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Metatarsalgia

Metatarsalgia describes pain in the ball of the foot that affects the metatarsals, the small bones that connect the toes to the foot.

What is Metatarsalgia?

Metatarsalgia is a condition in which the ball of your foot becomes painful, inflamed and difficult to walk on. It is extremely common in runners but can also occur from activities such as jumping.

When you are running the forefoot absorbs as much as 110 tons of cumulative force per mile through the five long bones that run from the arch to the ball of the foot. Knowing this you can see how metatarsalgia can happen.

 

As well as movement-based exercises metatarsalgia can also be caused by foot mechanics or ill-fitting shoes that are too tight or too loose.

Generally, a metatarsalgia is not serious but it can impact how much you can exercise.

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How to test for metatarsalgia.

At Riixo we always recommend speaking to a medical professional to better understand a condition and fully diagnose but this test can help identify if you have metatarsalgia.

 

Squeeze test (Morton’s test).

  1. In a seated position in a chair or on the floor.
  2. Imagine drawing a line from the bottom of the big toe joint across to the bottom of the little toe joint. This is where you want to have your hand positioned. Hold the painful foot in your hand so you are gripping the foot with your thumb on one side and your fingers on the other.
  3. Squeeze the foot.

If this brings on your pain then you may have a metatarsalgia

 

 

It is also worth noting that this is also the test for Morton’s Neuroma.

What are the symptoms of metatarsalgia?

Metatarsalgia will present itself as a sharp, aching or burning pain in the ball of the foot more towards the centre away from your big toe or just beside. If you have had it for a long time, it may cause some mild tingling or numbness in the toes.

Runners have often described the sensation like running with a small stone in their shoe.

Movements that involve the flexing of the toes will cause pain, this is increased when you add weight through the movement such as standing, walking or running. Hard surfaces will also increase the pain and symptoms, which can be magnified if you are barefoot. Shoes with a padded insole or inserts with arch support can help alleviate pain and symptoms.

 

What causes metatarsalgia?

In some cases, it is easy to identify one cause behind metatarsalgia but often it is a combination:

  • High-intensity exercise. Endurance runners are at risk of metatarsalgia due to the high volume of force that is absorbed through the ball of the foot. Anyone who participates in high-impact exercise, more so on hard surfaces, is also at risk.
  • High arches. If you have high arches this can put additional force through the metatarsals and the joints. Supportive insoles can help to alleviate this pressure.
  • Foot and ankle mechanics. Reduced ankle range of movement, caused by tight calves, for example, can contribute to metatarsalgia. If you have a reduced range of movement in the ankle this places more pressure on the joints of the toes when trying to walk or run. If your second toe is longer than your big toe, something that occurs in around 42% of the population, it can cause a shift in the weight distribution through the second toe joint.
  • Ill-fitting footwear Wearing shoes that are too small, or high heels, can cause your foot to become misshapen over time. Bunions and downward curling toes (hammertoe) can cause metatarsalgia and high heels transfer extra weight through the ball of your foot. Narrow athletic shoes or ones that lack the proper level of support for your foot mechanics can also alter the weight distribution putting excess force through the 2nd and 3rd metatarsal (toe bone).
  • Obesity. As most of your body weight transfers to your forefoot when you walk, carrying excess body weight will increase the force through the ball of your foot.
  • Stress fractures. These are small cracks in the bone usually caused by repetitive injury focused on a localised area of the foot such as altered foot mechanics on an endurance runner. The repetitive movement and transfer of force over long distances can put the metatarsal under increased stress causing cracks.
  • Morton's neuroma. This is a bundling of tissue around the head of the nerve usually between the 3rd and 4th toes. It causes similar symptoms to metatarsalgia and can often contribute to metatarsalgia on other joints by increasing the stress between the bones.

How to treat metatarsalgia.

When acute pain first appears follow this protocol:

  • P: Protect the area. This can be changing footwear to something more supportive.
  • OL: Optimal Loading. Take as much weight as you can without making things worse. You may need rest, different footwear or crutches.
  • I: Ice the area for 20 minutes at a time to relieve inflammation.
  • C: Compress the area with a soft wrap to reduce swelling.
  • E: Elevate the area by putting the foot on a few pillows.

 

Insoles & Footwear.

Changing your footwear to something with more cushioning or more support may be all that is required to help alleviate your symptoms. Padded insoles are a second option to provide arch support and additional padding to the ball of the foot.

 

Exercises for metatarsalgia.

Single-Leg Standing

This exercise helps with neuromuscular control by strengthening the small intrinsic muscles that help with balance, joint stability and movement feedback to the brain.

  • Place a folded towel or pillow on the floor.
  • Stand with one foot on the object.
  • Lift one foot off the ground keeping your hands by your side and a slight bend in the knee.

Frequency and duration 

  • Stand for 30 seconds for each leg
  • Complete this frequently throughout the day or for a more structured approach, 3 sets of 30 seconds on each leg 4 times a day.

Alternatives

  • Easier - Do this on a hard floor
  • Harder - close your eyes

Calf Stretch

  • Stand facing a wall with one foot in front of the other toes pointing forward.
  • Place your hands on the wall and lean forward bending the knee closest to the wall.
  • Keep the heel of the foot behind you pressed into the ground.
  • You should feel the stretch through the Achilles tendon and calf muscle

Frequency and duration

  • Hold for a count of 30 seconds on each leg
  • Complete frequently throughout the day.

Alternatives

  • Harder - complete this exercise on a step allowing your heel to drop lower increasing the stretch.
  • Soleus stretch - Bend the rear knee slightly but keeping your heel on the ground. This will target the deeper muscles in the calves.

 

Plantar Flexion Against Resistance

This exercise is designed to help strengthen the calf muscles as well as improve ankle mobility.

  • Sit on the ground with one foot planted for support and the other slightly out in front.
  • Place a resistance band or towel around the ball of the foot
  • Gripping the band/towel in both hands, push the foot down whilst still keeping the heel in place.
  • Return the foot back to the neutral position in a controlled manner.

Frequency and duration

  • Push down for a count of 2 seconds
  • Hold for a count of 2 seconds
  • Raise back up for a count of 2 seconds
  • Complete 3 sets of 12 on each leg

Alternatives

  • Easier - Apply less resistance
  • Harder - Apply more resistance

 

The information on this site is intended for educational purposes.

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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