a Pro Athlete Would Ask

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to their beloved game or sport:

1. Are you concerned that I may have a stress fracture in my foot or toes?

2. Could my foot symptoms be related to nerves in my back or leg?

3. Will orthotics help, and if so, where can I find them at a reasonable price?

4. If faced with this same problem, where would you go for therapy?

Sports Medicine Tips

If the Shoe Doesn’t Fit, Don’t Wear It – It’s a fact that women’s shoe designs help keep foot doctors in business.  They may look sexy and stylish but are absolute killers for the health of your feet.  Ladies (and gentlemen) – rid your closet of any ill-fitting shoes ASAP!

Do Some Sole Searching – Assess the overall health of your shoes in addition to your feet. Wearing old, “expired” shoes with worn soles is a common factor that leads to foot and arch pain.

(Yet Another) Test with a #2 Pencil – Using the eraser end, apply pressure between the metatarsal bones of the foot to help pinpoint the location of the pain and lead to a diagnosis.

Ice is Your Friend – I’m sorry, but it’s true – the bitter chill of ice is necessary to treat this injury.  The pros will tell you that ice is their best teammate.  Stop complaining and stock your freezer accordingly!