Metatarsalgia: Causes, Symptoms, Treatment, and Rehabilitation

What is Metatarsalgia?

Metatarsalgia is not a specific disease but a symptom of pain in the forefoot, particularly around the metatarsal heads. It is often described as a sharp, aching, or burning sensation in the ball of the foot.

Causes of Metatarsalgia

Metatarsalgia can result from various factors that increase pressure or stress on the metatarsals, such as:

• Overuse and High-Impact Activities: Running, jumping, or prolonged standing.

• Poor Footwear Choices: High heels or shoes lacking arch support.

• Foot Shape and Biomechanics:

  • High arches or flat feet.

  • Bunions or hammertoes altering pressure distribution.

• Weight Changes: Obesity or sudden weight gain.

• Medical Conditions:

  • Rheumatoid arthritis or osteoarthritis.

  • Gout or Morton’s neuroma.

• Injury or Trauma: Stress fractures or soft tissue damage.

Symptoms of Metatarsalgia

The primary symptom of metatarsalgia is pain in the ball of the foot. Additional signs include:

• A feeling of walking on pebbles.

• Sharp or burning pain that worsens during activity.

• Numbness or tingling in the toes.

• Swelling or redness in the affected area.

Diagnosis of Metatarsalgia

Diagnosing metatarsalgia involves:

1. Clinical Examination:

   • Reviewing your symptoms and medical history.

   • Assessing foot shape, alignment, and weight distribution.

2. Imaging Studies:

   • X-rays: Identify fractures or deformities.

   • MRI or Ultrasound: Detect soft tissue issues or Morton’s neuroma.

Treatment for Metatarsalgia

Non-Surgical Treatment

1. Rest and Activity Modification:

   • Avoid high-impact activities to reduce stress on the foot.

2. Footwear and Orthotics:

   • Wear supportive, cushioned shoes with a wide toe box.

   • Use custom orthotics to redistribute pressure.

3. Pain Management:

   • Apply ice packs to the affected area.

   • Use over-the-counter NSAIDs (e.g., ibuprofen) for pain relief.

4. Physiotherapy:

   • Stretching Exercises: Focus on the Achilles tendon, plantar fascia, and calf muscles.

   • Strengthening Exercises: Improve foot and ankle stability.

   • Manual Therapy: Reduce tension and improve mobility in the foot.

5. Padding and Taping:

   • Cushion the metatarsals with gel pads or metatarsal domes.

   • Tape the foot to offload pressure from the painful area.

Advanced Treatment Options

• Corticosteroid Injections: Alleviate inflammation in severe cases.

• Shockwave Therapy: Promote healing in chronic or stubborn cases.

Surgical Treatment

Surgery is rarely required for metatarsalgia but may be necessary if conservative treatments fail or if there are structural deformities contributing to pain.

Rehabilitation for Metatarsalgia

Effective rehabilitation is key to preventing recurrence and restoring function. At Palms Physiotherapy & Allied Health, we focus on:

• Flexibility Training: Stretching the calf muscles and plantar fascia.

• Strengthening Exercises: Building foot and ankle muscle strength to improve biomechanics.

• Balance and Proprioception: Enhancing stability and coordination.

• Gradual Return to Activity: Ensuring a safe progression to normal activities and sports.

Preventing Metatarsalgia

Preventative strategies can reduce the risk of metatarsalgia:

• Wear properly fitted shoes with good arch support and cushioning.

• Gradually increase exercise intensity and duration.

• Maintain a healthy weight to reduce stress on the feet.

• Regularly stretch and strengthen the feet and ankles.

Metatarsalgia can interfere with daily activities and quality of life, but it is a manageable condition with the right care. Contact Palms Physiotherapy & Allied Health today for a personalised treatment plan to get you back on your feet.