Metatarsalgia is a painful condition that affects the ball of the foot. The metatarsals are bones that connect the toes to the ankles. It can result from overuse or high-impact sports, arthritis, or wearing inappropriate footwear, such as high-heeled shoes.
Causes
Metatarsal joint pain commonly results from misalignment of the joint surfaces, which puts pressure on the joint lining and destroys cartilage in the joints.
Metatarsophalangeal joint misalignment can be caused by many disorders and one of them is rheumatoid arthritis, which inflames the joints. In rheumatoid arthritis, hammer toes can develop, which can worsen joint pain and misalignment. Fat tissue, which helps cushion the joints when bearing weight, can be pushed forward under the toes, resulting in a loss of cushioning in the ball of the foot. This loss of cushioning normally occurs as many people age. But, at the same time it makes people more susceptible to pain when the ball of the foot is stressed or injured repeatedly. This loss of cushioning may lead to damage to the nerves of the foot and to the development of calluses and small bursae.
Metatarsophalangeal joint pain can also result from osteoarthritis or stiffening of the joints of the ball of the foot, often at the big toe joint. Most people with these disorders have an abnormal motion of the foot when bearing weight and walking.
What to Expect
If your bones are still aligned you will probably wear a cast or splint for 6 to 8 weeks. You may be told not to put weight on your foot. You will need crutches or other support to help you get around. You may also be fitted for a special shoe or boot that may allow you to bear weight. If the bones are not aligned, you may need surgery. A bone doctor will do your surgery. After surgery you will wear a cast for about 6 to 8 weeks.
Risk factors
Factors that can contribute to metatarsalgia include:
- Footwear: Shoes that are too tight can cause pain, or high heels that add pressure to the ball of the foot as it is forced into a tight space.
- Being overweight: The excess weight can put strain on the foot.
- Age: The pad of fat that protects the foot can get thinner with age, leading to metatarsalgia.
- High impact exercise: Running or playing high impact sports increases the risk.
- Shape of the foot and toes: Having a high arch or a second toe that is longer than the big toe can add to the pressure.
- Stress fractures: Small breaks in the toe bones can cause pain when pressure is applied.
- Stiff ankle: This can add pressure to the metatarsal bones.
Treatment
Treatment will mainly focus on easing discomfort and pain.
This may include:
- applying ice to the area several times a day, each time for 15 to 20 minutes with the ice wrapped to protect the skin.
- using anti-inflammatories, such as ibuprofen, will reduce inflammation and relieve the pain
- keeping pressure off the feet, and keeping the feet up when resting
Strategies for supporting the foot include the use of metatarsal pads or a metatarsal bar to reduce pressure from the metatarsal bones, and shock-absorbing insoles or arch supports to relieve pressure when walking.
Follow-up
As you recover, your provider will check how well your foot is healing. You will be told when you can:
- Stop using crutches
- Have your cast removed
- Start doing your normal activities again
As stated before, not every fracture is clearly categorized into one of these fracture types. Determining the best treatment is dependent not only on the specific fracture pattern but also the patient's expectations for treatment.
