Having pain at the front of your foot or your midfoot can make it difficult to walk and live comfortably. Our podiatrists understand the importance of prompt and effective treatment of forefoot pain so you can get back to moving without pain.
Metatarsalgia is the name given to describe pain at the front of your foot. The name comes from combining the area of pain - your metatarsals (the long bones of the feet), with the ‘algia’ suffix which means ‘pain’. Hence, the literal translation is pain at the long bones of the feet.
Interestingly, despite metatarsalgia being listed as a common diagnosis by health professionals, it is actually a broad term that encompasses a range of potential forefoot problems and conditions. If your initial diagnosis with us is unclear and you need medical imaging to confirm the exact structures that have been damaged, we may label your interim diagnosis as metatarsalgia.
Metatarsalgia is a common problem because of the large amount of weight the joints and tissues at the ball of your feet take on with every step. During every part of your gait cycle where one foot is in the air, the other is bearing the entire weight of your body. This places a very large demand on your feet, which is why it’s essential to always keep our feet supported with the right footwear, take good care of our feet in general, and treat any aches or niggles as they arise - before they get worse.
As metatarsalgia can include a range of problems or conditions, you may feel anything from a dull or throbbing ache to sharp severe pains at the ball of your foot. The pain will likely be exacerbated by walking, especially in hard or unsupportive shoes. Going up on the ball of your foot or your toes may feel very painful, which can catch you off guard during regular activities like walking up stairs or hills. You may find that your pain is localised to a specific joint or area that is tender to touch, swollen, red, or warm. You may also feel some burning or tingling if the nerves in the area have been affected.
Anything that overloads the ball of the foot and places it under excess strain or pressure may lead to metatarsalgia. There is a wide range of causative factors which include:
If you suspect you have metatarsalgia, it’s important to see your podiatrist who can help identify the likely causes and create an effective treatment plan. Specifically, they may also diagnose you with:
You may be more at risk of developing metatarsalgia if you participate in a lot of high-impact activity such as those that involve running or jumping, have a higher body weight, are older (our protective pad at the bottom of the foot can thin with age), or have differences in the shape of your feet or toes that places more pressure on the ball of the foot such as flat feet or high arches.
Diagnosing metatarsalgia accurately is important to understand exactly which structures have been damaged, so that the best, specific and timely course of treatment can be prescribed.
Our podiatrists will undertake a comprehensive assessment to identify the cause of your forefoot pain. This will involve a video gait analysis and an in-shoe pressure analysis which help uncover whether the way you are loading your feet during gait is likely to have contributed to the development of the problem, along with your shoes. If needed, we will refer you for x-ray or ultrasound imaging to gain a clearer picture of the severity of the damage.
After we understand the extent of your injury and importantly why it has occurred, our podiatrists will prescribe a custom treatment plan for you. There are three stages to treating metatarsalgia: relieving your initial symptoms, supporting the damaged structures to heal and make a full recovery, and finally keeping you pain-free by putting the right measures in place to help reduce the risk of the problem returning in the future.
We use an evidence-based treatment approach that considers your unique preferences, goals and characteristics. Your podiatrist will discuss
all of your treatment options with you during your appointment to create the best plan. This may include:
As high-impact weight bearing sports can overload the forefoot and cause further injury, we may also recommend some activity modifications until we achieve the desired level of healing and pain reduction. We know how important exercise is for many of our patients, and we want to assure you that you can still stay active and exercise with metatarsalgia - it’s just the activities that you do and the way you go about it that may need to change temporarily.
While we always recommend following the guidance of your podiatrist for metatarsalgia exercises as part of your treatment, here are a few simple exercises you can try at home before you’ve seen your podiatrist. It’s important to note that any stretch you do should never feel painful. Tension or tightness is fine, but pain is not. If you feel any pain, cease the action immediately.
Tightness in your calf muscles and your Achilles tendon (below) can have a direct impact on the pressure on your forefoot with any given step. Hence, keeping the calves stretched and flexible can help reduce this overloading and help prevent the recurrence of metatarsalgia in the future.
When your big toe is stiff and has reduced mobility, it can lead to extra pressure being placed on your lesser four toes. This can contribute to the development of metatarsalgia.
A stress fracture describes tiny micro-cracks in a bone that occur for the same reasons as metatarsalgia - repetitive overloading. Metatarsalgia can include a stress fracture under its umbrella of forefoot pain, but it can also include many other tissue and joint injuries. Learn more about stress fractures here.
Absolutely. Once we help repair the damage and address the contributing factors, in most instances you should be back to walking and living without pain and be cured of your metatarsalgia. It can come back in the future, but that is independent of your current course of treatment.
While we don’t encourage going on long walks with metatarsalgia that is not being treated and addressed, or if your foot is not well supported, we also take a realistic approach to treatment that considers your quality of life. Most people cannot take time off work for foot pain, or neglect their responsibilities at home. As such, our treatment supports you in staying active and walking when it comes to your daily responsibilities, while modifying exercise-related walking to support your recovery.
On its own, if the cause of your metatarsalgia is not addressed, it is unlikely to go away for good. You may go through flares where the pain is better or worse, absent or present. This will likely be influenced by your level of activity and your specific causative factors (like the shoes you wear). Unfortunately for many this means battling with a recurring problem for many years before finally seeking long-term relief from their podiatrist.
The speed of your recovery really depends on the severity of your pain and injury, and which specific structures have been injured. As this is a broad condition, recovery can take anywhere from weeks to months. Your podiatrist will be able to narrow down the timeframe for you after your assessment, based on what the cause and severity is in your unique case.