Q. Hi, I’m having some pain in my forefoot. It feels ok when I exercise, but gets really sore and pain after. What gives?
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A. Metatarsalgia is a descriptive term used to describe any forefoot pain. Usually the term refers to inflammation which occurs in the joints between the metatarsal bones in the foot and phalanges bones of the toes.
Symptoms typically consist of pain in the forefoot which is worse during weight bearing, particularly during the middle phase and push off phase of walking when the foot is in contact with the ground.
Pain usually comes on gradually with tenderness felt when pressing in on the MTP joints under the ball of the foot.. It is usually the 2nd, 3rd, and 4th toes which are effected and is frequently in more than one joint at the same time. Symptoms range from mild to severe.
In the early stages a separation between two toes may be seen and is known as the V sign. Passive flexion or bending of the toe can reproduce pain. There may also be hard skin or calluses under the foot due to excess pressure.
The cause of metatarsalgia pain is usually from the synovial sheath or membrane around the MTP joints becoming inflamed, usually from excess pressure on the joints over a period of time. A few contributing factors include:
- A high or rigid arched foot (pes cavus) may increase the likelihood of metatarsalgia by increasing the pressure on the forefoot.
- Over pronation of the foot is where the foot rolls in or flattens too much during the gait cycle. This will increasing pressure on the forefoot making inflammation more likely.
- The extensor tendons extend or straighten the toes. If these are tight this can lead to inflammation.
- Poorly fitting footwear may compress the forefoot or if the athlete laces up shoes too tightly this can also compress the forefoot increasing the likelihood of joint inflammation.
- Stress fractures of the metatarsals. A stress fracture is a hairline fracture which has gradually occurred with over use.
- Repetitive high impact such as running or jumping.
- Arthritis resulting in general wear and tear of the joints in the foot.
There are more…these are just a few of the primary causes.
Ultimately treatment of metatarsalgia involves providing relief from the pain and identifying and treating any structural or bio-mechanical causes.
NSAID’s such as ibuprofen (non steroidal anti inflammatory drugs) may reduce pain and inflammation. Always speak to your Doctor first. Use padding to protect the foot and re-distribute weight on the metatarsal bones.
A Metatarsal lift compression pad which is inserted into the front of the shoe is ideal. Or a gel type shock absorbing and cushioning insoles which have the cushioning material in the forefoot can also provide relief from symptoms. Wearing flat, spacious shoes that do not restrict the forefoot can help as can stretching the calf muscles regularly throughout the day.
A podiatrist may assess your foot position and gait walking pattern and if necessary custom orthotics or insoles can be made to correct the movement of the foot. A doctor may inject a corticosteroid injection into the foot. Traction applied longitudinally to the toe can increase the joint space relieving symptoms.
Source: Sports Injury Clinic. Metatarsalgia. http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/metatarsalgia. Accessed on May 25, 2015.